Fluoride Guidelines

In December 2010, the ADA published “Evidence-Based Clinical Recommendations on the Prescription of Dietary Fluoride Supplements for Caries Prevention”. In this widely publicized paper, the authoring panel emphasized the need for caries risk assessment and judicious prescription of dietary fluoride supplements.

In addition, we have completed a review of the literature on fluoride use as a dental decay preventive measure. Based on these reviews, we have revised our guidelines for the use of fluoride for our children and adolescent patients. Please do not alter your current systemic fluoride regimen without first discussing it with one of our pediatric dentists.

All Children and Adolescents

  • Use a fluoride-containing toothpaste, regardless of age and town’s fluoridation status
  • Swish and spit out excess with minimal rinsing
  • Quantity
    • Under 3 years – smear size of paste
    • Over 3 years – pea size of paste

Systemic Fluoride Supplementation ONLY IF

*Living in a non-fluoridated community AND moderate/high risk for decay which is defined as:

  • Mother or primary caregiver had active decay in the past 12 months
  • Continual use of bottle/sippy cup with fluid other than water
  • Greater than 3 between meals, snacks or beverages consisting of sugars/starch/fermentable carbohydrates
  • Special health care needs that increases caries risk
  • White spots, decalcifications, decay, previous restorations, visible plaque, enamel defects
  • Saliva reducing factors: medications, medical conditions

*If using strong topical fluoride supplements such as Prevident®, then discontinue using the supplement.

Those living in a fluoridated community BUT using well water:

  • No supplement
  • Suggest using fluoridated bottled water and/or ACT mouth rinse.


  1. Ramos-Gomez F, Crystal Y, Ng MW, Crall J, Freatherstone J. Pediatric Dental Care: Prevention and Management Protocols Based on Caries Risk Assessment. CDA Journal 38:746-761, 2010.
  2. American Academy of Pediatric Dentistry, Policy Guidelines on Caries-Risk Assessment and Management for Infants, Children, and Adolescents. http://www.aapd.org/media/Policies_Guidelines/G_CariesRiskAssessment.pdf 2011. Accessed May 2, 2011.
  3. American Academy of Pediatric Dentistry, Policy on Fluoride Therapy. http://www.aapd.org/media/Policies_Guidelines/G_FluorideTherapy.pdf Accessed May 2, 2011.
  4. American Academy of Pediatric Dentistry, Policy on Use of Fluoride. http://www.aapd.org/media/Policies_Guidelines/P_FluorideUse.pdf. Accessed May 2, 2011.
  5. Rozier G, Adair S, Graham F, Iafolla, T, et al. Evidence-Based Clinical Recommendations on the Prescription of Dietary Fluoride Supplements for Caries Prevention. JADA 141(12): 1480-1489, 2010.