Pediatric Dentistry | How fluoride protects children's teeth springermedizin.de

The scientific societies of dentists and paediatricians repeatedly refer to the three pillars of dental health:

"From a scientific point of view, there is no doubt about the protective effect of these natural salts from the earth's crust," emphasizes Professor Dr. Berthold Koletzko, Chairman of the Children's Health Foundation. “Fluoride hardens the enamel and makes the teeth more resistant. At the same time, they inhibit the settlement and metabolism of bacteria in plaque and thus protect the tooth enamel from destruction. That is why we pediatricians, in unanimity with dentists and nutrition experts, recommend the use of fluorides for babies, toddlers and preschool children to prevent tooth decay”.

Too much of a good thing is not healthy

As so often, the same applies here: Too much of a good thing is not healthy. If a child takes in too much fluoride (e.g. because it repeatedly swallows large amounts of fluoride-containing toothpaste when brushing its teeth), whitish to yellowish-brown discolouration can develop on the teeth. Sometimes only narrow, white lines can be seen, in other cases chalky, brownish spots. The discolorations are referred to as dental fluorosis, enamel fluorosis, or dental fluorosis.

In order to avoid this mostly harmless but cosmetically disturbing discoloration and at the same time to achieve optimal protection against caries, scientific societies of paediatricians, dentists and nutritionists have now joint recommendations for caries prevention with the nationwide network "Gesund ins Leben". developed in infancy and early childhood.

The recommended amounts of fluoride are intended to be both effective and safe. For this reason, the new recommendations for action for the first time contain not only abstract dosage information for the toothpaste in milligram quantities, but also understandable and pictorial quantities for all parents, adjusted to age groups:

From birth to the eruption of milk teeth

Babies should be given a daily combination of fluoride and vitamin D in tablet form until their first milk tooth erupts. The vitamin D protects the child from the dangerous softening of the bones rickets. Professor Berthold Koletzko: "By taking this tablet, the recommended and safe dose of fluoride can be adhered to most reliably".

From the eruption of the milk teeth to 12 months

In addition to the fluoride tablet, parents should gradually and playfully introduce their child to brushing their teeth from the very first teeth, so that the child enjoys doing it and gets used to brushing their teeth regularly. Important: tablets containing fluoride should not be combined with toothpaste containing fluoride!

The new recommendations for action offer two approaches:

"If toothpaste with added fluoride is used, precise dosing of the recommended amount of toothpaste is crucial in order to avoid excessive fluoride intake and undesirable effects," emphasizes Professor Dr. Berthold Koletzko with great emphasis. “Babies and toddlers are not yet able to spit out toothpaste and therefore swallow a large part. Added to this is the habit of many parents in Germany to use plenty of toothpaste when brushing their child's teeth, often more than four times the recommended amount. If you brush twice a day, too much fluoride can end up in your child’s stomach.”

12 to 24 months

Dose the "grain of rice" amount precisely! Brushing twice a day with a grain of rice-sized amount of children's toothpaste (with 1,000 ppm fluoride) is still necessary. It should be applied by the parents in a dose that is as correct as possible in order to reliably avoid excessive intake.

Professional advice and training for the families on oral hygiene, tooth-friendly nutrition, careful dental care and the correctly dosed use of fluoride toothpaste would now also be desirable. The preventive appointments U6 and U7 with the pediatrician and the dental early detection examinations between the 13th and 24th month of life offer the appropriate framework for this, according to the new recommendations for action for the network “Gesund ins Leben”.

24 months to 72 months: Now a "pea-sized" amount of toothpaste

At this age, for most children, in addition to brushing their teeth in the morning and evening, there is another brushing appointment at daycare or kindergarten. So, in addition to the parents, the caregivers there also have the important task of ensuring the correct dosage of toothpaste when cleaning, namely just a "pea-sized" amount.

Caries on the retreat, but still a lot to do

Thanks to good care from pediatricians and dentists and the widespread use of fluoride tablets, later fluoridated toothpaste, and the use of fluoridated table salt in the household, the frequency of caries in children in Germany has been declining impressively for some time, reports the Children's Health Foundation with satisfaction. Today, 12-year-old children only have an average of 0.5 decayed, filled or missing teeth. In 1997, this value was still 1.7. In an international comparison, Germany is even in a top position when it comes to the quality of teeth in children and young people. However, the milk teeth, which have a much thinner enamel, are attacked more frequently. A study by the German Working Group for Youth Dental Care e. V. (DAJ) showed that every tenth three-year-old (11.4 percent) had teeth that needed treatment.

Social gap in dental health

According to all current studies, there is an increased risk of caries for children from families with problematic nutrition and oral hygiene behavior and with a low socio-economic status, as well as for children with disabilities and chronic diseases, emphasizes the Children's Health Foundation.

The results of the large children's health study KiGGS Wave 2 show that children from socially disadvantaged families follow the recommendations for daily tooth brushing less often. Children from families with a migration background are also less likely to brush their teeth daily and take fluoride supplements less often than children from families without a migration background.

Advertising tempts to overdose

Compliance with the current recommendations for action is not an easy task, emphasizes the Children's Health Foundation. In advertising for toothpaste and even in educational brochures, whole strands of toothpaste are repeatedly shown on toothbrushes (see picture). This is an exaggerated representation that, as a role model, can lead to an overdose of fluorides. In addition, the suggested quantities such as "the size of a grain of rice" (0.125 g) or "the size of a pea" (0.25 g) cannot be measured precisely with the toothpaste tubes currently in use.

It would therefore be desirable to have products that allow the recommended maximum amount of toothpaste to be dosed precisely:

_{Source: Giulia Roggenkamp, ​​press office of the Children's Health Foundation}