In the past 30 years most developed countries have seen a decrease in the prevalence and severity of dental caries in children, with most disease now found in children often characterised by a low socioeconomic status. The aim of this Cochrane review was to evaluate the efficacy of fluoride supplements for preventing dental caries in children.
Detailed searches of a range of databases ( Cochrane Oral Health Group’s Trials Register), the Cochrane Central Register of Controlled Trials [CENTRAL] , Medline , Embase, WHOLIS/PAHO/MEDCARIB/LILACS/BBO and Current Controlled Trials) were conducted. Reference lists were searched and selected authors contacted. Randomised or quasi-randomised controlled trials that compared fluoride supplements (tablets, drops, lozenges) with no fluoride supplement or with other preventive measures such as topical fluorides in children less than 16 years of age with a minimum or two-year follow-up were included. Caries increment measured by the change in decayed, missing and filled tooth surfaces (DMFS) was the main outcome.
They included eleven studies ( 7196 Children) and found:-
- Comparing fluoride supplements were compared with no fluoride supplement
- In permanent teeth, fluoride supplements were associated with a 24% (95% CI; 16 to 33%) reduction in decayed, missing and filled surfaces(D(M)FS).
- In deciduous or primary teeth the effect was unclear. ( One study showed no effect, the other a substantial reduction in caries increment).
- When fluoride supplements were compared with topical fluorides or with other preventive measures, there was no differential effect on permanent or deciduous teeth.
- The review found limited information on the adverse effects associated with the use of fluoride supplements.
They concluded:-
This review suggests that the use of fluoride supplements is associated with a reduction in caries increment when compared with no fluoride supplement in permanent teeth. The effect of fluoride supplements was unclear on deciduous teeth. When compared with the administration of topical fluorides, no differential effect was observed. We rated 10 trials as being at unclear risk of bias and one at high risk of bias, and therefore the trials provide weak evidence about the efficacy of fluoride supplements.
Tubert-Jeannin S, Auclair C, Amsallem E, Tramini P, Gerbaud L, Ruffieux C, Schulte AG, Koch MJ, Rège-Walther M, Ismail A. Fluoride supplements (tablets, drops, lozenges or chewing gums) for preventing dental caries in children. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD007592. DOI: 10.1002/14651858.CD007592.pub2.
Actually, this study shows that the evidence is weak and that not enough is known or studied about fluoride supplements adverse effects especially to teeth (dental fluorosis)
In the summary of findings table for the main comparisons (caries increment on permanent teeth surfaces and permanent teeth) the reviewers rated the quality of evidence as moderate when applying the GRADE approach. This means that , Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
The evidence is so weak and the studies are so old that I would prefer not to propose using fluoride supplements to my patients. The effort is to reinforce toothbrushing, with at least similar effect and of course less iatrogenic effects regarding fluorosis.
In one of its “news” releases, Nys Cof states the following under the title “Studies of fluoride supplements: No evidence of safety-No benefit either”:
“According to the Cochrane Oral Health Group, fluoride supplements fail to reduce tooth decay in primary teeth, permanent teeth cavity-reduction is dubious and health risks are little studied (1). Further, “When fluoride supplements were compared with topical fluorides or with other preventive measures, there was no differential effect on permanent or deciduous teeth,” write Cochrane researchers Ismail et al, reports the New York State Coalition Opposed to Fluoridation, Inc. (NYSCOF).”
As any intelligent person can see from reading the entire Cochrane Report, as presented above, this “news” put out by Nys Cof is an excellent example of how they and other antifluoridationist groups present half-truths, out-of-context quotes and skewed conclusions to support their opposition. It is clearly stated in the Cochrane Report that in permanent teeth, fluoride supplements were associated with a 24% reduction in decayed, missing, and filled surfaces, when compared with no fluoride supplements. It does indeed state that the effect was unclear in primary teeth, this rating being given due to one study having shown no effect, while another showed a substantial reduction in caries increment. No where in the report, as presented above, does it state, as Nys Cof reported in its “news” release, that “fluoride supplements fail to reduce tooth decay in primary teeth, permanent teeth cavity-reduction is dubious and health risks are little studied”. This type of misleading and irresponsible twisting of the facts has no place in credible healthcare debate. The only “controversy” over water fluoridation is that caused by these groups utilizing these tactics. They present these misleading “facts” then claim there to be a controversy where there is not.
I agree, misquoting the science is not appropriate…I found the same just now.
What do you say to this study?:
Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis (2012)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491930/
This metaanalysis suggests that fluoride is a neurotoxin and it make people stupid.
[…] […]