Oral Health Program: Fluoridation for Health Care Professionals

Research

Water fluoridation has been researched and studied for 80 years. National and international panels of experts in various health and scientific disciplines complete reviews of new and updated peer-reviewed scientific literature that use carefully designed methods to critically examine evidence. Recommendations are made based on findings across the entire body of scientific evidence rather than one study alone due to study designs and limitations.

Review the following resources to find information on fluoridation.

• FLUID Fluoride Legislative User Information Database: Comprehensive database containing legal decisions by U.S. courts and current information on federal, state and local policies regarding community water fluoridation.
• Fluoride Science: Fluoride Science reviews fluoride studies for professional communities that may engage in patient care and public health services.
• Fluoridate Concentration Recommendation, U.S. Public Health Service: Read about the U.S. Public Health Service's fluoridation recommendation.
• Scientific Statement on Community Water Fluoridation, CDC (Centers for Disease Control and Prevention): Read the CDC's scientific statement and recommendations regarding water fluoridation.

Trainings

• Community Water Fluoridation 101 (Log in required) DHS training: Course covering the topic of community water fluoridation (CWF). The course will provide attendees examples of the type of myths spread by those opposed to CWF and how to respond. As a foundation to understanding these myths, the course will also provide basic information on the science behind fluoridation, how it works and why it works to prevent tooth decay. The objective of this course is to educate members of the oral health workforce (dental professionals, medical professionals, public health professionals, and water operators and engineers) on the evidence and science of CWF. Additionally, The Wisconsin Oral Health Coalition will offer one dental CE for Wisconsin dental providers completing the course.
• Community Water Fluoridation: How Dental Professionals Can Lead the Conversation CareQuest training: Course covering how to communicate confidently and address any questions patients may have about water fluoridation.
• Fluoridation Learning Online (FLO) CDC training: A free resource designed to build the capability of state fluoridation programs, and to help increase knowledge and refine skills to implement and maintain community water fluoridation. FLO covers the science, history, management, and technical information of water fluoridation.
• National Oral Health Curriculum, Smiles for Life: Complete the comprehensive oral health curriculum to better understand oral health.

Fluoride varnish is a protective coating painted on teeth to prevent, slow down, or stop tooth decay. It's a safe, and effective treatment applied to all teeth. A medical or dental professional can provide this safe and effective treatment. Depending on how likely a person is to get a cavity, fluoride varnish may be applied two to four times per year. Fluoride varnish is used along other things that prevent cavities, including regularly brushing, flossing, using fluoridated toothpaste, and eating healthy foods. 

Resources are available for providers interested in helping meet their patient's oral health needs. The materials needed to apply fluoride varnish are readily available from medical and dental supply companies. The American Academy of Pediatrics provides resources for help with getting paid for oral health services. Wisconsin Medicaid’s policy (PDF) outlines billing practices for medical professionals, such as physicians, nurses, and physician assistants as well as dental professionals. 

Easily accessible fluoride varnish programs include:

• School-based sealant programs—Wisconsin Seal-A-Smile
• Local health departments or Health Check agencies
• Pediatric primary care practices—considered standard of care

Resources

• Fluoride Varnish: an Evidence-Based Approach Research Brief (PDF) Association of State and Territorial Dental Directors publication
• Fluoride Varnish Fact Sheet for Parents (PDF) Hawai'i State Department of Health, Family Health Services Division, and the University of Hawai'i (UH) Mānoa Nancy Atmosphera-Walch School of Nursing publication
• Steps to Applying Fluoride Varnish (PDF) Hawai'i State Department of Health, Family Health Services Division, and the UH Mānoa Nancy Atmosphera-Walch School of Nursing publication

Fluoride Supplementation, P-44531 (PDF)is the process of prescribing fluoride supplements in dietary forms to reduce dental caries in children at high risk for tooth decay and whose primary drinking water has a low fluoride concentration. The below process outlines necessary considerations for fluoride supplementation.

Assess the patient's fluoride intake

It's important to start by assessing a patient's fluoride intake. This allows you to understand where a patient may or may not be receiving fluoride before prescribing any supplements. 

• Residential water: Determine the fluoridation level of the patient’s drinking water.
  • For city water, check the CDC's My Water Fluoride website.
  • For private wells, the owner must test their well water as shown in the fact sheet, Fluoride in Private Well Water, P-03521, to find the fluoride level.
• School and day care water: Determine how much fluoride is in the school or day care drinking water.
• Bottled water: Determine if the patient drinks fluoridated bottled water. Most bottled water contains insignificant amounts of fluoride, but some brands have levels of fluoride that could be at or near recommended amounts. If it’s not listed on the label, contact the manufacturer to ask about the fluoride content.
• Breast milk or infant formula: Determine the level of fluoridation the infant is receiving.
  • Breast milk has very low levels of fluoride.
  • Concentrated formula (powdered and liquid) contains varying levels of fluoride depending on the water it’s mixed with.
  • Ready-to-feed formulas contain very low levels of fluoride.

Determine the patient's caries risk level

Perform a caries risk assessment to determine a patient’s risk of developing caries. Follow the American Academy of Pediatrics' Oral Health Risk Assessment Tool for guidance.

When do I start or end prescribing fluoride supplements?

• Start: Fluoride supplementation starts at about 6 months or as soon as their fluoride intake is determined insufficient.
• End: Fluoride supplementation should end by age 16.

Dietary fluoride supplements

• Fluoride drops
• Fluoride tablets or lozenges

Fluoride supplement prescriptions should be reviewed and adjusted accordingly

Fluoride supplement dosing may change:

• If an infant in a fluoridated area consumes anything in addition to breast milk.
• If an infant in a fluoridated area consumes anything in addition to "ready-to-feed" formula.
• When a child reaches age 3 and again when they reach age 6.
• If there is a change in the source of the child's drinking water.

Use the following resources to help guide your conversations with patients and find valuable resources to share with patients.

• Campaign for Dental Health: Health Professionals AAP: As a health care professional, patients rely on your advice to live healthier, longer lives. That is why it is vital to discuss how oral health and water fluoridation can help them do just that. Here are tools that can help.
• Chairside Guide for Talking to Your Patients About Fluoride (PDF) Michigan Department of Health publication: Talking with your patients about fluoride can be difficult – there is a lot of misinformation out there and it can often seem like you’re at a loss for words. Here’s a few phrases to start or reframe the discussion about fluoride.
• Say This, Not That: Tips For Talking About Community Water Fluoridation (PDF) AAP publication, Say This, Not That in Spanish (PDF): Designed to help health providers address technical, challenging questions with comfort and ease. Addressing many of the most common concerns, this tool offers discussion-friendly responses in a clever graphic format.
• Community Water Fluoridation, P-40111 (PDF) DHS publication: Fact sheet containing information for addressing tooth decay as a public health issue and how evidence-based prevention strategies like Community Water Fluoridation support Wisconsin's future.
• Fluoride: What it is, and Why it Matters for Individual and Community Health Public Health Communications Collaborative has created shareable graphics and social media posts that explain what fluoride is and why it matters to health.

Review the following resources for more information on fluoridation.

• All About Fluoride ADA publication: Fact sheet providing talking points and links to the latest science to help dental professionals learn about community water fluoridation and feel better prepared to share information with patients and community leaders.
  • Fluoridation Facts ADA publication: With answers to frequently asked questions, this e-book shares the scientific truth about community water fluoridation: It’s not only safe, but also good for preventing tooth decay and cavities. The book includes the newest research on the topic, helping keep policymakers and the general public in the know.
• How to Read a Study about Fluoride or Fluoridation (PDF), American Fluoridation Society: Guide describing the process of reading and understanding research and studies about water fluoridation.
• Fluoride Safety: A Guide for Health Professionals AAP publication, Fluoride Safety in Spanish: A concise explanation of the regulation and safety of fluoride additives and fluoridated water. Common concerns, including daily intake and infant formula, are addressed. Links to valuable resources are provided.
  • Common Questions about Fluoride: A Resource for Parents and Caregivers (PDF) AAP publication, Common Questions about Fluoride in Spanish (PDF): Explains the importance and safety of fluoride in a question and answer format. A companion to Fluoride Safety: A Guide for Health Professionals, this handout lets your patients leave the office with accurate fluoride information in hand.
  • Fluorosis Facts: A Resource for Parents and Caregivers (PDF) AAP publication, Fluorosis Facts in Spanish (PDF): Explains sources of fluoride, dental fluorosis, and gives parents stepwise guidance on preventive oral health care. A companion to Fluorosis Facts: A Guide for Health Professionals, this handout lets your patients leave the office with helpful information in hand.
• Fluorosis Facts: A Guide for Health Care Professionals (PDF) AAP publication, Fluorosis Facts in Spanish (PDF): Gives health professionals a quick, thorough understanding of dental fluorosis and includes photos, follow-up resources, and suggestions for counseling on prevention.
• Oral Health Practice Tools Helps primary care providers incorporate oral health into practice with these easy-to-use tools and downloadable resources. Learn how to perform an oral health risk assessment, provide nutrition and oral hygiene counseling, and to apply fluoride varnish as vital components of well-child exams. Starting with the Oral Health Prevention Primer can help!
• Oral Health Toolkit for Primary Care Practice The integration of oral health into primary care practice is essential to improving oral health and overall health outcomes across the lifespan. For too long, oral health has been separated from the rest of the body, making it difficult for many populations and communities to access necessary preventive and emergent oral care. Developed through a collaboration (PDF) between the Hawai'i State Department of Health, Family Health Services Division, and the UH Mānoa Nancy Atmosphera-Walch School of Nursing, this toolkit contains valuable resources for integrating oral health into your primary care practice.