How to protect children’s teeth when water has no fluoride ^{CEFR B2}

Fluoridated public water has long been a key part of preventing tooth decay in American children. Recently, however, skepticism about fluoridation has increased and some places, including the states of Utah and Florida, have stopped adding fluoride to public water supplies. Major dental organizations — the American Academy of Pediatrics, the American Dental Association and the American Academy of Pediatric Dentistry — continue to strongly recommend fluoridated water. Cheen Loo, chair of pediatric dentistry at Tufts University School of Dental Medicine, says it is concerning that two states have banned fluoride and that about one-third of Americans lacked access to fluoridated water even before those recent changes.

Dentists say fluoride strengthens teeth by replenishing minerals that acids and mouth bacteria remove from tooth enamel. There are effective alternatives to community water fluoridation:

• fluoridated toothpaste, safe and effective when used in the right amount,
• fluoride rinses for older children, and
• topical fluoride varnishes applied at the dentist about every six months.

At the Tufts pediatric clinic, dentists see more decay in children from towns without fluoridated water. For those children, Loo often recommends fluoride toothpaste and sometimes a supplemental fluoride rinse or prescription-strength toothpaste. Parents should supervise brushing because younger children often miss back teeth and lack the dexterity to brush well. Dentists use disclosing dyes to show where plaque remains. Flossing usually needs adult help until a child has the fine motor skills to do it alone; floss holders are an option but may not clean as well as floss wrapped around fingers. Over-the-counter fluoride rinses are not recommended for children under 6 because they may swallow the rinse. Ingestible fluoride supplements such as drops or chewable tablets should be used with care. In October the Food and Drug Administration recommended that ingestible fluoride products not be given to children under 3 or to those not at high risk of tooth decay. Many pediatric dentists now prefer professional topical varnish, which lasts for several months.