USPSTF Updates Recommendations on Preventing Dental Caries in Children — Physician’s First Watch

Medical News |
May 6, 2014

USPSTF Updates Recommendations on Preventing Dental Caries in Children

By Kristin J. Kelley

Oral fluoride supplementation should be prescribed for children aged 6 months and older whose water supply is deficient, and fluoride varnish should be applied to the primary teeth of all infants and children, the U.S. Preventive Services Task Force says in an expansion of its 2004 guideline on preventing dental caries. Both grade B recommendations are for children aged 5 years and younger.

In addition, the USPSTF says the evidence is insufficient to weigh the benefits and harms of routine screening for dental caries by primary care clinicians in children from birth to age 5 years.

Reader Comments (3)

David Kennedy, DDS Other Healthcare Professional, Dentistry, retired

Since there is ZERO evidence that fluoride acts systemically to reduce tooth decay and since fluoride vitamins and supplements are NOT FDA approved this recommendation seems far afield from standard medical practices.

It is malpractice for an doctor licensed to practice in the US to prescribe unapproved drugs that can and do have an adverse systemic effect (dental fluorosis among others).

Published in the Federal register the FDA rejected one New Drug Applications (NDA) for systemic fluoride vitamins in 1975 and allowed 35 others to be "voluntarily" withdrawn.

NDA withdrawn for fluoride and vitamin combinations
Drug Therapy June 1975

"The FDA has addressed a ”regulatory letter” to approximately 35 companies marketing combination drugs consisting of fluoride and vitamins. The letter states that these drugs are related to a product (Ernziflur lozenges) for which FDA has withdrawn approval of a new drug application. The NDA for Enziflur was withdrawn because there is no substantial evidence of drug effectiveness as prescribed, recommended, or suggested in its labeling.

The FDA has therefore advised manufacturers of combination fluoride and vitamin preparations that their continued marketing is in violation of the new drug provisions of the Federal Food, Drug, and Cosmetic Act; they have, therefore, requested that marketing of these products be discontinued."


This quote from the recommendation says it all, in spades:

"Dental caries is the most common chronic disease in children in the United States (1). According to the 1999–2004 National Health and Nutrition Examination Survey (NHANES), approximately 42% of children ages 2 to 11 years have dental caries in their primary teeth. After decreasing from the early 1970s to the mid-1990s, the prevalence of dental caries in children has been increasing, particularly in young children ages 2 to 5 years (2)."

Basically, it says the amount of dental caries in children has gone down and up, but we have no idea why. So... why don't we paint their teeth over with fluoride varnish in the hope that it will block the problem we don't understand.

It reminds me of a common saying "when you have a hammer, everything looks like a nail". The dentists have fluoride, so they're not interested in looking for the right tools, nor even in understanding the problem.

Carol Kopf Other, Other

The USPSTF failed to consider the 2011 Cochrane review of fluoride supplement research which found that fluoride supplements fail to reduce tooth decay in primary teeth, permanent teeth cavity- reduction is dubious and health risks are little studied.. Further,
"When fluoride supplements were compared with topical fluorides or with other preventive measures, there was no differential effect on permanent or deciduous teeth."

The USPSTF itself says of the fluoride supplement studies it reviewed, "the studies had some methodological limitations, such as lack of adjustment for potential confounders, inadequate blinding, or unreported attrition, and were fairly heterogeneous..."

It should also be pointed out that the FDA considers fluoride supplements "unapproved drugs." which have never been safety tested.

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