Research Sheds New Light on Professionally Applied Fluoride
The long-held belief that all children benefit from having professionally applied fluoride treatment on their teeth may no longer hold true, according to a study recently published in the Journal of Public Health Dentistry.
The study was conducted by Stephen A. Eklund, D.D.S., MHSA, DrPH of the University of Michigan, School of Public Health; James Pittman, D.D.S., MS, consultant with Delta Dental of Michigan; and, Keith E. Heller, DDS, MPH, DrPH, University of Michigan, School of Public Health. The study was partially supported by a grant from the Agency for Health Care Research and Quality.
The study, the largest of its kind, examined claims from Delta Dental of Michigan for 15,190 children. Treatment had been provided by 1,556 different dentists between 1990 and 1997. Its purpose was to look at the effectiveness of professionally applied fluoride in reducing the use of fillings in children.
It found no association between the frequency of the use of professionally applied fluoride and the use of fillings for the treatment for cavities. Further, despite recommendations that professionally applied topical fluorides are only needed for children with a moderate to high number of cavities, approximately two-thirds of the children in the study received fluoride at every recall visit, nearly two times per year.
"This study is further evidence that mass application of fluoride for all children may no longer be necessary or cost effective," said Dr. Eklund. "Today fluoride is more available than ever. In addition to fluoridated public water systems, which have been in place for decades, most people are now using fluoride-enhanced toothpaste and they are consuming canned foods and beverages that are prepared with fluoridated water."
He added, "Fluoridated water supplies, combined with better self-care and higher expectations of improved oral health have resulted in a steady decline in children’s cavities over the years." In fact, National Health and Nutritional Examination Survey data show that the number of children without cavities has more than doubled the past 20 years from 26 percent to 55 percent.
According to Dr. Pittman, "Our research data suggests that it might be more useful for the dental community to use fluoride treatments on a selective basis, for instance, on children at higher risk for developing cavities."
The study’s findings are not only significant for children, their parents and dentists, but for employers and dental benefit carriers like Delta Dental of Michigan. If dental care moves more toward the tailored needs of individual patients, then routine application of topical fluoride is less likely to occur.
"Delta Dental of Michigan will continue to use research data to assist in designing innovative dental benefit programs." said Dr. Thomas Fleszar, executive vice president and chief operating officer of Delta Dental of Michigan. "By doing so, we can meet differing needs for distinct segments of the population and ensure that needed care is delivered in the most effective manner."
Among the findings of the study were:
Patients of dentists who always use fluoride are nearly as likely to receive treatment for cavities as patients of dentists who very rarely apply fluorides; this argues against a protective use of fluoride when used in a wholesale manner.
Dentists who rarely use fluoride and those who always use fluoride clearly are not making selective choices for individual patients.
The overwhelming majority of dentists in both the high and low fluoride use groups are practicing in communities that have been fluoridated for decades.
Approximately two-thirds of the children in the study received topical fluoride treatments at every recall visit. This applied equally to general practitioners and pediatric dentists.
"The results of this study do not imply that professionally applied topical fluorides are never effective in preventing cavities," said Dr. Pittman. "The children covered by these dental benefit policies are from middle and upper income families, and they have very low levels of disease. Nearly all of them live in fluoridated communities; in fact, 85 percent of Michigan community water supplies are fluoridated. While it may be reasonable to assume that regular topical fluoride treatment may not have a measurable impact on these children, such treatment may help children at higher risk."
Professionally applied topical fluoride treatments were included as a standard benefit in early dental benefit programs because of the then high levels of cavities found in children and concern for individuals living outside fluoridated areas. Topical fluoride is typically reimbursed at 100 percent. Eventually, coverage for adult fluoride treatments was dropped as a benefit because of lack of scientific evidence showing its effectiveness. Currently, payment for fluoride treatments is usually limited to children through age 18.
The study is particularly significant because of the large amount of data made available to the researchers. Only a carrier of Delta Dental’s size and with its experience (established in 1957) in the dental benefits field would have such extensive records regarding dental treatment patterns over extended periods of time. |
