Pediatric dentistry and the controversy over fluoride use: integrative review
DOI:
https://doi.org/10.62741/ahrj.v3iSuppl.%202.189Keywords:
Fluoride, Pediatric dentistry, Adverse effects, Dental caries, Fluorosis and Fluoridation.Abstract
Introduction: Dental caries remains one of the most prevalent chronic diseases in childhood, representing a significant public health concern. Fluoride is widely recognized as the gold standard for its prevention, due to its effectiveness in promoting enamel remineralization and reducing cariogenic activity. However, excessive fluoride exposure has been associated with dental fluorosis and potential systemic effects, although the evidence remains limited. At the same time, alternative agents such as nano-hydroxyapatite have emerged, but their clinical efficacy is still inconclusive.
Objectives: This study aims to examine the ongoing debate surrounding the use of fluoride in pediatric dental practice, considering both its preventive benefits on oral health and potential systemic adverse effects.
Methodology: A comprehensive literature review was conducted using two distinct research approaches. The first focused on exploring the physiological and toxicological consequences of chronic fluoride exposure, examining recent studies on its effects on various bodily systems, including the central nervous, endocrine, hepatic, and skeletal systems. The second research strategy centered on evaluating fluoride´s efficacy as a preventive measure against dental caries, particularly in primary teeth, with a specific emphasis on topical applications such as fluoridated toothpastes, varnishes, and silver diamine fluoride, as well as community-wide practices likewater fluoridation. A total of 41 scientific articles were included, selected from reputable databases (PubMed, B-on, SciELO, among others), spanning the years 1984 to 2025.
Results: While fluoride remains a cornerstone in the preventionof dental cavities, there is growing body of evidence indicating potential risks associated with excessive fluoride exposure, particularly in children. Reported adverse effects include dental fluorosis, cognitive impairments, thyroid irregularities, and systemic toxicity. Nonetheless, emerging alternatives such as nanostructured hydroxyapatite and the combination of fluoride with bioactive compounds hold promise as potentially safer alternatives.
Conclusion: The decision to use fluoride in pediatric dental care should be personalised based on a thorough evaluation of risks versus benefits, considering factors such as age, method of administration, frequency of use, and cumulative exposure. It is essential for parents to be educated, dental professionals to provide oversight, and for children to use of low-concentration toothpastes (<1000 ppm) maximise the advantages of fluoride while minimising potential harm. This critical review offers a comprehensive perspective on the topic and underscores the necessity for updated clinical guidelines grounded in robust scientific research.
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