European Archives of Paediatric Dentistry

, Volume 10, Issue 3, pp 149–156 | Cite as

Caries preventive effect of fluoride in milk, salt and tablets: A literature review

  • I. EspelidEmail author


BACKGROUND: There are a number of studies in the literature about the effectiveness of fluoride in tablets, fluoride added to frequently-consumed food like milk, or to food additives like salt, in prevention of dental caries. This literature has been evaluated in different evidence based reviews. AIM: The scope of this paper was to identify the most recent evidence-based reviews on the effect in caries prevention from added fluoride in milk, salt and fluoride tablets/drops including newer RCT studies, and to synthesize the findings into practice guidelines. The key question was as follows: Does regular use of fluoride in milk, salt and fluoride tablets/drops prevent dental caries among children and adolescents? METHODS: MEDLINE, EMBASE and EBM reviews (Cochrane database of systematic reviews) were searched using modified filters from a Cochrane review. One evidence-based report on fluoridated milk was identified. Salt fluoridation was covered by three HTA reviews. One Cochrane protocol on the caries preventive effect of fluoridated salt was identified. RESULTS: Very few studies of good quality were identified in general. Two studies on fluoridated milk were tabulated and seven studies dealing with fluoride tablets/drops were analysed. One study showed a 78% reduction in caries in newly erupted permanent teeth among 8 year olds after 3 years with fluoridated milk. For primary teeth one study showed 31% caries reduction. The differences between fluoride-group and control were statistically significant. The reduction in caries prevalence in the fluoride tablet group compared with a negative control varied from 81% (carious surfaces in permanent teeth erupted in the study period) to 49% in DMFS for all permanent teeth. No RCT studies on fluoridated salt were identified. CONCLUSION: There is limited evidence that F tablets and drops are effective, and compliance is a key factor. There are good reasons to believe that fluoride in different applications and formulas does work as caries preventive agents under supervision. There is a need for new, well-designed studies within this field, but the use of negative controls without any fluoride exposure is difficult due to ethical reasons. In particular new research is needed concerning possible caries preventive effect of fluoridated milk and salt.

Key Words

Child Dental Caries/prevention & control Dietary Supplements Fluoridation/standards Fluorides/administration & dosage 


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  1. Björnström H, Naji S, Simic D, Sjöström I, Twetman S. Fluoride levels in saliva and dental plaque after consumption of snacks prepared with fluoridated salt. Eur J Paediatr Dent 2004: 5(1):41–45.PubMedGoogle Scholar
  2. Burt BA. Fluoridation and social equity. J Public Health Dent 2002: 62(4):195–200.PubMedCrossRefGoogle Scholar
  3. Burt BA, Marthaler TM. Fluoride tablets, salt fluoridation, and milk fluoridation. In: Fejerskov O, Ekstrand J, Burt BA, eds. Fluoride in dentistry. København: Munksgaard, 1996:291–310.Google Scholar
  4. Centers for Disease Control and Prevention. Recommendations for using fluoride to prevent and control dental caries in the united states. MMWR Recomm Rep 2001: 50 (RR-14):1–42.Google Scholar
  5. Driscoll WS, Heifetz SB, Brunnelle JA. Treatment and posttreatment effects of chewable fluoride tablets on dental caries: Findings after 7 1/2 years. J Am Dent Assoc 1979: 99(5):817–821.PubMedGoogle Scholar
  6. Driscoll WS, Nowjack-Raymer R, Selwitz RH, Li SH, Heifetz SB. A comparison of the caries-preventive effects of fluoride mouthrinsing, fluoride tablets, and both procedures combined: Final results after eight years. J Public Health Dent 1992:52(2):111–116.PubMedCrossRefGoogle Scholar
  7. Estupinan-Day SR, Baez R, Horowitz H, et al. Salt fluoridation and dental caries in jamaica. Community Dent Oral Epidemiol 2001: 29(4):247–252.PubMedCrossRefGoogle Scholar
  8. Gillespie GM, Marinho VCC, Marthaler TM, et al. Salt fluoridation for preventing dental caries (protocol). Cochrane Database of Systematic Reviews 2005: (4).Google Scholar
  9. Harbour R, Miller J. A new system for grading recommendations in evidence based guidelines. BMJ 2001: 323(7308):334–336.PubMedCrossRefGoogle Scholar
  10. Haugejorden O, Birkeland JM. Analysis of the ups and downs of caries experience among norwegian children aged five years between 1997 and 2003. Acta Odontol Scand 2005: 63(2):115–122.PubMedGoogle Scholar
  11. Hedman J, Sjoman R, Sjostrom I, Twetman S. Fluoride concentration in saliva after consumption of a dinner meal prepared with fluoridated salt. Caries Res 2006: 40(2):158–162.PubMedCrossRefGoogle Scholar
  12. Irigoyen ME, Sanchez-Hinojosa G. Changes in dental caries prevalence in 12-year-old students in the state of mexico after 9 years of salt fluoridation. Caries Res 2000: 34(4):303–307.PubMedCrossRefGoogle Scholar
  13. Ismail AI. Prevention of early childhood caries. Community Dent Oral Epidemiol 1998: 26 (1 Suppl):49–61.PubMedGoogle Scholar
  14. Ismail AI, Hasson H. Fluoride supplements, dental caries and fluorosis: A systematic review. J Am Dent Assoc 2008: 139(11):1457–1468.PubMedGoogle Scholar
  15. Jones S, Burt BA, Petersen PE, Lennon MA. The effective use of fluorides in public health. Bull World Health Organ 2005: 83(9):670–676.PubMedGoogle Scholar
  16. Kallestal C. The effect of five years’ implementation of caries-preventive methods in swedish high-risk adolescents. Caries Res 2005: 39(1):20–26.PubMedCrossRefGoogle Scholar
  17. Limeback H, Ismail A, Banting D, et al. Canadian consensus conference on the appropriate use of fluoride supplements for the prevention of dental caries in children. J Can Dent Assoc 1998: 64(9):636–639.PubMedGoogle Scholar
  18. Lin YT, Tsai CL. Comparative anti-caries effects of tablet and liquid fluorides in cleft children. J Clin Dent 2000:11(4):104–106.PubMedGoogle Scholar
  19. Macpherson LM, Stephen KW. The effect on human salivary fluoride concentration of consuming fluoridated salt-containing baked food items. Arch Oral Biol 2001: 46(10):983–988.PubMedCrossRefGoogle Scholar
  20. Marthaler TM, Petersen PE. Salt fluoridation-an alternative in automatic prevention of dental caries. Int Dent J 2005: 55(6):351–358.PubMedGoogle Scholar
  21. Mascarenhas AK, Scott T. Does exposure to fluoridated water during the crown completion and maturation phases of permanent first molars decrease pit and fissure caries? J Evid Based Dent Pract 2008: 8(1):17–18.PubMedCrossRefGoogle Scholar
  22. Maslak EE, Afonina IV, Kchmizova TG, Litovkina LS, Luneva NA. The effect of amilk fluoridation project in volgograd. Caries Res 2004:38(4):377 (abstract 360).Google Scholar
  23. National Health and Medical Research Council. A systematic review of the efficacy and safety of fluoridation. Canberra, Australia, 2007.Google Scholar
  24. Pakhomov GN, Kolesnik AG, Shamsheva AA, Kuz’min EM, Stepanova IA. Milk fluoridization efficacy in a controlled study and dental caries experience dynamics in conditions of wide availability of local f-containing means (Russian). Stomatologiia (Mosk) 2005: 84(4):37–42.Google Scholar
  25. Poulsen S, Gadegaard E, Mortensen B. Cariostatic effect of daily use of a fluoride-containing lozenge compared to fortnightly rinses with 0.2% sodium fluoride. Caries Res 1981: 15(3):236–242.PubMedCrossRefGoogle Scholar
  26. Singh KA, Spencer AJ. Relative effects of pre- and post-eruption water fluoride on caries experience by surface type of permanent first molars. Community Dent Oral Epidemiol 2004: 32(6):435–446.PubMedCrossRefGoogle Scholar
  27. Singh KA, Spencer AJ, Brennan DS. Effects of water fluoride exposure at crown completion and maturation on caries of permanent first molars. Caries Res 2007: 41(1):34–42.PubMedCrossRefGoogle Scholar
  28. Solorzano I, Salas MT, Chavarria P, Beltran-Aguilar E, Horowitz H. Prevalence and severity of dental caries in costa rican schoolchildren: Results of the 1999 national survey. Int Dent J 2005: 55(1):24–30.PubMedGoogle Scholar
  29. Stecksen-Blicks C, Holgerson PL, Twetman S. Effect of xylitol and xylitolfluoride lozenges on approximal caries development in high-caries-risk children. Int J Paediatr Dent 2008: 18(3):170–177.PubMedCrossRefGoogle Scholar
  30. Stephen KW. Fluoride prospects for the new millennium-community and individual patient aspects. Acta Odontol Scand 1999: 57(6):352–355.PubMedCrossRefGoogle Scholar
  31. Stephen KW, Boyle IT, Campbell D, McNee S, Boyle P. Five-year double-blind fluoridated milk study in scotland. Community Dent Oral Epidemiol 1984: 12(4):223–229.PubMedCrossRefGoogle Scholar
  32. Stephen KW, Campbell D. Caries reduction and cost benefit after 3 years of sucking fluoride tablets daily at school. A double-blind trial. Br Dent J 1978: 144(7):202–206.Google Scholar
  33. Stephen KW, Creanor SL, Russell JI, et al. A 3-year oral health dose-response study of sodium monofluorophosphate dentifrices with and without zinc citrate: Anti-caries results. Community Dent Oral Epidemiol 1988: 16(6):321–325.PubMedCrossRefGoogle Scholar
  34. Swedish Council on Technology Assessment in Health Care. Att förebygga karies. En systematisk litteraturöversikt (Swedish). Stockholm, Sweden, 2002.Google Scholar
  35. The Scottish Intercollegiate Guidelines Network. Sign 50: A guideline developer’s handbook. 2008.Google Scholar
  36. Weintraub JA, Ramos-Gomez F, Jue B, et al. Fluoride varnish efficacy in preventing early childhood caries. J Dent Res 2006: 85(2):172–176.PubMedCrossRefGoogle Scholar
  37. Wennhall I, Matsson L, Schroder U, Twetman S. Outcome of an oral health outreach programme for preschool children in a low socioeconomic multicultural area. Int J Paediatr Dent 2008:18(2):84–90.PubMedCrossRefGoogle Scholar
  38. Yeung CA. A systematic review of the efficacy and safety of fluoridation. Evid Based Dent 2008: 9(2):39–43.PubMedCrossRefGoogle Scholar
  39. Yeung CA, Hitchings JL, Macfarlane TV, et al. Fluoridated milk for preventing dental caries. Cochrane Database Syst Rev 2005: (3): CD003876.Google Scholar

Copyright information

© Adis International 2009

Authors and Affiliations

  1. 1.Dept. of Paediatric Dentistry and Behavioural Science, Faculty of DentistryUniversity of OsloBlindern, OsloNorway

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