26 American Dental Association difficult due to the fact that some patients have multiple sources of drinking water during a typical day. For example, while a patient may have access to drinking water in the home, they often also spend a large part of their day accessing drinking water at day care or school, which could be a different water system. It might be necessary to contact the local, county or state health departments for information on the fluoride content of public water sources or to be referred to a certified laboratory that can provide a fluoride test for private wells. Additional information on this topic can be found in this Section, Question 4. The ADA offers information on caries risk assessment78 on the web at http://www.ADA.org/ en/member-center/oral-health-topics/caries-risk- assessment-and-management. It should be noted that dietary fluoride supplements are recommended only for children at high risk for tooth decay.8 Caries risk assessments should be completed for patients on a regular basis to determine their risk for tooth decay which can change over time. Dietary fluoride supplements can be effective in helping to prevent tooth decay. To receive the optimal benefit from fluoride supplements, the use of supplements should begin at six months of age and continue daily until the child is 16 years old.8 However, individual patterns of compliance can vary greatly. For that reason, the report suggests that providers carefully monitor the adherence to the schedule to maximize the therapeutic benefit of supplements in caries prevention. If the health care provider has concerns regarding a lack of compliance to the schedule, it might be best to consider other sources of fluoride exposure for the patient, such as bottled water with fluoride.8 While dietary fluoride supplements can be effective in reducing tooth decay, there are a number of factors that can impede their use and resulting therapeutic value: • Patients/parents/caregivers must have access to a professional health care provider who can provide the necessary assessments and provide prescriptions for the supplements — often repeatedly over time. • The supplements must be obtained through a pharmacy/pharmaceutical service and refilled as necessary. • The cost of supplements can be a financial hardship for some individuals. • The compliance required (a child should take the supplement every day until 16 years of age) to obtain the optimal therapeutic affect often is difficult to achieve. Table 1. Dietary Fluoride Supplement Schedule for Children at High Caries Risk8 Age Fluoride ion level in drinking water (ppm)* 0.3 ppm 0.3-0.6 ppm 0.6 ppm Birth - 6 months None None None 6 months - 3 years 0.25 mg/day** None None 3-6 years 0.50 mg/day 0.25 mg/day None 6-16 years 1.0 mg/day 0.50 mg/day None * 1.0 part per million (ppm) = 1 milligram/liter (mgL) **2.2 mg sodium fluoride contains 1 mg fluoride ion.