28 American Dental Association new dosage schedule developed acknowledging that numerous sources of topical and systemic fluoride are available today that were not available many years ago.81 The supplement schedule was reviewed and reissued in December 2010. At that time, the American Dental Association Council on Scientific Affairs (CSA) published evidence-based clinical recommendations for the schedule of dietary fluoride supplements.8 The evidence-based review recommended that the age stratification established in the ADA’s 1994 supplement schedule remain unchanged. The review also recommended that prior to prescribing fluoride supplements, the prescribing provider should assess the patient’s risk for cavities and only those at high risk should receive supplements.8 If at high risk, then the fluoride level of the patient’s primary drinking water source should be assessed.8 It should be noted that an accurate assessment of the patient’s primary drinking water source can be difficult due to the various sources of fluoridated water. For example, the patient might not have access to fluoridated water in the home, but may drink fluoridated water while at day care or school. The current dietary fluoride supplement schedule appears as Table 1.8 Additional information on this topic can be found in this Section, Question 12. 14. What are salt and milk fluoridation and where are they used? Answer. Salt and milk fluoridation are fluoridation methods used to provide community-based fluoridation in countries outside of the United States where various political, geographical, financial or technical reasons prevent the use of water fluoridation. Fact. The practice of salt fluoridation began in the 1950s, approximately 10 years after water fluoridation was initiated in the United States.82 Based on the success several decades earlier of the use of iodized salt for the prevention of goiter, fluoridated salt was first introduced in Switzerland in 1956.83 According to a review published in 2013, salt fluoridation is available in a number of countries in Europe but its coverage varies greatly.82 Germany and Switzerland have attained a coverage exceeding two-thirds of their populations (67% and 85% respectively). In other European countries including Austria, the Czech Republic, France, Slovakia and Spain, salt fluoridation is reportedly used on a very limited scale.82 Additional countries, such as Hungary, Romania, Slovenia, Croatia and Poland, have considered salt fluoridation but have failed to take action.84 European regulations (current as of 2017) permit the addition of fluoride to salt and water.82 However, it appears that the majority of European countries favor the twice daily use of fluoride toothpaste as the most important measure for improving the public’s dental health.84 In Europe, toothpaste sold over the counter typically contains 1,500 ppm fluoride,85 while toothpaste in the United States typically contains 1,000 to 1,100 ppm fluoride.86 On a historical note, prior to the political changes that occurred in the late 1980s and early 1990s in Europe, water fluoridation was widely available in the German Democratic Republic and the Czechoslovak Republic and to a lesser extend in Poland. With the end of the Communist regimes, efforts related to public health dentistry were largely discontinued. While fluoridation continued in several small towns until 1993, in general, it was abandoned.84 In North and South America, salt fluoridation is available in Belize, Bolivia, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Peru, Uruguay and Venezuela. Like in Europe, the extent of salt fluoridation varies between countries. Columbia, Costa Rica, Jamaica, Mexico and Uruguay provide fluoridated salt to nearly their entire populations while there is less coverage in other countries.82 In 2013, it was estimated that approximately 60 million people in Europe and 160 million in the Americas had access to fluoridated salt.82 The Pan American Health Organization (PAHO), a regional division of the World Health Association (WHO) with responsibilities for health matters in North, South and Central America and the Caribbean, has been active in developing strategies to implement decay prevention programs in the regions of the Americas using water and salt fluoridation.87 In order to achieve the greatest reduction in tooth decay while minimizing the risk of dental fluorosis, it is advisable that a country implement only one of these two