28 l © 2025 American Dental Association
Section 1: Effectiveness and Benefits
Specific to prescribing dietary fluoride supplements, the recommendations included conducting an
accurate assessment of the fluoride content of the patient’s primary drinking water source(s).75 The
identification of the “primary” sources is sometimes difficult because 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, school,
or a place of work, which could be a different water system. To determine fluoride levels, it might be
necessary to contact the local, county, or state health departments or municipalities or private water
companies for information on the fluoride content of multiple public water sources or to contact 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 assessment145 on its website. Caries risk assessments should
be completed for patients on a regular basis to determine their risk for tooth decay, which can change
over time.
While dietary fluoride supplements can be an effective means of caries prevention, they must be used
daily, and individual patterns of adherence to the schedule (compliance) vary greatly. Therefore, the
recommendations suggest that providers carefully monitor compliance to maximize the therapeutic
benefit of dietary fluoride supplements in caries prevention. If the health care provider has concerns
regarding compliance, it might be best to consider other sources of fluoride exposure for the patient,
such as ensuring regular twice daily use of fluoride toothpaste.75
While dietary fluoride supplements can be effective in reducing tooth decay, there are several factors
that can impede their use and resulting therapeutic value:
• Patients/parents/caregivers must have access to a professional health care provider who can conduct
the necessary assessments and provide prescriptions for dietary fluoride supplements repeatedly
over time, with these often needing adjustment based on age and changes in water sources.
• The dietary fluoride supplements must be obtained through a pharmacy/pharmaceutical service
and refilled as necessary.
• The cost of the dietary fluoride 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 effect often is difficult to achieve.
• Tablets and lozenges are manufactured with 1.0, 0.5, or 0.25 mg fluoride. To maximize the
topical effect of fluoride, tablets and lozenges are intended to be chewed or sucked for 1–2 mins
before being swallowed for infants, supplements are available as a liquid and used with a dropper.
Noting the potential obstacles listed above, where feasible, community water fluoridation is preferred
because it offers proven decay prevention benefits without the need for access to a health care
professional or a change in behavior on the part of the individual. Simply by drinking water at home,
school, work, or play, everyone in the community benefits regardless of socioeconomic status,
educational attainment, or other social variables.58
While dietary fluoride supplements can reduce a child’s risk of tooth decay, community water
fluoridation extends that benefit to adults in the community. Additionally, the cost of dietary fluoride
supplements over an extended period of time can be a financial concern to a family. In looking at
overall costs, consideration should be given to the cost per person and the number of people who can
benefit from a dietary fluoride supplement or community fluoridation program.60
Section 1: Effectiveness and Benefits
Specific to prescribing dietary fluoride supplements, the recommendations included conducting an
accurate assessment of the fluoride content of the patient’s primary drinking water source(s).75 The
identification of the “primary” sources is sometimes difficult because 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, school,
or a place of work, which could be a different water system. To determine fluoride levels, it might be
necessary to contact the local, county, or state health departments or municipalities or private water
companies for information on the fluoride content of multiple public water sources or to contact 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 assessment145 on its website. Caries risk assessments should
be completed for patients on a regular basis to determine their risk for tooth decay, which can change
over time.
While dietary fluoride supplements can be an effective means of caries prevention, they must be used
daily, and individual patterns of adherence to the schedule (compliance) vary greatly. Therefore, the
recommendations suggest that providers carefully monitor compliance to maximize the therapeutic
benefit of dietary fluoride supplements in caries prevention. If the health care provider has concerns
regarding compliance, it might be best to consider other sources of fluoride exposure for the patient,
such as ensuring regular twice daily use of fluoride toothpaste.75
While dietary fluoride supplements can be effective in reducing tooth decay, there are several factors
that can impede their use and resulting therapeutic value:
• Patients/parents/caregivers must have access to a professional health care provider who can conduct
the necessary assessments and provide prescriptions for dietary fluoride supplements repeatedly
over time, with these often needing adjustment based on age and changes in water sources.
• The dietary fluoride supplements must be obtained through a pharmacy/pharmaceutical service
and refilled as necessary.
• The cost of the dietary fluoride 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 effect often is difficult to achieve.
• Tablets and lozenges are manufactured with 1.0, 0.5, or 0.25 mg fluoride. To maximize the
topical effect of fluoride, tablets and lozenges are intended to be chewed or sucked for 1–2 mins
before being swallowed for infants, supplements are available as a liquid and used with a dropper.
Noting the potential obstacles listed above, where feasible, community water fluoridation is preferred
because it offers proven decay prevention benefits without the need for access to a health care
professional or a change in behavior on the part of the individual. Simply by drinking water at home,
school, work, or play, everyone in the community benefits regardless of socioeconomic status,
educational attainment, or other social variables.58
While dietary fluoride supplements can reduce a child’s risk of tooth decay, community water
fluoridation extends that benefit to adults in the community. Additionally, the cost of dietary fluoride
supplements over an extended period of time can be a financial concern to a family. In looking at
overall costs, consideration should be given to the cost per person and the number of people who can
benefit from a dietary fluoride supplement or community fluoridation program.60
