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Application of topical fluoride during children's dental checkups has no impact on restorative care

Current recommendations suggest that dentists apply topical fluoride only to the teeth of children who have moderate or high risk of dental caries. Yet a new study shows that about two-thirds of privately insured Michigan children who saw a dentist from 1990 through 1997 received topical fluoride at every recall visit, nearly two times each year. In addition, there was no association between how frequently the dentists applied topical fluoride and restorative care (fillings for cavities). The use of topical fluoride by dentists began in the 1970s in Michigan, when there were high levels of caries and few areas had fluoridated water, which is not currently the case, explains Stephen Eklund, D.D.S., M.H.S.A., Dr.P.H., of the University of Michigan.

In a study supported by the Agency for Healthcare Research and Quality (HS09554), Dr. Eklund and his colleagues reviewed dental claims data for 15,190 children seeing 1,556 dentists from 1990 through 1997. The dental claims file used for this study includes data on dental care provided to more than 2 million individuals by more than 6,000 different dentists, covering about 25 percent of the State of Michigan. The goal of the study was to correlate application of topical fluoride with dental fillings.

The researchers found that children who received topical fluoride most frequently were at least as likely to receive fillings as children who received little or no topical fluoride, which argues against the protective action of fluoride when used in a wholesale manner. Indeed, the most powerful predictor of restorative care was the tendency of individual dentists to place restorations in children. Dentists tended to fall into one extreme or the other, rarely using fluoride (1 treatment per 100 examinations) or almost always using it (98 per 100 examinations). Clearly, these dentists were not following current recommendations for selective use of fluoride only in patients at higher risk of dental caries.

See "Professionally applied topical fluoride and restorative care in insured children," by Dr. Eklund, James L. Pittman, D.D.S., M.S., Keith E. Heller, D.D.S., M.P.H., Dr.P.H., in the Winter 2000 Journal of Public Health Dentistry 60(1), pp. 33-38.

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