# Fluoride application in middle childhood. A cross-sectional study

## TL;DR

This study finds that most children aged 6-12 are not meeting fluoride exposure guidelines, highlighting a need for better parental education and additional fluoride sources.

## Contribution

The study provides empirical data on fluoride exposure in middle childhood and identifies gaps compared to current recommendations.

## Key findings

- Most children use less toothpaste than recommended, leading to insufficient fluoride intake.
- Only 37.7% of children use additional fluoride sources beyond toothpaste.
- Parental knowledge about fluoride prophylaxis is limited, with only 43.48% believing it is recommended for their child.

## Abstract

Fluoride application is crucial for caries prevention; yet guidelines for middle childhood remain limited. This study evaluated the daily fluoride exposure of children aged six to 12 years and compare the findings with the available recommendations.

Children applied their usual amount of toothpaste to a manual toothbrush, which was weighed before and after application. Additionally, data on residence in relation to fluoridation of tap water, frequency of oral hygiene practices, the oral hygiene products used, additional fluoride supplementation, and parental knowledge regarding fluoride prophylaxis was collected to determine daily fluoride exposure. The data were analysed in accordance with current recommendations.

The study included 458 children aged 8.0 ± 1.77 years. Age-appropriate toothpaste was used by 76.4%. The mean quantity of toothpaste utilised was 0.42 ± 0.27, while 0.5–0.75 g are recommended. The mean daily fluoride intake via toothpaste was found to be 1.01 ± 0.81 mg. 94.1% of the study cohort does not meet the recommendations of the German Society for Preventive Dentistry. Only a third of the cohort used at least one supplementary fluoride source in addition to toothpaste (37.7%). 43.48% of legal guardians expressed the opinion that fluoride prophylaxis is recommended for their child.

The results highlight an urgent need for parental education.

In an area of low-fluoridated drinking water children over six years should use a full brush length (>0.5 g) of fluoridated toothpaste (approximately 1450 ppm) twice daily, along with an additional fluoride source such as fluoridated salt, mouthwashes or gels. Study register of the University Hospital Innsbruck (clinical trial registration number 20220331-2872)