Fluoride mouth rinsing by children receives renewed attention

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

Photo: Protoflux via Flickr

Photo: Protoflux via Flickr

A time-honored preventive dental treatment is getting another look.

A cheap and simple fluoride mouth rinse is highly effective in reducing tooth decay in school children, a recent Cochrane review has concluded.

The paper updates a 2003 review that also showed clear evidence of the decay-inhibiting effect of fluoride rinses. Authors of the new report looked at 37 trials conducted across the Americas, Europe and New Zealand that spanned more than four decades and involved nearly 16,000 children and adolescents. The combined results found on average a 27 percent reduction in decayed, missing and filled tooth surfaces in the permanent teeth of children who used the fluoride mouth rinses compared with those who used a placebo or no rinse.

The benefit was likely to be present even among children who used fluoride toothpaste or lived in communities with fluoridated water, the researchers found.

All of the trials included in the review looked at the supervised use of fluoride mouth rinse in schools, with two studies also examining home use. Mouth rinses were swished and spit out – not swallowed. Treatment protocols varied from trial to trial. Most used sodium fluoride, at concentrations ranging from 100 to 900 parts per million. The children were administered the rinses at frequencies ranging from once or twice daily to every two weeks.

The question the reviewers set out to answer was this:

“How effective and safe is the use of fluoride mouth rinse for preventing tooth decay (dental caries) in children and adolescents compared with placebo (a mouth rinse without the active ingredient fluoride) or no treatment?”

The results were noteworthy, they concluded.  “This review found that supervised regular use of fluoride mouth rinse by children and adolescents is associated with a large reduction in caries increment in permanent teeth,” the review said.

The reviewers acknowledged some limitations in the studies. Most had a high risk of bias, and the papers collectively offered little information about unwanted side effects or about how well children coped with the use of the mouth rinses.

Regardless, school-based fluoride mouth rinse programs have been recognized as a “best practice” by the Association of State and Territorial Dental Directors (ASTDD). In recent years though, these programs have declined amid questions about the cost-effectiveness of operating them in communities where decay rates among children have fallen,  ASTDD observed in a 2011 policy statement. At the same time, mouth rinses have remained an important preventive option, particularly for use in schools in high-risk communities where access to professional care and fluoridated water may be limited.

“School fluoride mouth rinse programs are inexpensive compared to professionally applied fluorides especially when volunteers are used,” ASTDD said.

The rinses are not recommended for children under the age of six because of the risk they might swallow the rinse rather than spit it out.

“Do any schools in your community offer a fluoride mouth rinse for their students?” the online dental publication DrBicuspid.com asked readers in an Aug. 30 story (registration required) about the new Cochrane review. “Do you counsel your pediatric patients, and their parents, to use such a rinse?” Those are good questions to ask in your reporting on this topic.

Kara Leigh Lofton reported on a push by public health officials in West Virginia to get more schools to participate in state’s decades-old fluoride mouth rinse program.

In a story for West Virginia Public Broadcasting’s Appalachia Health News, Lofton described the scene in a classroom where children were trying out the rinse for the first time.

“At Mount Hope Elementary School in Fayette County, health educator Rosalie McCauley passes out toothbrushes and plastic cups of bubblegum-flavored fluoride mouth rinse to students.

“Remember, do not swallow, swish around, and when I say ‘go’ we will begin. Are you ready? Go!” she says to a class of enthusiastic third graders.

School nurse Jeanne Black said she hoped the program would not only reduce dental decay but help instill lifelong hygiene habits.

Meanwhile, the children Lofton interviewed enjoyed “swishing around the mouthwash.”

Could schools in your community benefit from using fluoride rinse programs to help cut down on tooth decay? It might be worth asking school and health officials. In a new tip sheet, I provide ideas on how to learn more about this time time-tested and low-tech approach to fighting tooth decay.

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