Tip Sheets

Are your local schools trying to fight tooth decay with a mouth rinse program?

Mary Otto

By Mary Otto

An Appalachia Health News story by Kara Leigh Lofton earlier this year highlighted West Virginia’s push to encourage more schools to promote a simple oral hygiene routine shown to significantly reduce tooth decay. The reporter did a great job at summing up the thinking behind the effort.

“School-based fluoride rinse programs have been available to West Virginia schools for decades,” Lofton reported. “Advocates argue they are still one of the cheapest and most effective tools schools have for preventing tooth decay. They are not well utilized, however, and the Bureau for Public Health, a funder, recently has begun a push to get more schools to take advantage of them.”

School mouth rinse programs, in which young students swish and spit a fluoride rinse solution under adult supervision, came into wide use around the world in the 1970s and 1980s. But they have seen a gradual decline in more recent years, particularly in places where decay rates have fallen. Yet the procedure remains an extremely useful cavity-fighting tool, public health officials say, especially in communities where children still face high a risk of disease due to poverty, a shortage of preventive care (such as professionally applied fluoride varnishes) and a lack of access to optimally fluoridated water.

A newly published Cochrane Review report serves as a reminder of the effectiveness of school mouth rinse programs. “Regular use of fluoride mouth rinse under supervision results in a large reduction in tooth decay in children’s permanent teeth,” concluded the authors of the paper.

In her story, Lofton brought her listeners along on a visit to Mount Hope Elementary in Fayette County, where third graders, armed with toothbrushes and cups of bubblegum-flavored rinse.

In West Virginia, mouth rinse program supplies are offered to schools at no cost, Lofton explained, but participating schools need a volunteer or staffer willing to lead the program. At the time Lofton aired her report, an estimated 9,600 students in the state were getting fluoride rinses at school. But more children could benefit if more schools signed up for the program, West Virginia officials believe.

The same could be true in your state.

Reporting the story

School-based fluoride mouth rinse programs have been recognized as a best practice approach to community disease prevention by the Association of State and Territorial Dental Directors (ASTDD), national non-profit organization representing the directors and staff of state public health agency programs for oral health.

“School fluoride mouth rinse programs are inexpensive compared to professionally applied fluorides especially when volunteers are used,” the organization noted. The programs range in cost from approximately 50 cents to $2.50 per child per year, a 2010 ASTDD survey of schools concluded.

“Fluoride mouth rinses work in the same way as other topical fluorides by enhancing fluoride concentrations in saliva, plaque and enamel,” the ASTDD said in a policy statement.

The organization recommends mouth rinses containing a concentration of 0.2 percent sodium fluoride (920 parts per million) offered weekly at school-based programs.

But mouth rinses, used at different concentrations and frequencies also have been used to fight decay among children worldwide, according to a new Cochrane Review report.

The authors looked at 37 trials conducted across the Americas, Europe and New Zealand spanning more than four decades and involving 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 studies 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. The 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 Cochrane authors acknowledged some limitations in the studies included in their review. A number of the papers showed a high risk of bias and collectively, they offered little information about unwanted side effects or how the children coped with the treatments.

Mouth rinses are not recommended for children younger than six, many experts have stressed. There is a risk that young children might swallow the rinse rather than spit it out.

“Substantial fluoride ingestion at this young age when the teeth are developing might result in enamel fluorosis thus affecting the appearance of the teeth,” the ASTDD noted. “Use of fluoride mouth rinse by children age six years and older does not place them at risk for enamel fluorosis. By age six, most children can rinse and spit with little to no ingestion, making a rinse a good method for topical fluoride.”

Enamel fluorosis, also known as dental fluorosis is a change in the appearance of the teeth that is caused by the overconsumption of fluoride. Fluorosis can range from barely noticeable white flecks in the teeth to more apparent mottling and pitting.

Want to know more about fluoride mouth rinses and a variety of other common fluoride products? The Centers for Disease Control and Prevention has complied this helpful guide

Mary Otto, AHCJ’s topic leader on oral health, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover oral health care. If you have questions or suggestions for future resources on the topic, please send them to mary@healthjournalism.org.