BRITISH DENTAL JOURNAL VOLUME 193 NO. 9 NOVEMBER 9 2002 529 General dental practitioner advice regarding the use of fluoride toothpaste in two areas with a school-based milk fluoridation programme and one without such a programme R. V. Harris, 1 Y. M. Dailey 2 and R. S. Ireland 3 Objective To describe the knowledge and practice of general dental practitioners (GDPs) working in Liverpool (where there is no milk fluoridation programme) and St Helens and Knowsley, and the Wirral (where children have fluoridated milk in schools and pre-schools) relating to the advice given for child patients regarding the use of fluoridated toothpaste. Design Data were collected via a postal questionnaire sent to all 329 GDPs working within the three areas. GDPs working in more than one of the areas and those working in specialist orthodontic or oral surgery practices were excluded. Results Two hundred and thirty-four (71%) questionnaires were completed and returned. Only 3% of dentists said that no-one in their practice gave advice on the concentration of fluoride toothpaste to be used. For caries free children under 7 years of age only 64% of GDPs gave advice concerning the concentration of toothpaste which coincided with the available clinical guidelines. Twenty eight per cent of GDPs also contradicted the guidelines by advising children under 7 with high caries to use a low fluoride toothpaste. Although 59% of GDPs in the fluoridated milk areas asked the child whether they had fluoridated milk at school, they did not appear to alter the advice given regarding the use of fluoridated toothpaste. Conclusion The study showed that a significant number of GDPs did not adhere to clinical guidelines relating to the use of fluoride toothpaste when giving advice to their child patients. For evidence- based dentistry to become a reality in this area, ways must be found to disseminate the available guidelines more fully and increase their acceptance and use by practitioners. 1 Senior Lecturer in Primary Dental Care; 2 Lecturer in Primary Dental Care; 3 Former Professor, Liverpool University School of Dentistry. *Correspondence to: Rebecca V. Harris 5th floor, Liverpool University School of Dentistry, Pembroke Place, Liverpool L69 3BX UK Email: R.V.Harris@liverpool.ac.uk Refereed paper Received 21.03.02; Accepted 17.07.02 © British Dental Journal 2002; 192: 529–533 The general dental practitioner (GDP) is in a key position to impart advice on prevention of dental caries to families with young chil- dren who may suffer from the disease. An important part of pre- ventive dental care for this group is the use of fluoride, and as part of the discussion regarding prevention of caries, the issue of fluo- ride in the form of fluoridated toothpaste, tablets or rinses is likely to arise. In recent years there has been an increasing awareness of the risk of developing enamel opacities through too high a fluoride intake during tooth development. 1 This has to be balanced against the obvious benefits that occur in the reduction of dental caries. 2 The use of fluoridated toothpaste and fluoride supplements are therefore subject to a debate on how to maximise the benefit of caries reduction whilst minimising the risks. 3 The GDP must assess the caries risk of the child, weigh this against any possible risk of dental fluorosis, and advise the parent and child accordingly. Guidelines exist to guide the clinician in this decision. The national clinical guidelines published by the Royal College of Surgeons at the request of the Department of Health state that to reduce the risk of opacities, children under the age of 6 years and considered to be at low risk of developing dental caries should use a toothpaste containing no more than 600 ppm of fluoride. 4 Those with a higher risk of developing caries should use a standard (1,000 ppm) paste. Children over the age of 6 years should be encouraged to use a standard (1,000 ppm) or higher (1,450 ppm) fluoride level paste. The guidelines reference the British Society of Paediatric Dentistry (BSPD) policy document on fluoride supple- ments and toothpastes, 5 and a paper by Rock, 6 which concur with the statements. From the age of six upwards, anterior teeth are not at risk from opacities, so that higher fluoride pastes may be safely used and should be particularly recommended for children at high risk of dental caries. The national guidelines also state that children under 6 years of age should use an amount of toothpaste no greater than a small pea. 4 The BSPD guidelines 5 state that formal recommendations should emphasize small rather than rely on a pea-sized amount which may be too much. Also, to reduce the risk of opacities, par- ents should supervise the amount of toothpaste used by children under 6 years of age. Where children are already receiving fluo- ride in the form of fluoridated water or fluoride supplements ● Guidelines are available concerning fluoride toothpaste use for children. ● There is a need for GDPs to be aware of the caries risk of child patients when advising on fluoride toothpaste use. ● Many GDPs do not give advice concerning the concentration of toothpaste that coincides with the available guidelines. ● There is a need to disseminate the available guidelines more fully and increase their acceptance and use by practitioners. IN BRIEF RESEARCH