Over the past several years, I have encountered a number of classrooms where children were given fluoride tablets or were brushing with a fluoride gel. In most of the cases, this was being done either improperly or illegally or both.

Fluoride is placed in many public water supplies for the sole purpose of preventing tooth decay. The amount is so small (1 part per million) that it causes no health problems, but it does reduce the amount of decay. If you put more fluoride in the water, you would prevent even more decay. However, you would also run the risk of causing a very mild form of teeth staining called fluorosis or mottling.

In many areas of the county, particularly in rural ones, fluoride is not found in the water supply (although fluoride may be found naturally in well water). In these areas, it is possible to provide fluoride to individuals in other ways, namely through fluoride supplements. Supplements which are ingested are called systemic fluorides and usually take the form of tablets and drops. Those that are applied directly to the teeth are called topical fluorides and take the form of rinses, gels, varnishes, toothpastes, and so forth. Some of these are available over-the-counter and some are available by prescription only.

Other than using a fluoride toothpaste, fluoride supplements should not be administered in a Head Start classroom unless it is recommended and supervised by a licensed dentist.

While the chances of causing a problem with fluoride supplements are minimal, it is far too complex a process to be undertaken by a non-professional. Before fluoride tablets or drops are given, it is necessary to test the child's home water supply for fluoride and interview the parents to determine if there are any other possible sources of fluoride. Dosage of fluoride tablets and drops varies according to the age of the child and the amount of other fluorides available. Fluoride rinses are not intended for young children because children tend to swallow them. Additionally, many of the fluoride gels are not recommended for children under the age of six. As I said, this is a complex issue.

Another serious problem is the wide availability of fluoride supplements without a prescription. Most of the fluoride supplements listed above are legally available by prescription only. Unfortunately, there are companies that will sell them directly to schools and Head Start programs, without the involvement of a dentist.

I recently talked with a health coordinator who was having the children brush once a week with a fluoride gel. She had never talked to a dentist about this, nor was one overseeing the program. This was simply something that they did when she got there. She was not even sure if there was fluoride in the local water supply. She was buying the gel directly from the catalog of a nationally known distributor that sells to most Head Start programs. I had her send me a bottle of it and it clearly states in large letters: CAUTION: FEDERAL U.S. LAW PROHIBITS DISPENSING WITHOUT PRESCRIPTION. If there was a prescription involved, it was certainly issued without the knowledge of the program.

The most important issue in this article is that fluoride supplements require the expertise and input of a dentist before they are administered by a Head Start program. The type of supplement and the dosage must be individualized to each child and must be administered according to strict protocols. Many state health departments have supplemental fluoride programs in rural areas and it is fine for Head Start programs to participate in them. They are overseen by dentists, adhere to state and federal laws, and use appropriate scientific principles. In all other cases, a Head Start program should enlist the help of a local dentist (preferably one who is on the Health Service Advisory Committee) and make sure that what she or he is doing is both proper and legal.

Harry W. Bickel, Jr. D.M.D., Western Kentucky University