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Oral Health Topics

Fluoride: Topical and Systemic Supplements

Key Points

  • The ADA recognizes the use of fluoride and community water fluoridation as safe and effective in preventing tooth decay for both children and adults. For more information, please visit the ADA Fluoride in Water resource page.
  • Fluoride is a mineral that is found in all natural water sources and is the ionic form of the trace element fluorine, which is commonly found in the environment; fluorine reaches water sources by leaching from soil and rocks into groundwater.
  • When used as directed or within the context of community water fluoridation programs, fluoride is a safe and effective agent that can be used to prevent and control dental caries.
  • Fluoride can be delivered topically and systemically. Topical fluorides strengthen teeth already present in the mouth, making them more decay resistant, while systemic fluorides are those that are ingested and become incorporated into forming tooth structures. Systemic fluorides also provide topical protection because fluoride is present in saliva, which continually bathes the teeth.
  • Self-applied topical fluorides include toothpastes, mouthrinses, and gels.  Professionally applied topical fluorides include higher-strength rinses, gels, and foams; fluoride varnishes; and silver diamine fluoride.
  • Community water fluoridation is the process of adjusting the fluoride content of fluoride-deficient water to the recommended level for optimal dental health, which is currently recommended at 0.7 parts fluoride per million parts water.
  • Many bottled waters on the market do not contain optimal levels of fluoride. In addition, some types of home water treatment systems (e.g., reverse osmosis and distillation systems) can reduce the fluoride levels in water supplies, potentially decreasing the decay-preventive effects of optimally fluoridated water; however, carbon/charcoal filtration systems do not remove fluoride.
  • Fluoride supplements can be prescribed for children ages 6 months to 16 years who are at high risk for tooth decay and whose primary drinking water has a low fluoride concentration.
  • A potential risk of fluoride use is the development of fluorosis, which may occur when excess levels of fluoride are ingested during tooth development. Fluorosis varies in appearance from white striations to stained pitting of enamel.
  • Introduction
  • Topical Fluorides
  • Systemic Fluorides
  • ADA Clinical Recommendations for Topical Fluorides (2013)
  • ADA Clinical Practice Guideline on Nonrestorative Treatments for Carious Lesions (2018)
  • Fluorosis
  • ADA Policies on Fluoride and Fluoridation
  • References
  • ADA Resources
  • Other Resources
Topic last updated: July 15, 2021

Prepared by:

Department of Scientific Information, Evidence Synthesis & Translation Research, ADA Science & Research Institute, LLC.


Content on the Oral Health Topics section of is for informational purposes only.  Content is neither intended to nor does it establish a standard of care or the official policy or position of the ADA; and is not a substitute for professional judgment, advice, diagnosis, or treatment.  ADA is not responsible for information on external websites linked to this website.