Table 8-3 shows the recently revised dietary fluoride supplement dosage schedule that was approved for U.S. and Canadian children by the American Dental Association and the American Academy of Pediatrics (ADA, 1994) and the Canadian Paediatric Society (1996). Supplements are available only by prescription and are intended for use by children living in areas with low water fluoride concentrations so that their intake is similar to that by children whose water fluoride concentrations are approximately 1.0 mg/liter. Based on the 1986 National Health Interview Survey (NHIS) data, it is estimated that 15 percent of children in the United States up to aged 5 years and 8 percent of those aged 5 to 17 years use dietary fluoride supplements (Wagener et al., 1995). Supplements are rarely prescribed for adults.

Intake from fluoridated dental products adds considerable fluoride (Burt, 1992; Whitford et al., 1987), often approaching or exceeding intake from the diet, particularly in young children who have poor control of the swallowing reflex. Although exposures to professionally applied products (for example, rinses and gels with high fluoride concentrations) occur less frequently, they also contribute to fluoride intake. The major contributors to nondietary fluoride intake are toothpastes (Osuji et al., 1988; Simard et al., 1989, 1991), mouth rinses (Bell et al., 1985), and dietary fluoride supplements (Ismail et al., 1990; Pendrys and Stamm, 1990).

Table 8-4 summarizes the findings from several studies of fluoride