兒童預防齲齒建議

1. 牙齒有沒有刷乾淨, 與齲齒關聯性不大. 沒刷乾淨的問題是髒, 刷的很乾淨還是可能發生齲齒.
2. 牙齒塗氟是預防齲齒最好的方式. 每天兩次使用含氟牙膏刷牙, 每次兩分鐘以上, 兩次間隔可以很接近(例如隔一小時前後刷兩次)
3. 每天刷兩次牙. 餐前餐後都無妨. 使用含氟牙膏刷牙. 可以不漱口
因此即使嬰幼兒不會吐出漱口水, 還是可以刷牙. 氟化鈉的安全劑量很高, 每天吃兩條牙膏, 連吃兩天才會有過量問題. 吃牙膏是開玩笑的. 但重點是要非常大劑量才會造成氟中毒
4. 兒童牙齒塗氟, 健保給付隨著身分不同有差異. 原住民兒童每三個月可申報一次.
5. 牙膏的選擇, 第一是要含氟化鈉 1000 ppm 以上才有療效. 台灣市售的很多是介於 500-1000 ppm. 目前僅含氟 1000 ppm 以上的才有醫學實症能預防齲齒
6. 何時可以開始幫兒童塗氟?
美國兒童牙醫學會AAPD建議，兒童在長第一顆牙開始，就使用含氟濃度至少1000ppm的牙膏, (也有牙醫師建議四顆以上才開始塗氟)

7. 三歲以下嬰幼兒, 每次使用含氟牙膏的量建議為「米粒大小」，每天需使用兩次，每次推薦至少兩分鐘。且潔牙後不漱口可能可以增加齲齒預防的效果，因此即使不會漱口的嬰兒，家長亦可在刷牙後將多餘的殘渣擦掉即可，米粒大小的牙膏量並不會造成嬰兒身體的長期危害，家長可以安心使用。

8. 而3歲以上兒童可增加為「豌豆大小」的牙膏濃度。另外，氟並不是讓牙膏辣辣的原因，含氟牙膏一樣可以做成水果口味，家長也不必因為口味而不敢選用。

9. 含氟牙膏的品牌不是重點, 含氟濃度超過 1000 ppm 才有保護預防齲齒效過
10. 兒童牙刷選擇便宜的就好. 一個月至三個月更換一次.
11. 每天不要吃超過五餐, 但每一餐是以30分鐘為一單位. 例如吃飯兩小時相當於吃四餐. 因此. 讓小孩吃飯吃越久, 例如小孩一邊玩耍, 家長一邊追著餵食, 不但會增加兒童肥胖的機率, 還會增加發生齲齒機率. 
12. 天然的水果比人工加工過的食物好, 水果再甜也比鹹餅乾好. 鹹餅乾造成齲齒的風險大於甜的天然水果
13. 兩歲以下不要喝飲料. 即使無糖奶茶也會增加齲齒機率(天然的食物優於加工過的食物)
14. 含糖的運動飲料一點也不健康, 是造成齲齒的重要原因之一


參考資料
1. 學會建議但非常規 OFFICIAL BUT UNFORMATTED 氟化物使用政策最新修訂版 2023
縮寫 AAPD：美國兒科牙科學會。NaFV：氟化鈉清漆。ppm：百萬分之一。美國：美國。

目的
美國兒童牙科學會 (AAPD) 確認使用氟化物預防齲齒是安全有效的。AAPD 鼓勵牙醫和牙科專業人員、其他醫療保健提供者、公共衛生官員和家長/護理人員優化氟化物暴露，以降低齲齒風險並增強受影響牙齒的再礦化。

方法
該文件由與其他團體聯絡委員會制定，於 19671 年通過，最後一次修訂於 2018 年 2 。使用以下術語進行電子數據庫搜索：氟化物、氟化、酸化磷酸鹽氟化物、氟化物清漆、氟化物治療和局部氟化物，以製定和更新本政策。當前的更新依賴於系統審查、專家意見和當前最佳實踐。

二胺氟化銀的使用在單獨的 AAPD 政策中得到解決。3

背景
氟化物通過三種重要方式預防齲齒：1
) 通過生成氟磷灰石來強化牙釉質，
2) 通過再礦化牙釉質，以及
3) 通過影響微生物代謝和減少致齲菌產生的酸。4

社區水氟化被認為是二十世紀十大公共衛生成就之一，因為它是一種有益且廉價的基於人群的方法，可以覆蓋整個社區。5根據定義，社區水氟化是將社區供水中的氟化物調整到最佳濃度以預防齲齒的過程。6 最近對社區水氟化的經濟評估進行的系統審查結果顯示，水氟化與較低的牙科治療成本相關。7 當公共水氟化到最佳水平時，乳牙腐爛、缺失和補牙的數量減少 35%，恆牙的腐爛、缺失和補牙的數量減少 26%。8 氟斑牙的發生，引起牙齒美觀問題，據報導，當公共水中氟化物含量為百萬分之 0.7 (ppm) 或毫克每升 (mg/L) 時，氟化物含量為 12%。8 當與其他飲食、口腔衛生和預防措施相結合時，氟化物的使用可以進一步降低齲齒的發生率。當兒童的家庭飲用水不含氟化物時，可以通過根據既定指南攝入每日氟化物補充劑來實現氟化物的防齲功效。6,9-11 在服用補充劑之前，仔細審查所有氟化物的飲食來源（例如，額外的飲用水來源[日托、學校、體育設施、瓶裝水]、其他飲用的飲料、預製食品[包括嬰兒配方奶粉]、牙膏）將有助於確定兒童對氟化物的真實接觸情況。6,12,13 此信息，結合兒童的齲齒風險評估，可用於確定是否需要補充氟化物。美國即食嬰兒配方奶粉的平均氟化物濃度為 0.15 ppm（乳基配方奶粉）和 0.21 ppm（大豆基配方奶粉）。 14 然而，更重要的問題是用氟化水沖調的濃縮或粉狀嬰兒配方奶粉的氟化物含量。當用含有 1 ppm 氟化物的水重構時，重構的粉末或液體濃縮物的氟化物範圍（以 ppm 計）為 0.64 至 1.07。14 14 然而，更重要的問題是用氟化水沖調的濃縮或粉狀嬰兒配方奶粉的氟化物含量。當用含有 1 ppm 氟化物的水重構時，重構的粉末或液體濃縮物的氟化物範圍（以 ppm 計）為 0.64 至 1.07。14 14 然而，更重要的問題是用氟化水沖調的濃縮或粉狀嬰兒配方奶粉的氟化物含量。當用含有 1 ppm 氟化物的水重構時，重構的粉末或液體濃縮物的氟化物範圍（以 ppm 計）為 0.64 至 1.07。14
隨著社區調整市政供水以符合美國衛生與公眾服務部 2015 年建議的 0.7 ppm 氟化物 15 ，用氟化水沖調嬰兒配方奶粉導致氟斑牙的風險降低。使用非處方含氟產品（例如牙膏、外用凝膠和口腔沖洗劑）可顯著達到防齲效果，特別是在沒有氟化飲用水的地區。6,16-20 建議所有兒童每天兩次用適量的含氟牙膏刷牙。 10,21 監測兒童使用外用含氟產品（包括牙膏）的情況，可防止攝入過量的氟化物。21,22 三歲以下兒童適合使用米粒大小的含氟牙膏，而三至六歲兒童建議用量不要超過豌豆大小。22 大量臨床試驗已證實專業外用氟化物治療的防齲效果，其中包括 1.23%酸化氟化磷酸鹽（[APF]；1.23% 氟化物）、5% 氟化鈉清漆（[NaFV]；2.26% 氟化物）、0.9% 二氟矽烷清漆（[DFS]）；0.1% 氟化物）、0.09% 氟化物漱口水和 0.5% 氟化物凝膠/糊劑。23-25 對於六歲以下的兒童，單位劑量中 5% 的 NaFV（通過限制氟化物的可用性來降低潛在傷害）是唯一推薦的專業應用的局部氟化劑。25 專業氟化物產品應由有執照的牙科或醫療保健提供者或在其指導下使用，該提供者熟悉兒童的口腔健康狀況，並可以根據完整的齲齒風險評估確定使用的需要和頻率。25 一些家長和看護者擔心他們的孩子接受氟化物，並且可能拒絕氟化物治療，儘管氟化物是安全有效的。26 這與反對社區水加氟類似。27 局部氟化物的拒絕和耐藥性可能是一個日益嚴重的問題，這反映了醫學上拒絕接種疫苗的趨勢。


政策聲明
AAPD： • 認識到每天兩次飲用氟化水和使用氟化牙膏刷牙是減少兒童齲齒患病率的最有效方法。• 鼓勵所有兒童每天兩次使用適量的含氟牙膏刷牙。• 認可並鼓勵在可行的情況下將公共飲用水供應中的氟化物含量調整至最佳水平（0.7 ppm）。• 鼓勵對所有有齲齒風險的個人進行專業氟化物治療。• 支持在全面的口腔檢查和齲齒風險評估後，根據牙醫的處方或命令，或在進行牙科篩查和齲齒風險評估後，根據醫生的處方或命令，將局部氟化物應用授權給輔助牙科人員或其他經過培訓的專職醫療人員。• 當城市飲用水中的氟化物水平不理想時，並考慮膳食氟化物的來源和兒童的齲齒風險後，根據美國牙科協會9、美國兒科學會10 和AAPD11 的建議，認可使用氟化物補充劑。• 鼓勵牙科服務提供者與家長討論氟化物的好處，並通過椅旁教育主動解決對氟化物的疑慮。• 鼓勵牙科團隊成員尋找機會提供循證社區教育，宣傳通過市政水氟化來安全且經濟地預防齲齒的益處。• 鼓勵美國食品和藥物管理局要求食品和飲料的營養標籤包含氟化物含量。與此同時，AAPD 鼓勵所有飲料和嬰兒配方奶粉的製造商在食品標籤上的營養成分中註明氟化物濃度。• 鼓勵牙科專業人士告知醫療同行，在牙釉質成熟之前攝入過量氟化物可能會導致氟斑牙。官方但未格式化 • 鼓勵繼續研究安全有效的氟化物產品 美國食品和藥物管理局要求食品和飲料的營養標籤包含氟化物含量。與此同時，AAPD 鼓勵所有飲料和嬰兒配方奶粉的製造商在食品標籤上的營養成分中註明氟化物濃度。• 鼓勵牙科專業人士告知醫療同行，在牙釉質成熟之前攝入過量氟化物可能會導致氟斑牙。官方但未格式化 • 鼓勵繼續研究安全有效的氟化物產品 美國食品和藥物管理局要求食品和飲料的營養標籤包含氟化物含量。與此同時，AAPD 鼓勵所有飲料和嬰兒配方奶粉的製造商在食品標籤上的營養成分中註明氟化物濃度。• 鼓勵牙科專業人士告知醫療同行，在牙釉質成熟之前攝入過量氟化物可能會導致氟斑牙。官方但未格式化 • 鼓勵繼續研究安全有效的氟化物產品 • 鼓勵牙科專業人士告知醫療同行，在牙釉質成熟之前攝入過量氟化物可能會導致氟斑牙。官方但未格式化 • 鼓勵繼續研究安全有效的氟化物產品 • 鼓勵牙科專業人士告知醫療同行，在牙釉質成熟之前攝入過量氟化物可能會導致氟斑牙。官方但未格式化 • 鼓勵繼續研究安全有效的氟化物產品


OFFICIAL BUT UNFORMATTED Policy on Use of FluorideLatest Revision2023
Abbreviations AAPD: American Academy Pediatric Dentistry. NaFV: sodium fluoride varnish. ppm: parts per million. U.S.: United States.

Purpose
The American Academy of Pediatric Dentistry (AAPD) affirms that the use of fluoride in the prevention of caries is safe and effective. The AAPD encourages dentists and dental professionals, other health care providers, public health officials, and parents/caregivers to optimize fluoride exposures to reduce the risk for caries and to enhance the remineralization of affected teeth.

Methods
This document was developed by the Liaison with Other Groups Committee, adopted in 19671 , and last revised in 2018 2 . An electronic database search using the terms: fluoride, fluoridation, acidulated phosphate fluoride, fluoride varnish, fluoride therapy, and topical fluoride was conducted to develop and update this policy. The current update relied upon systematic reviews, expert opinions, and best current practices.

The use of silver diamine fluoride is addressed in a separate AAPD policy.3 Background Fluoride acts in three important ways to prevent caries:
1) by strengthening enamel through the creation of fluorapatite,
2) by remineralizing enamel, and
3) by affecting microbial metabolism and reducing acid production by cariogenic bacteria.4

Community water fluoridation is recognized as one of the ten greatest public health achievements of the twentieth century because it is a beneficial and inexpensive population-based approach that can reach the entire community.5 By definition, community water fluoridation is the process of adjusting the fluoride in community water supplies to optimal concentration for preventing caries. 6 Results from a recent systematic review on the economic evaluation of community water fluoridation reveal fluoridation of water is associated with fewer dental treatment costs.7 When public water is fluoridated to an optimal level, there is a 35 percent reduction in decayed, missing, and filled primary teeth and 26 percent fewer decayed, missing, and filled permanent teeth. 8 The occurrence of dental fluorosis, causing dental esthetic concerns, has been reported to be 12 percent when public water contains 0.7 parts per million (ppm) or milligrams per liter (mg/L) fluoride. 8 When combined with other dietary, oral hygiene, and preventive measures6 , the use of fluorides can further reduce the incidence of caries. When a child's home drinking water supply does not contain fluoride, the caries-preventive benefits of fluoride can be achieved through the intake of daily fluoride supplements according to established guidelines. 6,9-11 Before supplements are prescribed, careful review of all dietary sources of fluoride (e.g., additional sources of drinking water [daycare, school, sports facilities, bottled water], other consumed beverages, prepared foods [including infant formula], toothpaste) will help establish the child’s true exposure to fluoride. 6,12,13 This information, along with the child’s assessed caries risk, can be used to determine a need for fluoride supplementation. The mean fluoride concentration of ready-to-feed infant formulas in the United States (U.S.) is 0.15 ppm for milk-based formulas and 0.21 ppm for soy-based formulas.14 The more important issue, however, is the fluoride content of concentrated or powdered infant formula when reconstituted with fluoridated water. The range of fluoride (in ppm) for reconstituted powdered or liquid concentrate when reconstituted with water containing one ppm fluoride is 0.64 to 1.07. 14
As communities adjust their municipal water supplies to align with the U.S. Department of Health and Human Services’ 2015 recommendation of 0.7 ppm fluoride 15 , the risk of dental fluorosis due to reconstituting infant formula with fluoridated water is decreased. Significant cariostatic benefits can be achieved by the use of over-the-counter fluoride-containing products such as toothpastes, topically-applied gels, and oral rinses, especially in areas without fluoridated drinking water.6,16-20 Toothbrushing with appropriate amounts of fluoride toothpaste twice daily is recommended for all children. 10,21 Monitoring children’s use of topical fluoride-containing products, including toothpaste, may prevent ingestion of excessive amounts of fluoride.21,22 A grain-ofrice-sized amount of fluoridated toothpaste is appropriate for children less than three years of age, while no more than a pea-sized amount is recommended for children ages three to six years.22 Numerous clinical trials have confirmed the anti-caries effect of professional topical fluoride treatments, including 1.23 percent acidulated phosphate fluoride ([APF]; 1.23 percent fluoride), five percent sodium fluoride varnish ([NaFV]; 2.26 percent fluoride), 0.9 percent difluorosilane varnish ([DFS]); 0.1 percent fluoride), 0.09 percent fluoride mouthrinse, and 0.5 percent fluoride gel/paste. 23-25 For children under the age of six years, five percent NaFV in unit doses (which reduces the potential for harm by limiting fluoride availability) is the only recommended professionally-applied topical fluoride agent.25 Professional fluoride products are intended for application by, or under the direction of, a licensed dental or medical care provider who is familiar with the child’s oral health status and can determine the need and frequency for application based upon a completed a caries risk assessment. 25 Some parents and caregivers are concerned about their child receiving fluoride and may refuse fluoride treatment even though fluoride is safe and effective. 26 This is similar to opposition to community water fluoridation. 27 Topical fluoride refusal and resistance may be a growing problem and mirror trends seen with vaccination refusal in medicine. Oral health promotion through patient education resources and social media may assist in addressing parental reluctance or misinformation about fluoride.


Policy statement
The AAPD: • recognizes that drinking fluoridated water and brushing with fluoridated toothpaste twice daily are the most effective methods in reducing dental caries prevalence in children. • encourages toothbrushing with appropriate amounts of fluoride toothpaste twice daily for all children. • endorses and encourages the adjustment of fluoride content of public drinking water supplies to an optimal level (0.7 ppm) where feasible. • encourages professionally-applied fluoride treatments for all individuals at risk for dental caries. • supports the delegation of topical fluoride application to auxiliary dental personnel or other trained allied health professionals by prescription or order of a dentist after a comprehensive oral examination and caries-risk assessment or by a physician after a dental screening and caries-risk assessment have been performed. • endorses the use of fluoride supplements according to established American Dental Association9 , American Academy of Pediatrics10, and AAPD11 recommendations when fluoride levels in municipal drinking water are suboptimal and after consideration of sources of dietary fluoride and the caries risk of the child. • encourages dental providers to talk to parents about the benefits of fluoride and to proactively address fluoride hesitance through chairside education. • encourages dental team members to seek opportunities to provide evidence-based community education on the safe and economical dental caries-preventive benefits of fluoride through municipal water fluoridation. • encourages the U.S. Food and Drug Administration to require food and beverage nutrition labels to include fluoride content. In the meantime, AAPD encourages manufacturers of all beverages and infant formula to include fluoride concentration with the nutritional content on food labels. • encourages dental professionals to inform medical peers of the potential of dental fluorosis when excess fluoride is ingested prior to enamel maturation. OFFICIAL BUT UNFORMATTED • encourages continued research on safe and effective fluoride products

塗氟-- 學會建議但非醫療常規.
摘要
該最佳實踐為從業人員提供了有關使用氟化物輔助預防和控制兒童牙科患者齲齒的信息。這些建議涉及全身氟化物（水氟化、膳食氟化物補充劑）、通過專業應用的局部氟化物輸送（酸化磷酸鹽氟化物凝膠或泡沫、氟化鈉清漆、氟化二胺銀）和家用產品（牙膏、漱口水）以及氟化物的相關風險。社區水氟化物的標準水平（氟化物為百萬分之 0.7）有助於平衡齲齒風險和牙齒發育早期因攝入過量氟化物而導致氟斑牙的可能性。針對 6 個月至 16 歲兒童膳食補充氟化物的具體建議是基於飲用水中的氟化物含量、其他膳食氟化物來源、氟化牙膏的使用以及齲齒風險。每個患者的具體需求決定了全身和局部氟化產品的適當使用，無論是在專業臨床還是家庭環境中提供。氟化物已被證明是降低嬰兒、兒童、青少年和有特殊需要的人齲齒患病率的有效療法。通過美國兒科牙科學會臨床事務和科學事務委員會的共同努力，


Fluoride Therapy OFFICIAL BUT UNFORMATTED Latest Revision 2023
Abbreviations CaF: Calcium fluoride. F: Fluoride. FSIQ: Full scale intelligent quotient. IQ: Intelligence quotient. mg: milligram(s). mg/kg: milligrams per kilogram. NaFV: Sodium fluoride varnish. ppm F: parts per million fluoride. SDF: Silver diamine fluoride. U.S.: United States. :302-5.
Abstract This best practice provides information for practitioners regarding the use of fluoride as an aid in preventing and controlling dental caries in pediatric dental patients. These recommendations address systemic fluoride (water fluoridation, dietary fluoride supplements), topical fluoride delivery via professional application (acidulated phosphate fluoride gel or foam, sodium fluoride varnish, silver diamine fluoride), and home-use products (toothpastes, mouthrinses) as well as the associated risks of fluoride agents. The standard level for community water fluoridation (0.7 parts per million fluoride) helps balance the risk of caries and the possibility of dental fluorosis from excessive fluoride ingestion during the early years of tooth development. Specific recommendations for dietary supplementation of fluoride for children ages six months through 16 years are based on fluoride levels in the drinking water, other dietary sources of fluoride, use of a fluoridated toothpaste, and caries risk. The specific needs of each patient determine the appropriate use of systemic and topical fluoride products, whether delivered in a professional clinical or a home setting. Fluoride has proven to be an effective therapy in reducing the prevalence of dental caries in infants, children, adolescents, and persons with special needs. Through a collaborative effort of the American Academy of Pediatric Dentistry Councils on Clinical Affairs and Scientific Affairs, this best practice was revised to offer updated information and recommendations to assist healthcare practitioners and parents in using fluoride therapy for management of caries risk in pediatric patients.