Caries prevention in infancy and early childhood:Recommendations for action by the nationwide Healthy Start—Young Family Network,Kariesprävention im Säuglings- und frühen Kindesalter:Handlungsempfehlungen des bundesweiten Netzwerks Gesund ins Leben

Background: In the past different recommendations for caries prevention through fluoride application in infancy and early childhood (0–6 years old) existed in Germany; however, if different recommendations coexist it leads to confusion among health professionals and parents/caregivers, to a lower acceptance of the recommendations and, consequently, to insufficient implementation. Methods: Joint recommendations were formulated in a multistage process, coordinated by the Healthy Start—Young Family Network (Netzwerk Gesund ins Leben). Representatives of the relevant German medical and scientific societies, professional associations and specialized institutions participated in the process and reviewed the scientific evidence. Feasibility and accessibility were considered, also with respect to families with an increased risk of caries. Recommendations: From birth to tooth eruption infants should receive a supplement with 400–500 IU vitamin D and 0.25 mg fluoride. After tooth eruption, the child should gently and gradually be introduced to tooth brushing. A choice should be made between continuing systemic fluoride application (400–500 IU vitamin D and 0.25 mg fluoride) or using a toothpaste with 1000 ppm fluoride (up to 2 times 0.125 g/day, the size of a grain of rice); vitamin D supplementation is continued until the second summer in the child’s life. During the first 12 months, infants fed exclusively or predominantly on formula food are given a vitamin D supplement without fluoride if the fluoride content of the water used to prepare the formula contains ≥ 0.3 mg fluoride/l. In this case the daily amount of fluoride toothpaste should also be reduced. From 12 months on tooth brushing twice a day with a toothpaste containing fluoride (1000 ppm fluoride) is recommended, first with a small amount of toothpaste (each time up to 0.125 g, the size of a grain of rice) and then with a larger amount of toothpaste from 24 months (each time up to 0.25 g, pea-sized). To avoid excessive fluoride intake, the correct amount of toothpaste is essential. Education and advice on caries prevention and on how to put the recommendations into practice should be provided during pediatric and dental examinations as well as within the National Dental Group Prevention Program.