Fluoride
Dental decay is a common disease in
Fluoride helps harden the tooth enamel and make it more resistant to tooth decay. A small cavity can be stopped and even reversed by the remineralization process enhanced by fluoride.
Fluoride can be delivered to the teeth in 2 ways; topically (direct contact on the teeth) and systemically (enters the blood stream).
Fluoride remineralize tooth enamel and make it more resistant to tooth decay. A small cavity can be stopped and even reversed by the remineralization process enhanced by fluoride.
Teeth in the mouth are in a constant state of remineralization (getting harder) and demineralization (getting softer). The equilibrium shifts towards demineralization when the environment in the mouth becomes acidic from eating sugary or acidic foods. Fluoride helps to keep the teeth in a remineralization phase longer.
Fluoride can be delivered to the teeth in 2 ways;
- Topically - direct contact on the teeth
- Systemically - enters the blood stream through swallowing water or foods containing fluoride. This fluoride eventually becomes topical by being incorporated into saliva which directly contacts teeth
Fluoride Safety
Fluoride is very effective in controlling dental decay when used properly. If not used in the proper doses, dental fluorosis and fluoride toxicity can occur.
Fluoride toxicity is when large amounts of fluoride are ingested during a short period of time. This can be dangerous to your health.
What exactly is a large amount of fluoride? Generally, the toxic level for fluoride is much higher than the amount recommended for daily use. An 8 year old child swallowing an entire tube of toothpaste would be and example of a toxic amount.
Symptoms may include nausea, diarrhea, vomiting, abdominal pain, increased salivation or increased thirst.
These symptoms would begin 30 minutes after ingestion and can last up to 24 hours.
Depending on how much fluoride is ingested, certain emergency procedures should be implemented. If any of the symptoms of toxicity are noticed, the following precautions should be taken:
- Drink milk
- Induce vomiting
- Call the local dentist or physician
- Call 911 (if the condition does not get better)
Dental fluorosis has become a growing concern and has brought the ingestion of fluoride into question. A child’s front teeth develop during the first 36 months. For healthy looking teeth, the amount of fluoride that a child is exposed to is crucial as swallowing too much fluoride could cause fluorosis. At the end of 36 months, the front teeth have finished developing and so fluorosis is no longer as much of a concern. However, from 4 - 9 years of age the canines and molars are developing and are at risk of fluorosis. Because these teeth are further back in the mouth, they can not be seen as easily and so, fluorisis is less of a concern.
- Dental fluorosis - is the change in visual appearance of the teeth. It is caused by an excess of fluoride intake during the stages of tooth development.
- Dental fluorosis ranges from mild (white specks on teeth) to severe (brown staining and pitting of enamel).
- Dental fluorosis can range from mild to severe.
- Mild consists of small white spots on the teeth. A tooth should be glossy, but mild fluorosis can have a matted, paper like look to it. 3
Moderate to severe fluorosis will affect more of the surfaces of the teeth. There is brown staining and some pitted areas.3
- To help ensure your young child (under 13) does not have any adverse effects from fluoride, you can follow some basic rules;
- fluoridated products should not be swallowed
- only a small amount of toothpaste, such as the size of a small pea is needed for a child
- fluoridated products, especially mouthrinses should not be given to a child under 6 years of age, or to anyone who cannot rinse ( those you suspect are swallowing some of the product)
- keep fluoridated products out of reach of children
- parental supervision is needed for children when brushing or using any fluoridated substances
Fluoride can be be in many food products depending on where the processing factory is, and if their water supply is fluoridated of not. Baby formula that is ready to eat may not have fluoride, ALL powdered formulas, when adding fluoridated water, raises the levels of fluoride taken into the bloodstream.8
Communities can either:
- naturally have fluoride in their water supply
- naturally not have fluoride in their water supply
- intentionally have fluoride added to their water supply
Families that wish to limit the amounts of fluoride that their children intake should keep in mind that there are many unknown sources of fluoride. Your children for example could be consuming foods and drinks that contain fluoride while at daycare. 8
Filtering your water or drinking bottled water will reduce the overall amount of fluoride you ingest. Labels on bottled water usually indicate the amount of fluoride it contains.
See your oral health professional, such as your dental hygienist, for further information pertaining to fluoride and its benefits and usage.
Topical Fluoride
Benefits of fluoride are evident before the teeth erupt (come in) because it goes directly into the developing pre-eruptive teeth, yet fluoride is still very beneficial for children and adults after the teeth are fully and post-erupted.
Topical fluoride has been clinically proven to help prevent cavities and even help cavities in their first stages to remineralize or “heal.”6
Topical fluorides are applied directly to the tooth structure to delay or slow down the tooth decay process. Topical fluorides such as the kind found in toothpaste, can become systemic if the person using it swallows the fluoride. That is why after a fluoride treatment from your dental professional, they advise you not to swallow the fluoride.
Topical forms of fluoride include:
- toothpaste - used daily, Use only a pea-sized amount for children under 6 and make sure they are being supervised while brushing. 10 A toothpaste with a CDA or ADA seal guarantees that the product is proven to be effective. If a child is in the habit of swallowing toothpaste when brushing, use non-fluoridated, or child appropriate toothpaste with half the fluoride (500ppm).8
- It is recommended that children under 2 use a fluoride free toothpaste to eliminate the risk of swallowing a toxic amount. However those with a high risk of tooth decay will benefit from the fluoride. It is advisable to contact your dental professional for more information regarding this issue.
- professional fluoride application - this is a gel or foam that is applied for 1 to 4 minutes, usually in a tray at the end of a visit with the dental hygienist. Not everyone is given a professional fluoride application; it depends on your oral health needs.
- professional fluoride varnishes – these are fluoride applications that are painted on to the tooth directly. It is safe for children because it is not as easily swallowed like other applications. Fluoride can also help make teeth less sensitive
- fluoridated home mouth rinses - can be purchased over-the-counter for children over 6 years of age, and adults who are susceptible to cavities.
- home care fluoride gels - applied by trays or by brush, these gels are for those who are highly susceptible to cavities. These people would include;
- adults with a high incidence of root cavities
- those who experience an extremely dry mouth
- people who wear braces or orthodontic appliances
- those who have rampant or excessive cavities
Fluoride gels can be bought over-the-counter or by prescription.
Seek the advice of your dental hygienist, dentist or dental therapist for a daily home fluoride program that is individualized for your needs.
Systemic Fluoride
Systemic and topical fluoride is delivered to the tooth surface via the bloodstream. Systemic fluoride can be derived from a food source, water source, or dietary supplements (pill, tablet, lozenge, and drop). Fluoridated water is an effective way to reduce the problem of dental decay.
Children from birth to 14 years of age will benefit the most from systemic fluoride. This is because when fluoride is ingested, it circulates through the bloodstream and into developing and pre-eruptive teeth. The fluoride is then built into the enamel structure of the developing tooth, making the tooth more resistant to acids. However, dental fluorosis can occur if too much fluoride is swallowed so it is important to have just the right amount of fluoride. Your dental professional should be able to tell you how much or how little is the right amount.
There has been controversy over water fluoridation. If you are not sure if your water is fluoridated you can call your city officials and talk to your dental professional. They will better be able to answer your questions on fluoride.
See your oral health professional, such as your dental hygienist, for further information pertaining to fluoride and it's benefits and usage.
References:
- Lynch RJ, Mony U, Ten Cate JM. The effect of fluoride at plaque fluid concentrations on enamel de- and remineralisation at low pH. Caries Research, 2006;40(6):522-9.
- Hellwig E, Lennon AM Systemic versus topical fluoride. Caries Research 2004 May-Jun;38(3):258-62
- Darby ML, Walsh MM. Dental Hygiene Theory and Practice 2nd Ed. St Louis: Saunders; 2003.
- Stephen KW, Macpherson LM, Gilmour WH, Stuart RA, Merrett MC. A blind caries and fluorosis prevalence study of school-children in naturally fluoridated and nonfluoridated townships of
- Yamazaki H, Litman A, Margolis HC. Effect of fluoride on artificial caries lesion progression and repair in human enamel: regulation of mineral deposition and dissolution under in vivo-like conditions. Arch Oral Biol. 2007 Feb;52(2):110-20. Epub 2006 Oct 16.
- Buchalla W, Attin T, Schulte-Monting J, Hellwig E. Fluoride uptake, retention, and remineralization efficacy of a highly concentrated fluoride solution on enamel lesions in situ. J Dent Res. 2002 May;81(5):329-33.
- Franzman MR, Levy SM, Warren JJ, Broffitt B. Fluoride dentifrice ingestion and fluorosis of the permanent incisors. J Am Dent Assoc. 2006 May;137(5):645-52.
- Levy SM, An Update on Fluorides and Fluorosis, J Can Dent Assoc 2003; 69(5):286-91
- Leverett DH Appropriate uses of Systemic fluoride: considerations for the 90’s. J public Health Dent 1991; 51(1):42-7
- The Fluoride Dialogue: CDHA position statements. http://www.cdha.ca/content/newsroom/pdf/ProbeFluoride.pdf
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