Dental Health and Fluoride Treatment

Fluoride is a mineral that occurs naturally in many foods and water. Every day, minerals are added to and lost from a tooth’s enamel layer through two processes, demineralization and remineralization. Minerals are lost (demineralization) from a tooth’s enamel layer when acids — formed from plaque bacteria and sugars in the mouth — attack the enamel. Minerals such as fluoride, calcium, and phosphate are redeposited (remineralization) to the enamel layer from the foods and waters consumed. Too much demineralization without enough remineralization to repair the enamel layer leads to tooth decay.

Fluoride helps prevent tooth decay by making the tooth more resistant to acid attacks from plaque bacteria and sugars in the mouth. It also reverses early decay. In children under 6 years of age, fluoride becomes incorporated into the development of permanent teeth, making it difficult for acids to demineralize the teeth. Fluoride also helps speed remineralization as well as disrupts acid production in already erupted teeth of both children and adults.

As mentioned, fluoride is found in foods and in water. It can also be directly applied to the teeth through fluoridated toothpastes and mouth rinses. Mouth rinses containing fluoride in lower strengths are available over-the-counter; stronger concentrations require a doctor’s prescription.

A dentist in their office can also apply fluoride to the teeth as a gel, foam, or varnish. These treatments contain a much higher level of fluoride than the amount found in toothpastes and mouth rinses. Varnishes are painted on the teeth; foams are put into a mouth guard, which is applied to the teeth for one to four minutes; gels can be painted on or applied via a mouth guard.

Fluoride supplements are also available as liquids and tablets and must be prescribed by your dentist, pediatrician, or family doctor.

It is certainly important for infants and children between the ages of 6 months and 16 years to be exposed to fluoride. This is the timeframe during which the primary and permanent teeth come in. However, adults benefit from fluoride, too. New research indicates that topical fluoride — from toothpastes, mouth rinses, and fluoride treatments — are as important in fighting tooth decay as in strengthening developing teeth.

In addition, people with certain conditions may be at increased risk of tooth decay and would therefore benefit from additional fluoride treatment. They include people with:

  • Dry mouth conditions: Also called xerostomia, dry mouth caused by diseases such as Sjögren’s syndrome, certain medications (such as allergy medications, antihistamines, antianxiety drugs, and high blood pressure drugs), and head and neck radiation treatment makes someone more prone to tooth decay. The lack of saliva makes it harder for food particles to be washed away and acids to be neutralized.
  • Gum disease: Gum disease, also called periodontitis, can expose more of your tooth and tooth roots to bacteria increasing the chance of tooth decay. Gingivitis is an early stage of periodontitis.
  • History of frequent cavities: If you have one cavity every year or every other year, you might benefit from additional fluoride.
  • Presence of crowns and/or bridges or braces: These treatments can put teeth at risk for decay at the point where the crown meets the underlying tooth structure or around the brackets of orthodontic appliances.

Ask your dentist if you could benefit from additional fluoride.

Fluoride is safe and effective when used as directed but can be hazardous at high doses (the “toxic” dosage level varies based on an individual’s weight). For this reason, it’s important for parents to carefully supervise their children’s use of fluoride-containing products and to keep fluoride products out of reach of children, especially children under the age of 6.

In addition, excess fluoride can cause defects in the tooth’s enamel that range from barely noticeable white specks or streaks to cosmetically objectionable brown discoloration. These defects are known as fluorosis and occur when the teeth are forming — usually in children younger than 6 years. Fluorosis, when it occurs, is usually associated with naturally occurring fluoride, such as that found in well water. If you use well water and are uncertain about the mineral (especially fluoride) content, a water sample should be tested. Although tooth staining from fluorosis cannot be removed with normal hygiene, your dentist may be able to lighten or remove these stains with professional-strength abrasives or bleaches.

Keep in mind, however, that it’s very difficult to reach hazardous levels given the low levels of fluoride in home-based fluoride-containing products. Nonetheless, if you do have concerns or questions about the amount of fluoride you or your child may be receiving, talk to your child’s dentist, pediatrician, or family doctor.

A few useful reminders about fluoride include:

  • Store fluoride supplements away from young children.
  • Avoid flavored toothpastes because these tend to encourage toothpaste to be swallowed.
  • Use only a pea-sized amount of fluoridated toothpaste on a child’s toothbrush.

Even though there are no scientific studies to suggest that people who drink bottled water are at increased risk of tooth decay, the American Dental Association (ADA) says that such people could be missing out on the decay-preventing effects of optimally fluoridated water available from their community water source. The ADA adds that most bottled waters do not contain optimal levels of fluoride, which is 0.7 to 1.2 parts per million (this is the amount that is in public water supplies, in the communities that have fluoridated water). To find out if your brand of bottled water contains any fluoride, check the label on the bottle or contact the bottle water manufacturer.

The amount of fluoride you receive in your drinking water depends on the type of home water treatment system used. Steam distillation systems remove 100% of fluoride content. Reverse osmosis systems remove between 65% and 95% of the fluoride. On the other hand, water softeners and charcoal/carbon filters generally do not remove fluoride. One exception: some activated carbon filters contain activated alumina that may remove over 80% of the fluoride.

If you use a home water treatment system, have your water tested at least annually to establish the fluoride level your family is receiving in the treated water. Testing is available through local and state public health departments as well as private laboratories. Also, check with the manufacturer of the product you purchased or read the information that came with the water treatment system to determine the product’s effects on fluoride in your home water.

To find out how much fluoride is in your tap water, ask your local dentist, contact your local or state health department, or contact your local water supplier. Information for contacting your local water supplier should be on your water bill or see the “local government” section of your phone book.

Approximately 62% of the U.S. population served by public water supplies has access to adequate levels of fluoride in their water, and 43 of the 50 largest U.S. cities have water fluoridation systems.


Is fluoride good for us?

Most of us put our trust in fluoride to help prevent tooth decay. It is a common ingredient in toothpaste and mouthwashes, and several countries, including large parts of the UK, add fluoride to the water supply.

Just last month, a study was published which reported that adding fluoride to table salt had reduced dental decay in Jamaica.

However, not all scientists are enthusiastic about fluoride. Recent evidence suggests it is not as effective in preventing tooth decay as was originally thought. In fact, it is believed fluoride treatment has the capacity to cause dental disease.

There is also some evidence that fluoride may increase the risk of other health issues, including weakened bones and thyroid conditions. So could adding fluoride to drinking water be doing us more harm than good?

Fluoride is a by-product of certain manufacturing practices (primarily the phosphate fertiliser industry). Precisely what lay behind the decision to add it to water supplies is not clear. Fluoride is, after all, a potentially toxic waste product.

When fluoridation of water started 60 years ago, there was no good evidence to suggest that fluoride might prevent tooth decay. However, partly as a result of later studies which suggested it might have tooth-protecting qualities, fluoridation of water became accepted practice.

More recently, the British government commissioned a review of the scientific literature on this subject, the results of which were published last year in the British Medical Journal. The York study concluded that the rationale behind the fluoridation of water is based on weak scientific evidence.

In addition, it found that the protection offered by fluoride is much less than previously thought: just one in six people drinking fluoridated water benefits from it.

Other studies show similarly poor results. In the largest dental health survey ever conducted in the U.S., fluoridation of water was found to protect less than 1 per cent of the total tooth surfaces in a child’s mouth.

Studies conducted in Finland, East Germany, Cuba and Canada have found that the rate of dental decay does not increase when communities stop fluoridation.

And while the benefits of fluoride appear to have been overrated, it seems that the hazards of this substance have been downplayed.

For instance, the York study found that almost 50 per cent of individuals drinking fluoridated water exhibit a condition known as ‘dental fluorosis’ – a mottling of the teeth thought to be caused by the toxic effects of fluoride.

So, while fluoridation of water may prevent dental disease in about 15 per cent of the population, it seems to cause dental dis-ease in about half those treated. And if toxic effects are seen in the teeth, what damage may be done in the rest of the body?

The authors of the York study said they could find no real evidence for the toxic effects of

fluoride on the body, but other studies claim fluoride has the capacity to weaken bones and increase the risk of fracture.

There is also evidence that fluoride can accumulate in the pineal gland in the brain. Potentially, this could disrupt a range of body processes, including sleep.

FLUORIDE is also known to reduce the function of the thyroid gland (responsible for regulating the speed of the metabolism), and studies in animals show fluoride may bring on premature puberty.

Another question is the ethics of fluoridation. If fluoride does indeed reduce dental decay, should it not be classed as a medicine? If this is the case, then individuals who live in areas where the water is fluoridated are essentially being medicated without their consent.

When doctors prescribe drugs, we generally do so knowing the patient’s sex, age, weight, medical history and current drug therapy.

They will judge whether a treat-ment is necessary, decide on an appropriate dosage and monitor the effects. None of this is true in the case of water fluoridation.

Ireland is the most heavily fluoridated country. About three-quarters of its water supply is treated with the chemical.

While the Irish have generally good dental health, studies show lower dental disease in non-fluoridated areas such as Wales and Scotland. In England, fluoridation depends on where you live.

Steps can be taken to reduce exposure to fluoride. Those living in a fluoridated region can avoid drinking tap water or filter their water.

For those wanting to avoid fluoride in toothpaste, many natural alternatives exist.

One particular brand based on aloe vera (called AloeDent) comes in several forms, one of which contains vitamin K which has been shown to be effective in preventing tooth decay. AloeDent can be found in health food stores.

¿¿¿ JOHN BRIFFA answers your questions online every week at

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