Fluoride. What is it? What does it do? Who needs it? And where do we find it? These are all questions that come through my office daily. I recently realized that fluoride is a big mystery to many patients as well as referring health professionals. Its perception and guidelines are constantly changing (like many things in life). So, let’s spend a few moments to get a better understanding of this substance, and hopefully walk away a bit more educated in our understanding of its necessity and appropriate use.
We start off with a bit of science. Fluoride is the 13th most abundant element on the earth’s crust. It is found naturally in soil, water, foods and several minerals. Its concentration found in seawater is very high while in fresh water it’s typically low. Fluoride is also synthesized, man-made in laboratories. It is made to add to drinking water, as well as what we are more familiar with, toothpaste and mouthwashes.
So, what does fluoride do? It is proven to protect the teeth in two ways: demineralization and remineralization. Demineralization occurs when bacteria in the mouth combine with sugars and produce acid. This acid, sometimes in an already acidic environment due to our diets, can erode the enamel of our teeth. Fluoride has the ability to protect this demineralization caused by acid. Remineralization is the strengthening of the damaged areas caused by acid, in which fluoride can play a role. Too much demineralization without remineralization to repair the damaged enamel layers leads to tooth decay. (I need a breath after that one...)
Fluoride is extremely useful in preventing cavities and making teeth stronger. It helps prevent decay by making the teeth resistant to acid attacks from plaque bacteria and sugars in the mouth. It can also reverse early signs of tooth decay. However, once cavities have formed, it is less effective.
So, who needs fluoride? Well, it depends, but virtually everyone. Children need fluoride to protect their teeth as they are being formed. In children under 6 years of age, fluoride becomes incorporated into the development of the permanent teeth. Adults who are prone to tooth decay can benefit from fluoride as well to help prevent future breakdown. It will help speed remineralization as well as disrupt acid production in the mouth.
Where do we find it? First place, and the cheapest source, is our tap water. The ADA has proven after 70 years of optimal levels of fluoride in community water that it is safe and effective in preventing tooth decay by at least 25 percent in both children and adults. Simply by drinking tap water, most Americans can benefit from its cavity prevention. The CDC, Center for Disease Control, named community water fluoridation one of the 10 great public health achievements of the 20th century.
The ADA says that “water that has been fortified with fluoride is similar to fortifying milk with Vitamin D, table salt with iodine, and cereals and beads with folic acid.” Research has shown that there is 60 percent less tooth decay among children in fluoridated areas. The fluoridation of community water supplies is only an adjustment of the naturally occurring fluoride levels in the drinking water to an ideal recommended level of 0.7-1.2 parts per million. (So, check into your local city water department.)
So, what if you drink bottled water? Or you are part of what I call the “water-cooler” generation. Are you missing out? Well, there is no scientific study that suggests that water-bottle drinkers are at an increased risk for decay. Obviously, there are many factors such as diet, keeping up with your routine dental care and oral hygiene that contribute as well. However, the American Dental Association says that such people could be missing out on the positive effects of the fluoride present in the local tap water, and that you receive benefit from drinking and using it in your foods for cooking. Most bottled waters do not contain optimal levels of fluoride; however, some have added to it (check your labels).
We can also find fluoride in our toothpaste. That’s an easy one. Brush twice a day with an ADA-approved fluoridated paste, or gel, and that goes a long way. We take that benefit for granted, assuming that all paste contains fluoride. However, recently I have had a few adult patients shown new signs of decay, and began to question their habits. Their diet was fairly healthy and organic. And then they brought me in their new holistic toothpaste they began to use a few months ago. It had no fluoride present. Hmmm. This was the only change in their routine. For this patient, this absence of fluoride paste in their brushing routine may very well be a contributing factor. (Look for those ADA seals on products; they are there for a reason.)
There are also fluoride rinses and fluoride treatments. Both are excellent ways to help reinforce enamel in children and adults. During your dental check-up visits as well as using routinely at home as part of your oral hygiene regimen, these fluoride products have been proven to truly strengthen the integrity of your teeth.
I am commonly asked about fluoride supplements for young children. I defer to my medical colleagues to make that decision on a case-by-case basis. It all depends. And we must be careful. We do find that many children are deficient; however, we don’t want them over-fluoridated as well.
Some mothers are using bottled water in formula, and others are using tap.
Please use caution; excessive levels of fluoride can produce dental or skeletal fluorosis.
As far as individual recommendations, I strongly advise you to speak with your dentist and physician. Discuss your daily habits, diets and the type of water you use, and determine together where you stand with your fluoride needs.
So, our takeaway is that fluoride is truly a proven “first line of defense” in the prevention of tooth decay. Consult with your dentist and make sure you are where you need to be.
Keep Drinking Water...
(Now, the disclaimer is that these are my observations, as well as those of other dentists, and each individual, along with their dentist and physician, should find the best diet for themselves for a healthy life.)
By Dr. Brian Kalb