What is Fluoride?
Fluoride….what is it exactly? And why do I or my children need it? Isn’t it a poison? Is there Fluoride in my drinking water? Why does Dr. Brandon recommend it?
As a pediatric dentist I get asked these questions frequently. I firmly believe preventative dentistry is the best dentistry, and the only avenue to successful preventative dentistry is via education. It’s important for parents and caregivers to understand what their children are ingesting and its safety…..so let’s talk fluoride.
Disclaimer #1: My recommendations are not merely opinion; they are based on the latest research and the industry’s experts. All recommendations are endorsed by the American Academy of Pediatric Dentistry, American Academy of Pediatrics and the Center for Disease Control.
Is it beneficial? It is very difficult to argue against the efficacy of fluoride and its impact on the reduction of dental cavities. Since its inclusion into drinking water, there has been a reduction in cavities (also known as caries in dental talk) of 55-60%. The CDC named water fluoridation as one of 10 great public health achievements of the 20th century.
How does it work? Fluoride works like this: sugar from the diet is processed by specific types of bacteria in our mouth. A byproduct of said sugar metabolism is acid. The acid leads to a demineralization of the tooth surface, or enamel (Figure 1). Saliva is naturally saturated with calcium, phosphate and………..fluoride. Fluoride also is found in something called the “pellicle.” The “pellicle” is an invisible film that harbors not only plaque, bacteria, sugars, but also fluoride. After an acid attach and demineralization of the tooth surface, phosphate, calcium and fluoride ions are absorbed by the tooth, resulting in remineralization of the tooth, and all is well. This demin-remin process is constant, occurring all day. Teeth need about 20-30 minutes to complete this remineralization process after an acid attach (so if you enjoy Dr. Pepper or Bill Miller’s ice tea, it’s better to drink them over a small amount of time vs sipping throughout the day……the constant sugar attacks do not allow for the remineralization process).
The real benefit of fluoride and its absorption into the tooth surface is what it creates: fluorohydroxyapatite crystals. These crystals are stronger, more acid-resistant compared to the nonfluoride hydroxyapatite crystals.
Fluoride also helps to inhibit the metabolism of bacterial activity, resulting is less acid production.
Okay….enough dental nerd talk. What does this all mean? The protection of our teeth to prevent cavities from the naturally occurring attack on our enamel due to our daily diet (no matter what type of diet consumed) is aided by the presence of fluoride.
Is it safe? Fluoride is and has been one of the most researched topics in dentistry. Since 1945, when water fluoridation was introduced, there have been extensive studies and reviews to assess its risks and benefits and assure its safety.
The biggest concern I’ve seen from parents is the risk of fluorosis. Fluorosis is an excess amount of fluoride in the diet resulting in a disturbance of the developing enamel. Fluorosis only occurs in developing permanent teeth. On average, by 8 or 9 years of age, the enamel is already formed (although the tooth not erupted into the mouth). Therefore fluorosis does not occur in older children. Studies have shown when water fluoridation is at an optimal level there is a reduction in cavities without significant risk of enamel fluorosis.
Is your water fluoridated? Check it out here.
So is fluoride safe? Yes, when properly utilized.
Is the fluoride treatment really needed after a cleaning? The ADA and AAPD recommend at least two (sometimes more often) professionally applied fluoride applications a year to reduce the risk of cavities. Fluoride is best utilized through a topical effect, meaning the greatest benefit to teeth is from the fluoride that actually sits on the tooth in the “pellicle”. This “pellicle” is removed during the cleaning and polishing process, thus removing the topical fluoride. The reapplication of the fluoride is extremely important in the protection of the teeth.
Fluoridated toothpaste? As a pediatric dentist this is one of the most asked about questions. First, fluoridated toothpaste IS safe for use for children of ALL ages. BUT, the amount of toothpaste is key. For children that cannot spit, generally 4-5 yrs and below, only a “smear” layer is recommended. If you ever visited with me in my office with your toddler, I always demonstrate proper brushing technique and toothpaste amount. I recommend dipping just a few bristles of the toothbrush into the tube of toothpaste. Kids generally like the taste of toothpaste and will want to eat or suck off the paste from the brush. Since most of the past will be swallowed, it’s important we monitor exactly how much is being used.
If you are unclear or concerned about how much to use, this would be one of the few times I recommend using non-fluoridated toothpaste until your dentist or pediatric dentist can demonstrate the proper amount to use.
Disclaimer #2: If you feel compelled to Google “fluoride”, know that you will find many anti-fluoride bloggers out there set out to warn the public about the governments slow takeover of its citizens through the use of water fluoridation……very little is back by solid research.
Perhaps you’ve decided not to use fluoride for one reason or another. I’d love to hear your reasons in hopes I can expand my own understanding of the “non-dental” perspective.
Dr. Brandon
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