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The Truth About Fluoride

Have you ever wondered about the benefits of the Swish-swash program in schools? Or why your octor prescribes fluoride tablets for your children? Or why your dentist recommends daily fluoride treatments for dry mouth resulting from taking medications?

Explanations to all these questions revolve around the term we’re all familiar with, but sometimes not fully informed about-fluoride. A mineral found naturally in some water supplies, dentists consider fluoride to be the single most effective agent in the reduction and prevention of tooth decay.

The decay process occurs when bacterial plaque reacts with sugars on the tooth and produces decay-causing acids. When people take fluoride systemically through fluoridated water, tablets or drops during the formation and growth of the teeth, the crystalline structure of the enamel strengthens, making it more resistant to these acids. Once teeth emerge from the gum into the mouth, topical applications of fluoride such as toothpaste, mouth rinses, or gels become the primary source of continued protection. They inhibit and can even repair the early stages of tooth decay.

The easiest and most cost effective method of receiving systemic fluorides is usually achieved by drinking fluoridated water. Studies have shown that when fluoridated water is consumed from birth, decay formation can be reduced by fifty percent.

Can Missoulians rely on the water supply to meet our systemic fluoride needs? Currently the answer is no. Naturally occurring fluoride in Missoula’s water ranges from .2 to .3 parts per million (ppm), well below the recommended standard of 1.0 ppm.

In the meantime, your children will benefit from prescribed fluoride supplements in tablet or drop form. Your physician or dentist can prescribe drops for infants and tablets for older children. Have your children avoid consuming milk products for half an hour after taking drops or tablets to facilitate maximum fluoride absorption.

Children under the age of six are susceptible to fluorosis, a mottling of the enamel on developing permanent teeth caused by too much fluoride. Your health care provider will prescribe a lower-dose fluoride tablet for this age group. Parents can also help prevent mild fluorosis in their children by encouraging them to use only a pea-sized amount of toothpaste. With this amount, children can adequately clean their teeth, and there is less chance of the child swallowing any excess fluoride.

Since systemic fluorides only affect teeth that are still developing in the jaws, including wisdom teeth, they lose their effectiveness when people reach age sixteen. Once teeth are in place in their mouth, topical applications of fluoride become the main source of fluoride protection. Research has shown that maintaining high fluoride concentrations in the mouth stops and even reverses the initial stages of decay. Topical fluoride application can actually help replace minerals lost from the enamel. This very important process is called remineralization and stops decay before it spreads deeper into the tooth.

The best and most user-friendly topical fluoride is standard fluoride toothpaste. Brushing after every meal, followed by minimal rinsing, gives sufficient fluoride protection to most people.

Mouth rinses, in addition to toothpaste, help optimize fluoride absorption for children, and adults with high risk of decay. Over-the-counter daily rinses are .05% solution, while children in the Swish-swash program receive weekly treatments that are four times stronger. Fluoride treatments can also be administered in a dental office, where the hygienist may use an even more concentrated solution, in the form of a rinse or gel. (Reminder: don’t drink or eat anything for thirty minutes after any fluoride application.)

Topical fluoride gels are used primarily for adults suffering from dry mouth, a condition caused by reduced salivary gland output. Dry mouth can result from radiation treatment, some systemic diseases such as diabetes, and even certain medications such as anti-depressants. Since saliva works as a buffer against the acidity produced by the decay process, a dry mouth predisposes the teeth to rampant decay. In severe cases, your dentist may recommend a highly concentrated prescription gel five times stronger than toothpaste to be used daily for as long as the dry mouth persists. Topical gels also decrease cold sensitivity in root-exposed surfaces of adult teeth.

When you expose your mouth continuously to any of the above forms of topical fluoride treatments, the fluoride is stored in any of three natural storage areas- enamel, gum tissue, or plaque. Enamel holds the fluoride for the longest time, and gum tissue for the shortest. Plaque is the most important fluoride storage area, however, since damage to the tooth can occur under it. The more fluoride you add to the plaque, the less damage the plaque will do to the tooth. Since plaque accumulates on tooth surfaces even with meticulous brushing and flossing, especially in children with orthodontic braces, it is important for any existing plaque to have as much fluoride in it as possible.

Running your own family fluoride campaign will lead to healthier, stronger teeth and lower dental expenses. But even the best fluoride routine alone cannot prevent all dental disease. Daily brushing and flossing, a well-balanced diet, and routine dental exams are all extremely important in combating tooth decay.

By Ronald Rosser, D.D.S.