I have a patient at least once a week tell me they don’t use fluoridated toothpaste, and I promptly ask them to divulge why. Let’s talk about why dentists recommend the use of fluoride and why I believe you should use it, too.
What Is Fluoride?
The CDC states the following about fluoride – ‘Fluoride is a mineral that occurs naturally and is released from rocks into the soil, water, and air. Almost all water contains some fluoride, but usually not enough to prevent tooth decay¹.’
The CDC is right – fluoride is just about everywhere in low concentrations, including seawater and freshwater and even in the layers of our atmosphere. There’s fluoride in almost all of the foods we consume, including most notably in tea and in fish. Black tea, for instance, has about 3ppm fluoride found in it². The ‘Halo’ effect of fluoride is a phenomenon that refers to the spread of fluoride in communities that have fluoridated water and also plays a large role in the fluoride we receive – this same water is bottled or used to water crops which increases our consumption of fluoride.
So How Does Fluoride Work?
‘Fluoride reduces the incidence of dental caries (cavities) and slows or reverses the progress of existing lesions.’ But how does it do it?
Fluoride is an antibacterial. It increases the acidity of the bacterial cytoplasm and disrupts their metabolism³. Along with its antimicrobial action, fluoride helps remineralize our teeth. As acids produced by bacteria interact with our teeth, minerals are leached from the surface. Fluoride present during this time ‘grabs’ on to those minerals, and places them back onto our teeth⁴. There aren’t a lot of materials out available today (though more are being studied) that produce the same remineralization action that fluoride presents, and it’s why we, as dentists, recommend fluoride so readily.
The point above about fluoride’s ability to remineralize is why it is so important to use and why other toothpastes just aren’t doing the same for you. If any patient I see has ‘starter cavities’ (also known as incipient lesions), extra strength fluoride toothpaste is my go-to treatment protocol.
Is Fluoride Safe?
Yes! At the right concentrations. That isn’t to say fluoride is harmless, though, and this is where a lot of ‘fluoride non-believers’ get apprehensive. Let’s take a look at some studies.
Studies have shown adverse effects of systemic over-consumption of fluoride resulting in negative performance on cognitive tests⁵. This literature review was conducted on fluoride exposure and intellectual disability for children in early development that was conducted in 2012. How does that affect those who use fluoridated toothpaste? It doesn’t – you shouldn’t be ingesting the toothpaste and if you’re reading this you most likely aren’t in early development. It IS important for children though, who may accidentally ingest their toothpaste. That’s why it’s important to use small amounts of children’s toothpaste – let’s take a look at the current recommendations:
‘Using no more than a smear or rice-size amount of fluoridated toothpaste for children less than three years of age may decrease risk of fluorosis. Using no more than a pea-size amount of fluoridated toothpaste is appropriate for children aged three to six (see Figure)⁵.’
On the other side of the argument, there are various articles stating that the efficacy and safety of fluoride is largely established (using reasonable proportions) – one literature review states – ‘Supported by more than half a century of research, the benefits of fluoride toothpastes are firmly established⁶.’ Another study goes on to claim ‘Epidemiological studies of fluoridation programmes have confirmed their safety and their effectiveness in controlling dental caries.⁷’
I truly believe it’s O.K. to want to lessen fluoride intake in children for precautionary measures – simply reduce the amount you place on your toothbrush (use the guidelines and picture above!). Quitting completely, though, currently is not supported by the literature. With that in mind, let’s talk about one common complication of fluoride that relies entirely on over-fluoridation of children’s teeth and what we can do to prevent it.
I Hear It Can Stain My Child’s Teeth?
If you’re reading intently, you may notice a line above that mentions fluorosis. Fluorosis isn’t dangerous, but it is unsightly. Fluorosis is a condition that was once known to be called ‘mottled enamel,’ and appears as darkened or chalky spots most notably around the anterior teeth. The spots represent areas of heightened enamel proteins that are deposited due to the over-intake of fluoride. These areas are actually cavity-resistant, but the trade-off isn’t worth the appearance⁸. To reduce the chance of this occurring in children, it’s important to keep the fluoride intake low (by using the guidelines above, once again).
So What’s The Bottom Line?
I start out with fluoride discussions by saying I’m a personal liberty believer – I don’t think anyone needs to be told what to do and can make decisions based off their research themself. That being said, I only recommend treatment to my patients based on if I’d perform it on myself or my family members. That’s why I recommend fluoridated toothpaste to every one of my patients, and even some stronger toothpastes for others. With the information and research available currently on fluoride, I encourage you to read peer-reviewed articles or some of the ones I’ve posted on this blog. Message me on social media if you’d like to #TalkFluoride.
¹CDC. (2019, March 8). About fluoride. Centers for Disease Control and Prevention. Retrieved November 19, 2021, from https://www.cdc.gov/fluoridation/faqs/about-fluoride.html.
²Kanduti, D., Sterbenk, P., & Artnik, B. (2016). FLUORIDE: A REVIEW OF USE AND EFFECTS ON HEALTH. Materia socio-medica, 28(2), 133–137. https://doi.org/10.5455/msm.2016.28.133-137
³Aoun, A., Darwiche, F., Al Hayek, S., & Doumit, J. (2018). The Fluoride Debate: The Pros and Cons of Fluoridation. Preventive nutrition and food science, 23(3), 171–180. https://doi.org/10.3746/pnf.2018.23.3.171
⁴Buzalaf MAR, Pessan JP, Honório HM, Ten Cate JM. Mechanisms of action of fluoride for caries control. Monogr Oral Sci. 2011;22:97-114. doi: 10.1159/000325151. Epub 2011 Jun 23. PMID: 21701194.
⁵AAPD. (2018). Fluoride Therapy. AAPD. Retrieved November 22, 2021, from https://www.aapd.org/media/Policies_Guidelines/BP_FluorideTherapy.pdf.
⁶Marinho, V. C., Higgins, J. P., Sheiham, A., & Logan, S. (2003). Fluoride toothpastes for preventing dental caries in children and adolescents. The Cochrane database of systematic reviews, 2003(1), CD002278. https://doi.org/10.1002/14651858.CD002278
⁷O’Mullane, D. M., Baez, R. J., Jones, S., Lennon, M. A., Petersen, P. E., Rugg-Gunn, A. J., Whelton, H., & Whitford, G. M. (2016). Fluoride and Oral Health. Community dental health, 33(2), 69–99.
⁸Chi, A., Neville, B., Damm, D., Allen, C. (052015). Oral and Maxillofacial Pathology, 4th Edition. [VitalSource Bookshelf 10.0.1]. Retrieved from vbk://9781455770526