Prevention

Fluoride

Facts About Fluoride

Cavities used to be a fact of life. But over the past few decades, tooth decay has been reduced dramatically. The key reason: fluoride. Research has shown that fluoride reduces cavities in both children and adults. It also helps repair the early stages of tooth decay even before the decay becomes visible. Unfortunately, many people continue to be misinformed about fluoride and fluoridation. Fluoride is like any other nutrient; it is safe and effective when used appropriately. This article will help you learn more about the important oral health benefits of fluoride.

Fluoride: Nature’s Cavity Fighter

Fluoride is a mineral that occurs naturally in all water sources, even the oceans. The fluoride ion comes from the element fluorine. Fluorine, the 17th most abundant element in the earth’s crust, is never encountered in its free state in nature. It exists only in combination with other elements as a fluoride compound.

Fluoride is effective in preventing and reversing the early signs of dental caries (tooth decay). Researchers have shown that there are several ways through which fluoride achieves its decay-preventive effects. It makes the tooth structure stronger, so teeth are more resistant to acid attacks. Acid is formed when the bacteria in plaque break down sugars and carbohydrates from the diet. Repeated acid attacks break down the tooth, which causes cavities. Fluoride also acts to repair, or remineralize, areas in which acid attacks have already begun. The remineralization effect of fluoride is important because it reverses the early decay process as well as creating a tooth surface that is more resistant to decay. Fluoride is obtained in two forms: topical and systemic.

  • Topical fluorides strengthen teeth already present in the mouth making them more decay-resistant. Topical fluorides include toothpastes, mouthrinses and professionally applied fluoride therapies.
  • Systemic fluorides are those that are ingested into the body and become incorporated into forming tooth structures. Systemic fluorides can also give topical protection because fluoride is present in saliva, which continually bathes the teeth. Systemic fluorides include water fluoridation or dietary fluoride supplements in the form of tablets, drops or lozenges.

Sources of Fluoride

Community water fluoridation is an extremely effective and inexpensive means of obtaining the fluoride necessary to prevent tooth decay. Studies prove that water fluoridation continues to be effective in reducing tooth decay by 20 to 40 percent.

Leading health organizations, including the American Dental Association, the U.S. Centers for Disease Control and Prevention and the American Academy of Pediatric Dentistry support community water fluoridation based on the overwhelming weight of scientific evidence, which continues to establish that it is safe and effective. Water fluoridation reduces tooth decay in both children and adults.

How much fluoride is in your water?

If your water comes from a public or community water supply, contact the local water supplier to determine the fluoride level. You can also check your local, county or state health department. There are two Internet sites that also supply information. One is the U.S. Environmental Protection Agency’s web (EPA) site for water quality reports (called Consumer Confidence Reports). Another is the U.S. Centers for Disease Control and Prevention’s (CDC) fluoridation Web site, “My Water’s Fluoride“. For those states that have provided information to the CDC, the agency’s Web site lists fluoridation status by water system.

If your water source is a private well, it will need to be tested and the results obtained from a certified laboratory. Contact your local or state health department for information about where you can have a water sample tested.

Water Quality Reports

In 1999, the U.S. Environmental Protection Agency (EPA) began requiring water suppliers to put annual drinking water quality reports into the hands of their customers. Water Quality Reports, (or Consumer Confidence Reports—CCRs) typically may be mailed to your home, placed in the local newspaper or made available through the Internet around July 1 each year. To obtain a copy of the report, contact your local water supplier. The name of the water system (often not the name of the city) can be found on your water bill. If the name of the system is unknown, contact the local health department. Although the EPA does not have the authority to regulate private drinking water wells, the agency recommends that private well water be tested every year. And although the EPA does not specifically recommend testing private wells for fluoride levels, health professionals will need this information before consideration of prescription of dietary fluoride supplements or to counsel patients about alternative water sources to reduce the risk of fluorosis if the fluoride levels are above 2ppm. As a result of the widespread availability of these various sources of fluoride, the decay rates in both the U.S. and other countries have greatly diminished.

The proper mix is key!

It is important to note that the effective prevention of dental decay requires that the proper mix of both forms of fluoride (topical and systemic) be made available to individuals. Your dentist can help you assess whether you are receiving adequate levels of fluoride for all family members from the two forms (topical and systemic).

Topical Fluorides

Self-Applied
One method of self-applied topical fluoride that is responsible for a significant drop in the level of cavities since 1960 is use of a fluoride-containing toothpaste. The American Dental Association recommends that children (over two years of age) and adults use a fluoride toothpaste displaying the ADA Seal of Acceptance or consult with a child’s dentist if considering the use of toothpaste before age 2. Other sources of self-applied fluoride are mouthrinses designed to be rinsed and spit out, either prescribed by your dentist or an over-the-counter variety. The ADA recommends the use of fluoride mouthrinses, but not for children under six years of age because they may swallow the rinse.

Professionally-Applied
Professionally-applied fluorides are in the form of a gel, foam or rinse, and are applied by a dentist or dental hygienist during dental visits. These fluorides are more concentrated than the self-applied fluorides, and therefore are not needed as frequently. The ADA recommends that dental professionals use any of the professional strength, tray-applied gels or foam products carrying the ADA Seal of Acceptance.

Systemic Fluorides

Systemic fluorides such as community water fluoridation and dietary fluoride supplements are effective in reducing tooth decay. These fluorides provide topical as well as systemic protection because fluoride is present in the saliva.

Community Water Fluoridation
Fluoride is present naturally in all water sources. Community water fluoridation, which has been around for over 50 years, is simply the process of adjusting the fluoride content of fluoride-deficient water to the recommended level for optimal dental health. That recommended level is 0.7 parts fluoride per million parts water. Water fluoridation has been proven to reduce decay in both children and adults. While water fluoridation is an extremely effective and inexpensive means of obtaining the fluoride necessary for optimal tooth decay prevention, not everyone lives in a community with a centralized, public or private water source that can be fluoridated. For those individuals, fluoride is available in other forms.

Dietary Fluoride Supplements
Dietary fluoride supplements (tablets, drops or lozenges) are available only by prescription and are intended for use by children ages six months to 16 years living in non-fluoridated areas and at high risk of developing tooth decay. Your dentist or physician can prescribe the correct dosage. It is based on the natural fluoride concentration of the child’s drinking water and the age of the child (see chart). For optimum benefits, use of dietary fluoride supplements should begin when a child is six months old and be continued daily until the child is 16 years old. The need for taking dietary fluoride supplements over an extended period of time makes dietary fluoride supplements less cost-effective than water fluoridation; therefore, dietary fluoride supplements are considerably less practical as a wide-spread alternative to water fluoridation as a public health measure. Fluoride supplements are recommended only for children living in non-fluoridated areas and at high risk of developing tooth decay. It is important to note that fluoridated water may be consumed from sources other than the home water supply, such as the workplace, school and/or day care, bottled water, filtered water and from processed beverages and foods prepared with fluoridated water. For this reason, dietary fluoride supplements should be prescribed by carefully following the recommended dosage schedule (see chart). Dietary fluoride supplements are not recommended for children residing in a fluoridated community. No matter how you get the fluoride you need—whether it be through your drinking water, supplements, toothpaste, mouthrinse or professionally applied fluoride—you can be confident that fluoride is silently at work fighting decay. Safe, convenient, effective…however you describe it, fluoride fits naturally into any dental care program. For more information about the oral health benefits of fluoride, just ask your dentist.

Fluoride Supplement Dosage Schedule—2010
Approved by the American Dental Association Council on Scientific Affairs

AGE FLUORIDE ION LEVEL IN DRINKING WATER (PPM)*
<0.3 0.3-0.6 >0.6
Birth–6 months None None None
6 months–3 years 0.25 mg/day** None None
3–6 years 0.50 mg/day 0.25 mg/day None
6–16 years 1.0 mg/day 0.50 mg/day None
*1.0 part per million (ppm) = 1 milligram per liter (mg/l)
** 2.2 mg sodium fluoride contains 1 mg fluoride ion.

Important Considerations When Using Dosage Schedule:

If fluoride level is unknown, drinking water should be tested for fluoride content before supplements are prescribed. For testing of fluoride content, contact the local or state health department. All sources of fluoride should be evaluated with a thorough fluoride history. Patient exposure to multiple water sources can make proper prescribing complex. Ingestion of higher than recommended levels of fluoride by children has been associated with an increase in mild dental fluorosis in developing, unerupted teeth. Fluoride supplements require long-term compliance on a daily basis.

Fluoride FAQ’s

What is fluoride?

Fluoride is a compound that contains fluorine, a natural element. Using small amounts of fluoride on a routine basis can help prevent tooth decay. In areas where fluoride does not occur naturally, it may be added to community water supplies. Research shows that community water fluoridation has lowered decay rates by over 50 percent, which means that fewer children grow up with cavities. Fluoride can be found as an active ingredient in many dental products such as toothpaste, mouth rinses, gels and varnish.

How does fluoride prevent cavities?

Fluoride inhibits loss of minerals from tooth enamel and encourages remineralization (strengthening areas that are weakened and beginning to develop cavities). Fluoride also affects bacteria that cause cavities, discouraging acid attacks that break down the tooth. Risk for decay is reduced even more when fluoride is combined with a healthy diet and good oral hygiene.

Will my child need fluoride supplements?

The pediatric dentist considers many factors before recommending a fluoride supplement. Your child’s age, risk of developing dental decay and dietary sources of fluoride are important considerations. Infant formulas contain different amounts of fluoride. Bottled, filtered and well waters also vary in the amount of fluoride they contain. Your pediatric dentist can help determine if your child is receiving — and not exceeding — the recommended amount.

How safe is fluoride?

Using fluoride for the prevention and control of decay is proven to be both safe and effective. Nevertheless, products containing fluoride should be stored out of the reach of young children. Too much fluoride could cause fluorosis of developing permanent teeth. Fluorosis usually is mild, with tiny white specks or streaks that often are unnoticeable. In severe cases of fluorosis, the enamel may be pitted with brown discoloration. Development of fluorosis depends on the amount, duration and timing of excessive fluoride intake. The appearance of teeth affected by fluorosis can be greatly improved by a variety of treatments in esthetic dentistry.

What type of toothpaste should my child use?

Your child should use toothpaste with fluoride and the American Dental Association Seal of Acceptance. Brushing twice a day (after breakfast and before bedtime) provides greater benefits than brushing once daily. Parents should dispense toothpaste to prevent their young children from swallowing too much.

How much toothpaste should my child use?

For children under 2-years-old, use a smear of fluoridated toothpaste. For those aged 2 to 5 years, a pea-sized amount is recommended.

What is topical fluoride?

Topical fluoride is a preventive agent applied to tooth enamel. It comes in a number of different forms. A dental professional places gels or foams in trays that are held against the teeth for up to four minutes. Fluoride varnish is brushed or “painted” on the enamel. Varnish is especially useful for young patients and those with special needs who may not tolerate fluoride trays. Children who benefit the most from fluoride are those at highest risk for decay. Risk factors include a history of previous cavities, a diet high in sugar or carbohydrates, orthodontic appliances, and certain medical conditions such as dry mouth.

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X-Ray use and Safety

Q: How often should a child have dental X-ray films?

Since every child is unique, the need for dental X-ray films varies from child to child. Films are taken only after reviewing your child’s medical and dental histories and performing a clinical examination, and only when they are likely to yield information that a visual examination cannot. In general, children need X-rays more often than adults. Their mouths grow and change rapidly. They are more susceptible than adults to tooth decay. For children with a high risk of tooth decay, the American Academy of Pediatric Dentistry recommends X-ray examinations every six months to detect cavities developing between the teeth. Children with a low risk of tooth decay require X-rays less frequently.

Q: Why should X-ray films be taken if my child has never had a cavity?

X-ray films detect much more than cavities. For example, X-rays may be needed to survey erupting teeth, diagnose bone diseases, evaluate the results of an injury, or plan orthodontic treatment. X-rays allow dentists to diagnose and treat conditions that cannot be detected during a clinical examination. If dental problems are found and treated early, dental care is more comfortable and affordable.

Q: Will X-ray films be taken routinely?

No. X-ray films are recommended only when necessary to evaluate and monitor your child’s oral health. The frequency of X-ray films is determined by your child’s individual needs. If your child’s previous dentist obtained X-ray films, request copies be sent to your new pediatric dentist to help reduce radiation exposure.

Q: How safe are dental X-rays?

Pediatric dentists are particularly careful to minimize the exposure of child patients to radiation. With contemporary safeguards, the amount of radiation received in a dental X-ray examination is extremely small. In fact, dental X-rays represent a far smaller risk than undetected and untreated dental problems.

Q: What safeguards are used to protect my child from X-ray exposure?

Lead body aprons and shields help protect your child. Today’s equipment filters out unnecessary X-rays and restricts the X-ray beam to the area of interest. High-speed film, digital X-rays, and proper shielding assure that your child receives a minimal amount of radiation exposure.

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Sealants

Q: What are sealants?

Sealants protect the grooved and pitted surfaces of the teeth, especially the chewing surfaces of back teeth where most cavities in children are found. Made of clear or shaded plastic, sealants are applied to the teeth to help keep them cavity-free.

Q: How do sealants work?

Even if your child brushes and flosses carefully, it is difficult—sometimes impossible—to clean the tiny grooves and pits on certain teeth. Food and bacteria build up in these crevices, placing your child in danger of tooth decay. Sealants “seal out” food and plaque, thus reducing the risk of decay.

Q: How long do sealants last?

Research shows that sealants can last for many years if properly cared for. Therefore, your child will be protected throughout the most cavity-prone years. If your child has good oral hygiene and avoids biting hard objects, sealants will last longer. Your pediatric dentist will check the sealants during routine dental visits and recommend re-application or repair when necessary.

Q: What is the treatment like?

The application of a sealant is quick and comfortable. It takes only one visit. The tooth is first cleaned. It is then conditioned and dried. The sealant is then flowed onto the grooves of the tooth and allowed to harden or hardened with a special light. Your child will be able to eat right after the appointment.

Q: How much does it cost?

The treatment is very affordable, especially in view of the valuable decay protection it offers your child. Most dental insurance companies cover sealants. Some companies, however, have age and specific tooth limitations. Check with your benefits provider about your child’s coverage and talk to your pediatric dentist about the exact cost of sealants for your child.

Q: Which teeth should be sealed?

The natural flow of saliva usually keeps the smooth surfaces of teeth clean but does not wash out the grooves and fissures. So the teeth most at risk of decay—and therefore, most in need of sealants— are the six-year and twelve-year molars. Many times the permanent premolars and primary molars will also benefit from sealant coverage. Any tooth, however, with grooves or pits may benefit from the protection of sealants. Talk to your pediatric dentist, as each child’s situation is unique.

Q: If my child has sealants, are brushing and flossing still important?

Absolutely! Sealants are only one step in the plan to keep your child cavity-free for a lifetime. Brushing, flossing, balanced nutrition, limited snacking, and regular dental visits are still essential to a bright, healthy smile.

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