Fluoride is a mineral widely distributed in nature throughout the world. Fluoride occurs naturally in many foods and water so that all humans ingest some fluoride on a daily basis. The amount of fluoride in water varies from area to area.
Fluoride helps prevent tooth decay by making the tooth more resistant to acid attacks from plaque bacteria and sugars in the mouth. It also reverses early decay and can repair teeth in the very early, microscopic stages of the disease
In children under 6 years of age, fluoride becomes incorporated into the development of permanent teeth, making it difficult for acids to demineralize the teeth. Fluoride also helps speed remineralization as well as disrupts acid production in already erupted teeth of both children and adults.
Fluoride therapy is the delivery of fluoride to the teeth, topically or systemically, to protect them from dental caries (cavities). Fluoride therapy repairs rather than prevents damage to the teeth. It reduces the decay of tooth enamel by the formation of fluorapatite and its incorporation into the dental enamel causing the mineral fluorapatite to be incorporated into damaged tooth enamel. Fluorapatite is not a natural component of human teeth. The main mineral found in natural tooth enamel is hydroxyapatite rather than the fluorapatite created in the presence of fluoride.
Every day, minerals are added to and lost from a tooth’s enamel layer through two processes, demineralization and remineralization. The fluoride ions reduce the rate of tooth enamel demineralization and increase the rate of remineralization of teeth at the early stages of cavities. Fluoride exerts these effects by the demineralization and remineralization cycle. Minerals are lost (demineralization) from a tooth’s enamel layer when acids formed from plaque bacteria and sugars in the mouth attack the enamel. The remineralization cycle as it applies to preventive methods is occurring when fluoride is present in the oral cavity. Minerals such as fluoride, calcium, and phosphate are redeposited (remineralization) to the enamel layer from the foods and waters consumed. Too much demineralization without enough remineralization to repair the enamel layer leads to tooth decay. After fluoride is swallowed it has a minimal effect.
The purpose of tooth-brushing is twofold: to mechanically remove plaque, and also to apply fluoride to the tooth surface, promoting re-mineralisation with fluorapatite.
The dentists in the Dental Clinics in India and the Dental Clinics in Delhi are proficient in applying fluorides to your teeth. Some people are more likely to have tooth decay, and the dental team may also advise using a higher-strength fluoride toothpaste for extra protection.
Indications for fluoride therapy
The individual’s risk factors and the reason for treatment will determine which method of fluoride delivery is used. Consult with a dentist before starting any treatment. Reasons for fluoride therapy include:
- White spots
- Moderate to high risk patients for developing decay
- Active decay
- Orthodontic treatment
- Additional protection if necessary for children in areas without fluoridated drinking water
- To reduce tooth sensitivity
- Protect root surface
- Decreased salivary flow
- Institutionalized patients
Benefits of fluoride?
Fluoride therapy has been proven to have a beneficial effect on the prevention of dental caries.
Fluoride can greatly help dental health by strengthening the tooth enamel, making it more resistant to tooth decay. It also reduces the amount of acid that the bacteria on your teeth produce.
Children who have fluoride when their teeth are developing tend to have shallower grooves in their teeth, so plaque can be more easily removed. Plaque is a thin, sticky film of bacteria that constantly forms on your teeth.
The use of fluoride toothpaste (with concentrations of 1000 ppm and above) and fluoride supplements, in the form of drops and tablets, to reduce the risk of dental caries in school-aged children and adolescents.
Water fluoridation has been proven to reduce decay by 40 to 60 percent.
Where can I find fluoride?
Fluoride is found naturally in many foods and in water supplies, and is also added to some drinking water. Having 0.7 to 1.2 parts of fluoride for every million parts of water (0.7ppm to 1.2ppm) has been shown to have the best effect.
All water contains some fluoride. Your local water supplier can tell you how much fluoride is in your drinking water.
If you drink bottled water you could be missing out on the decay-preventing effects of optimally fluoridated water available from their community water source. Most bottled waters do not contain optimal levels of fluoride, which is 0.7 to 1.2 parts per million (this is the amount that is in public water supplies, in the communities that have fluoridated water).
Is there enough fluoride in my water supply?
Water fluoridation of municipal drinking water is considered as a safe, effective and economical means of preventing dental caries in all age groups.
Possibly. Only a few places have enough natural fluoride to benefit dental health. In other places it is added to water.
Fluoride is also in some foods and drinks, for example fish and tea. Some countries add fluoride to their table salt and milk instead of to the water supplies. One cup of tea can contain between 0.3 milligrams and 0.5 milligrams of fluoride, and if you drink it with milk your teeth will also benefit from the calcium. It is best to drink tea without sugar to reduce the risk of tooth decay even more.
Fluoride levels in the water supplies should be monitored and adjusted to ensure consistency in concentrations and avoid fluctuations.
What about fluoride toothpaste?
Most toothpastes now contain fluoride, and most people get their fluoride this way. Fluoride toothpaste is very effective in preventing tooth decay. The amount of fluoride in toothpaste is usually enough to reduce decay.
In areas where the water supply has fluoride added, fluoride toothpaste gives extra protection.
Parents should supervise their children’s brushing, and use only a pea-sized smear of fluoride toothpaste until they are about 7 years old.
Is fluoride safe?
Fluoride toothpaste and correctly fluoridated water, salt and milk are of great benefit to dental health, help to reduce decay, and cause no harmful side effects to general health.
All fluoridation methods provide low concentrations of fluoride ions in saliva, thus exerting a topical effect on the plaque fluid. Fluoride does not prevent cavities but rather controls the rate at which they develop, and so repeated exposure throughout the day is essential for its effective function. The more constant the supply the more beneficial fluoride will be in cavity prevention.
Should people have extra fluoride?
Children who are living in poorer areas where the water supplies are not fluoridated. They can have 5 times more decay than children living in more affluent or fluoridated areas.
Risks Associated With Fluoride Use?
Fluoride is safe and effective when used as directed but can be hazardous at high doses (the “toxic” dosage level varies based on an individual’s weight). For this reason, it’s important for parents to carefully supervise their children’s use of fluoride-containing products and to keep fluoride products out of reach of children, especially children under the age of 6.
1. Fluoride toxicity
Consumption of large amounts of fluoride can lead to fluoride poisoning and death. The lethal dose for most adult humans is estimated at 5 to 10 g (which is equivalent to 32 to 64 mg/kg elemental fluoride/kg body weight). Ingestion of fluoride can produce gastrointestinal discomfort (nausea, vomiting, diarrhoea, abdominal pain) at doses at least 15 to 20 times lower (0.2–0.3 mg/kg) than lethal doses. Systemically can cause hyperreflexia, convulsions, paraesthesia, cardiac failure & respiratory paralysis.
In such cases Emergency treatment is required:
a. Induce vomiting
b. Administration of fluoride binding liquid if patients do not vomit
– Lime Water- gastric lavage
c. Support respiratory and circulation
d. Call emergency services and transport to hospital
Chronic intake and topical exposure may cause dental fluorosis, and excess systematic exposure can lead to systemic effects such as skeletal fluorosis.
2. Dental fluorosis
The use of fluoride toothpaste (with concentrations of 1000 ppm and above) and fluoride supplements in children below the age of six years, and especially within the first three years of life, when the teeth are developing is associated with a greater risk of dental fluorosis. It can also happen when children swallow toothpaste.
This excess fluoride can cause defects in the tooth’s enamel that range from barely noticeable white specks or streaks to cosmetically objectionable brown discoloration. These defects are known as fluorosis and occur when the teeth are forming — usually in children younger than 6 years. Fluorosis, when it occurs, is usually associated with naturally occurring fluoride, such as that found in well water. If you use well water and are uncertain about the mineral (especially fluoride) content, a water sample should be tested. Although tooth staining from fluorosis cannot be removed with normal hygiene.
Dentists in Delhi may be able to lighten or remove these stains with professional-strength abrasives or bleaches.
A few useful reminders about fluoride include:
- Store fluoride supplements away from young children.
- Avoid flavored toothpastes because these tend to encourage toothpaste to be swallowed.
- Use only a pea-sized amount of fluoridated toothpaste on a child’s toothbrush.
- Be cautious about using fluoridated toothpaste in children younger than age 6. Children younger than 6 years of age are more likely to swallow toothpaste instead of spitting it out.
Forms of Fluoride Available?
In topical fluoride therapies, fluoride is applied directly to the surface of the teeth, most commonly by means of a fluoride toothpaste. Other topical fluoride therapies include fluoridated mouth rinses, lozenges, gels, foams, and varnishes.
Mouth rinses containing fluoride in lower strengths are available over-the-counter; stronger concentrations require a doctor’s prescription.
Varnishes are painted on the teeth; foams are put into a mouth guard, which is applied to the teeth for one to four minutes; gels can be painted on or applied via a mouth guard.
Typically, it is applied with a cotton swab or brush, or it is used as a rinse or placed in a tray that is held in the mouth for several minutes. After the treatment, you may be asked not to rinse, eat or drink for at least 30 minutes to allow the teeth to absorb the fluoride and help repair microscopic carious areas. Depending on your oral health status, fluoride treatments may be recommended every three, six or 12 months.
In systemic fluoride therapies, fluoride is swallowed as an additive to drinking water, salt, or milk, or as an ingredient in tablets, lozenges, or drops. Where public water supplies are fluoridated, other systemic fluoride therapies are not recommended.
The maximum reduction in dental caries is achieved when fluoride is available both topically and systemically.
When Is Fluoride Intake Most Critical?
It is certainly important for infants and children between the ages of 6 months and 16 years to be exposed to fluoride. This is the timeframe during which the primary and permanent teeth come in. However, adults benefit from fluoride, too. Topical fluoride — from toothpastes, mouth rinses, and fluoride treatments are as important in fighting tooth decay as in strengthening developing teeth.
In addition, people with certain conditions may be at increased risk of tooth decay and would therefore benefit from additional fluoride treatment. They include people with:
- Dry mouth conditions : Also called xerostomia, dry mouth caused by diseases such as Sjögren’s syndrome, certain medications (such as allergy medications ,antihistamines, antianxiety drugs, and high blood pressure drugs), and head and neck radiation treatment makes someone more prone to tooth decay. The lack of saliva makes it harder for food particles to be washed away and acids to be neutralized.
- Gum disease : Gum disease, also called periodontitis, can expose more of your tooth and tooth roots to bacteria increasing the chance of tooth decay. Gingivitis is an early stage of periodontitis.
- History of frequent cavities : If you have one cavity every year or every other year, you might benefit from additional fluoride.
- Presence of crowns and/or bridges or braces : These treatments can put teeth at risk for decay at the point where the crown meets the underlying tooth structure or around the brackets of orthodontic appliances as they trap a lot of bacteria that can lead to cavities.
Ask your dentist if you could benefit from additional fluoride.
Posted By – Dr. Shriya