What makes teeth strong versus weak? Why do some people brush and floss really well and still get cavities? Cavities are multifactorial, which means that they are influenced by many factors. But three things have to be present for a cavity to be formed: 1) tooth structure, 2) bacteria (specific kinds), and 3) a dietary component for those bacteria to consume. But many other things can influence the health of your gum and bones including but not limited to smoking, alcohol consumption, habits, genetics and even the water you drink.
This is where fluoride comes in. Fluoride is a natural mineral found in the earth’s crust and widely distributed in nature. In the early 1900’s, in a community in southern Colorado, a dentist made the initial discovery that led into more research which showed that teeth with fluoride exposure had almost 2/3rd less cavities than teeth without. Since then many cities have included water fluoridation into their water treatment to help prevent cavities on a public health level. But do not worry, the fluoride levels are very tightly regulated and in the city water are kept to a very safe level: just potent enough to help with cavities but no more potent than it needs to be. The key level is 0.7-1.2 milligrams of fluoride per liter (mg/L). That is very diluted!
Newer research still has shown how important fluoride varnish (the sticky stuff the dentist puts on your teeth) is for everyone especially children. Local researcher Patty Braun showed that if children under the age of three have four or more fluoride applications (consistent with regular dental visits) than their rate for caries is decreased significantly. This is true for even high risk children!
IS FLUORIDE SAFE?
In the right quantities, fluoride is absolutely safe! The Center for Disease Control has shown that water fluoridation is not only safe, but recommended to help prevent cavities. In appropriate doses, fluoride can really help to keep teeth healthy and strong. But like all other substances, too much of a good thing is also possible. The CDC is not alone. According to the ADA, over 125 international organizations all recognize the merits fluoride can have. Across the world, these organizations see the safety and value of fluoride, including the American Dental Association, the American Medical Association and the World Health Organization. After years of research, the main risk to excessive fluoride intake is that it can cause dental fluorosis (a discoloration of teeth). But this happens in situations like swallowing excessive fluoride (for example, if a child were to swallow an entire tube of toothpaste).
How can I make sure my family is getting the right amount of fluoride?
It is hard to get excessive fluoride in most metro areas. We recommend drinking tap water (or at least using it for foods and cooking). Refrigerated filter water also still has fluoride (those particles are not filtered out). Tap water is particularly important for pregnant women and growing kids. If the fluoridated water is available while the tooth bud is forming (for both primary and adult teeth), the fluoride gets integrated into the tooth structure while it is being made and makes the teeth intrinsically strong. Adults can also gain from tap water by bathing their teeth in fluoride.
Topical applications of fluoride are most commonly using a fluoridated toothpaste. Anything with an ADA approved stamp will have the right amount of fluoride. When you see your dentist, ask them for a fluoride varnish treatment which research shows should be applied at every visit (6 month appointments) for both young and older patients alike. You can also use a fluoridated mouthwash like ACT to get additional fluoride, especially if you have small cavities starting to form. Make sure your kids only use this mouthwash if they are able to expectorate.
Is fluoride bad for my body?
Fluoride can help with your teeth and oral health in the right quantities. Fluoride is not harmful if proper dosing is followed. To avoid excessive fluoride you can follow the following protocols. Keep fluoride items out of kids reach so they cannot overconsume. A smear of fluoridated toothpaste when brushing teeth is perfectly safe even if the child is not able to spit it out yet. Check your drinking water to see levels of fluoridation here. If you drink well water or non-regulated water, get your water checked. Some natural water sources can have high levels of fluoride. Visit your dentist with any questions you may have about fluoride. If fluoride is a concern for you, you can schedule a free consult with Dr Jyothi K to discuss options for your family.
Is natural fluoride enough?
Most adults do not get enough fluoride from natural sources, especially if they live in an urban area. Urban water is very unlikely to have excessive fluoride since it is regulated by the treatment facilities. And most sources of minimal fluoride (teas, some processed foods and beverages, some meats, etc) do not have a long enough contact time with your teeth to really impart dental effects (especially if it is not during tooth bud formation). That is why dental fluoride is so important. To use fluoridated toothpaste during brushing ensures 4 minutes of contact time a day, long enough to help remineralize your teeth and prevent cavities. Dental fluoride varnish is one step further. It provides about 6 months worth of fluoride in one go and is a great benefit for those who have small budding cavities that need to be prevented.
How does fluoride make my teeth stronger?
Acids from bacteria on teeth cause a process called demineralization. This means that the teeth start to form a cavity because minerals are dissolved out of the tooth structure. Remineralization can reverse the cavity process in certain conditions for certain teeth. Yes, some small cavities can heal on their own, depending on how small they are. Topical fluoride which you get from toothpaste and fluoride varnish at the dental office will help supply minerals for enamel reconstruction by growing enamel crystals which stimulates the remineralization process. These crystals are larger and therefore less susceptible to caries or acid attacks from future bacteria.
When fluoride is taken systemically and incorporated into the structure of the building tooth (tooth bud), the developing crystals incorporate fluoride into the tooth structure and make fluorapatite instead of hydroxyapatite, the enamel’s normal crystalline structure. Fluorapatite is much stronger and better at protecting against cavities.
What kinds of fluoride are there?
Fluoride is categorized into two main categories: systemic fluoride and topical fluoride. Systemic fluoride is ingested (eaten or drank) and is helpful for when the teeth are forming. This creates internal, structural protection while the tooth structure is made, making the teeth resistant to cavities. If your teeth are fully formed, systemic fluoride (like that of tap water) will end up in your saliva and still offer good benefits for tooth protection.
Topical fluoride, like that of toothpaste, mouthwash or varnish, bathes your teeth to protect them from the outside. The reason varnishes are important preventative tools is that they are designed to stick on your teeth until the teeth have internalized the right amount of fluoride to be protected.
What are my options if I am trying to live fluoride-free?
It is hard to avoid fluoride completely in the outside world. There are trace amounts in a lot of the foods we normally eat. If you and your family have decided to live a fluoride-free lifestyle, then we welcome you to our practice. Our practice is meant to be a dental home for all families from all walks of life. Living a fluoride free lifestyle does put you at increased risk for cavities but with our care, we would love to mitigate that risk and help give you tips and care which will help you protect your teeth and oral health. We are very conscious about which of our dental products (including our filling materials) which contain fluoride and so we can offer alternatives and be meticulous in offering care which fits with your beliefs.