Fluoride And Fluoridation

Definition

Fluorine is an essential trace element and as fluoride it is a natural constituent of all water and some foods. However, the amounts found from "natural" sources are often not sufficient to help develop decay-resistant teeth and strong bones.

Fluoridation is an adjustment of fluoride levels in the water supply to a level of 0.7 to 1.2 parts of fluoride per million parts (ppm) of water.

Description

Fluoride ingested in water that has been fluoridated is completely safe. Fluoridation reduces tooth decay by 50 to 70 percent, depending on how soon after birth one uses fluoridated water on a daily basis.

Fluoride's effectiveness is ongoing as long as an individual continues to receive fluoridated water. There are substitutes for fluoridation in the form of fluoride drops, and fluoride tablets. Toothpastes and mouthwashes containing fluoride and dental treatments with topical fluoride solutions help to potentiate the benefits of fluoridation. But none of the substitutes are as effective as fluoridation, and all are more expensive.

In addition to greatly reducing tooth decay, fluoridated water helps decrease the prevalence and severity of osteoporosis, a common disease of aging.

By the mid-1950s, the results of decade-long controlled studies of water-supply fluoridation had established beyond a doubt both the effectiveness and the safety of fluoridation in reducing tooth decay. The practice was - and continues to be - endorsed by the American Medical Association, American Dental Association, the U.S. Public Health Service, and the National Research Council.

Only fluoride taken internally, whether in drinking water or dietary supplements, can strengthen babies' and children's developing teeth to resist decay. Once the teeth have erupted, they are beyond the help of ingested fluoride.

For both children and adults, fluoride applied to the surface of the teeth can nonetheless add protection, at least to the outer layer of enamel, and it has unquestionably played a role in reducing decay. T

The most familiar form, of course, is fluoride-containing toothpaste, introduced in the early 1960s. Fluoride rinses are also available, as are applications by dental professionals. All these products are regulated by the FDA. They are considered effective adjuncts to ingested fluoride - and they are the only useful sources of tooth-strengthening fluoride for teenagers and adults.

Fluoride Supplements

To be sure that teeth incorporate decay-fighting fluoride during structural development, infants and children need fluoride on a regular basis. Whether or not supplements are needed, and how much, depends on both the local water supply and sources in a child's diet.

Fluoride supplements, which are regulated by the FDA as drugs, may take the form of drops, or for older children, chewable tablets. They are available both alone or in combination with vitamins.

The daily requirement of thumb suggested by the American Dental Association is 0.25 milligrams per day up to age 2, 0.5 mg for ages 2 and 3, and 1 mg after age 3 and until the teen years.

Children who consume tap water with a fluoride concentration of less than 0.3 parts per million (ppm) need full supplementation. At water supply levels between 0.3 and 0.7 ppm, only half the need is met; if the water supply provides 0.5 ppm, for example, an average 5-year old should receive 0.5 milligrams of supplemental fluoride per day.

Breastfed infants are exceptions to the rule, since breast milk contains almost no fluoride (nor do ready-to-drink formulas).

Dental Fluorosis

Too much fluoride can cause a condition called dental fluorosis. In its mildest form, this condition causes small, white, virtually invisible opaque areas on the teeth. In its most severe form, it causes a brownish mottling. However, dental fluorosis does not result from artificial fluoridation, because the levels are kept low enough to avoid this defect.

Where To Get Fluoride

Many adults who brush thoroughly with a fluoride toothpaste twice a day get enough fluoride to protect against cavities, especially if they drink fluoridated water. However, people who have receding gums, who suffer from dry mouth, or who have had tooth decay in recent years may need extra protection.

There are several options. An over-the-counter fluoride rinse, such as ACT or Fluoriguard, is most convenient and will suffice for most people. For those who? have sensitive exposed roots or who are at higher risk of decay, a prescription gel (Gel-Kam, Previ Dent) decreases discomfort and may provide higher levels of fluoride as well.

If those home applications are not sufficient, a dentist can apply a concentrated gel twice a year. A newer treatment is a fluoride varnish called Durafluor. The varnish packs even higher levels of fluoride into the teeth than the gel does. After four hours, you simply brush the varnish off.

Questions to Ask Your Doctor

What is the fluoride concentration of our community's water supply?

Is this supply adequate to prevent tooth decay?

What are the benefits of increased use of fluoride?

Is additional fluoride needed? How is it obtained?

Should fluoride supplements be taken?

Would fluoride rinses be helpful?

Do you recommend topical applications of fluoride?