Fluoride

Think of fluoride as part of the “antidote” to the sugar in a poor diet. Fluoride comes in many different forms and reduces tooth decay. It is important that it be used properly by those who need it. Combined with good oral hygiene, proper diet and new anti-cavity treatments, correct fluoride use can help reduce decay. Proper fluoride use is also known to reduce tooth sensitivity.

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If a patient is decay free and is at very low risk, we now suggest no fluoride is necessary. Often we can avoid decay with a low-cavity diet, good nutrition, good home care and non-fluoride tooth powders and rinses. The average Canadian eats 110g of sugar a day (Including natural and added sugars) , 40kg per year. The World Health Organization recommends no more than 50g per day, ideally 25g. People following this guideline usually don’t need fluoride, but many Canadians eat up to 100kg of sugar a year, and this kind of diet needs help from fluoride.

Topical Fluoride

Topical fluoride works only on the outer surface of teeth already visible in the mouth. It should not be taken internally. Topical fluoride can be found in rinses, toothpastes, varnishes, sealants and fluoride gels. School rinses used to be offered in this area, but this wasn’t the most effective way to get fluoride. Correct fluoride exposure with toothpaste is now more important than ever for those at risk, and protection with topical fluoride is needed for children at high risk for decay.

Toothpastes with fluoride have made a huge difference in reducing decay world-wide. For maximum effect, toothpaste should be in contact with teeth for 4 minutes. Care should be used, especially with children, to prevent swallowing of the toothpaste. No more than a pea-sized smear of toothpaste should be used (see photo). For very young children who have difficulty avoiding swallowing, reduced-fluoride toothpastes are available. Most people use too much toothpaste for too little time.

Fluoride Varnishes are applied to cavity-prone areas of teeth. They are very good for kids that can’t tolerate a fluoride gel application. They can be applied to hard-to-reach early decay too. We apply these every check-up for any cavity-prone areas.

High Strength Fluoride Toothpastes: “CTX4 Gel 5000” or “Clinpro 5000” are examples of high strength fluoride toothpastes for adults at extreme decay risk (Often due to medical conditions). These are best brushed on in the evening. Be sure to spit it out completely, but do not rinse for at least a half an hour. Avoid swallowing.

Topical fluoride gels and foams are good for patients in full braces who may be prone to decay.

If a patient is decay free and is at very low risk, we now suggest no topical fluoride treatment is necessary, even for children. Often we can avoid decay with a low-cavity diet, good home care and non-fluoride tooth powders and rinses.

Fluoride-releasing Sealants (like Fuji Triage) are placed on the grooves of teeth in cavity-prone patients. They slow-release fluoride into these areas of the teeth that are most prone to decay, and recharge with fluoride when you brush. They come in pink and white.

There are home fluoride rinses which are useful for patients experiencing decay. We sell CariFree rinse at cost to our patients. For patients who are at high risk for decay, we recommend rinsing for 4 minutes daily, perhaps while shaving or applying make-up. Avoid swallowing. For patients with dry mouth problems and very high decay rates, we recommend a quick rinse every time you visit the bathroom.

Anti-decay rinse system: We now have a special anti-cavity mouth rinse system that changes the entire environment of the mouth so “bad” bacteria cannot grow and “good” normal bacteria can take over. There is a very good maintenance fluoride rinse that helps keep the bad bacteria down. Unlike other fluoride rinses, this one neutralizes acid and contains Xylitol for extra protection.

Dietary (Systemic) Fluoride

Dietary fluoride gives teeth low but prolonged fluoride exposure, which provides protection for patients at risk of decay. In Bolton, Toronto, Mississauga, and Brampton (south of 18th Sideroad) tap water has fluoride added. No supplement is recommended.

In Palgrave and surrounding communities, there is almost no fluoride in the water. We recommend that patients prone to decay get topical spot treatments from our office. With custom fluoride spot treatments instead of water fluoridation it is possible to carefully regulate how much fluoride is used. We recommend fluoride varnish treatments for children over 18 months of age who are at high risk for decay. This includes:

Children who have had several cavities already
Children where other siblings have had high decay, or whose parents are prone to cavities
Children who are “poor eaters” and have many sweets and/or drinks of juice or pop

Chewable fluoride tablets: These put fluoride directly in the grooves on the chewing surfaces of teeth which are most prone to decay, giving extra protection. If you use these, we suggest a lower dose than usual. Although there is no need to swallow the tablet, the dosage we recommend (1/4-1/2 mg) is quite a low daily dose and is much lower than that ingested through water fluoridation or overuse of toothpaste.

“Pedi-Dent” and “Fluor-a-day” (see picture above) are examples of chewable tablet fluoride supplements. Please note the new dosages we advise. These may be different from that on the bottles:

18 months - 3 years: 1/4 tablet per day
3-12 years: 1/2 tablet per day

We prefer topical applications – varnish in-office, home rinses and fluoride toothpastes if the patient is old enough to cooperate and not swallow the rinse or toothpaste.

Hidden Sources of Fluoride: Too Much of a Good Thing?

Fluoride is effective in the correct dosage if you have problems with decay. However, excess fluoride does not give additional benefit. In fact, in young children, it may case superficial white spotting of teeth (called “fluorosis” - shown below). High swallowed doses can cause serious health problems. We feel that the benefits of fluoride outweigh the risks for those prone to decay. It is still necessary to be aware of major sources of excess fluoride.

The largest source of excess fluoride is toothpaste “abuse.” Unsupervised children may use large amounts of toothpaste, especially kid-flavored pastes. This can be a major source of excess fluoride if they swallow some. Limit the amount of paste used to a small pea-sized smear. Some bottled waters contain very high natural levels of fluoride. 0.7 PPM (part per million) is the optimum concentration of fluoride for tap water for cavity prevention. However, some mineral water can contain 5 PPM or more. Check the labels, and avoid those with over 1 PPM.

Palgrave and the area has no fluoride added to the water. Bolton’s water does have fluoride added. Interestingly, we are not seeing a difference in decay in our patients drinking Palgrave water vs Bolton water, so obviously other factors make a difference too.

Children attending school in Bolton, Brampton or Toronto may be drinking fluoridated water during part of the day. Also, bottled or canned drinks and processed foods from Toronto and other major centres are made with 0.7- 1.0 PPM fluoridated water. For this reason, even in our non-fluoridated area there is some fluoride exposure. To compensate for these other sources of fluoride, we have reduced our recommended doses of fluoride supplements if you use them. We are eliminating them completely now for children with low decay and low risk.

People drinking fluoridated water can get excess exposure too. If you consume 1L a day, you receive the recommended 1mg. If however you drink several litres a day, as many athletic people do, and consume some more through food and cooking, you may be receiving many times this amount. You may consider drinking fluoride-free bottled water, distilled or reverse-osmosis water. You will still receive some fluoride from food and other sources.

Water fluoridation definitely gives good benefits especially to those who do not or cannot brush their teeth often, such as elderly and disabled people, socio-economically disadvantaged people, or for other people at high risk for decay who can’t do topical treatment properly.