The Center for Disease Control groups water fluoridation with immunizations, understanding tobacco as a health hazard, and motor vehicle safety in the list of the “ten greatest public health achievements in the 20th century”. At the same time many organizations tell Americans that fluoride is poison and that we are being “medicated by force”. What is the truth? At Ponte Vedra Complete Dentistry, we are committed to public education about oral health and other issues in dentistry. Today we will tackle fluoride by reviewing some of the myths and the facts. Our hope is to answer and clarify many of the questions and uncertainties. We hope you enjoy!
Before we begin, it is important to review a few facts about fluoride. Fluoride is an inorganic ion of fluorine. Fluoride can be found in the air we breath, the soil, living organisms, and a myriad of other common sources we encounter daily. Many of the foods and drinks that we consume contain fluoride including wine, carrots, raisins, black tea, and potatoes. Fluoride is also used in the dental field in many ways including toothpastes, varnishes, and mouth rinses. In 1945, Grand Rapids Michigan became the first city in America to begin water fluoridation. Since then much of America has followed suit and fluoridated the public drinking water. Today the current recommended level of fluoride in our water is .7-1.2ppm (parts per million).
What are the benefits of fluoride for our teeth?
Why do we use fluoride? To answer that, it is first important to know how we get cavities. The outer surface of our teeth is made of enamel. Enamel is the hardest substance in the body and is made mostly of hydroxyapatite. This is a highly mineralized substance. To simplify the process we can think of the cavity as a balance between demineralization and remineralization. Demineralization happens when the complex environment in the mouth becomes more acidic causing minerals to be pulled from the tooth structure. Remineralization takes place naturally and protects the teeth. Remineralization can be accredited much to the actions of our saliva which is rich in the necessary minerals.
Fluoride benefits our tooth structure by creating fluoroapatite which is much less soluble than hydroxyapetite even in an acidic environment. This not only protects us from demineralization but actually expedites remineralization. The result is teeth with strong and healthy enamel.
Is fluoride really dangerous?
History gives us many examples of people dying from hyponatremia. Hyponatremia is water intoxication. People have actually died from drinking too much water. What’s the point? Too much of anything can be harmful. Fluoride in excessive quantities can be damaging. Ingested fluoride uptakes predominantly into bones and tooth structure. This is mainly dangerous during development. Cases of excessive fluoride ingestion have shown to cause pitting and other surface defects in tooth enamel as well as brittle bones. This said, in 1974 Congress passed the Safe Water Drinking Act. Among other things, this act provided us with goals for maximum water contaminant levels. These goals are based on the best available scientific information and were created to set a ceiling on the levels of fluoride where no adverse health effects would occur. Today that number is 4ppm. It is important to note that this is 4 times what most of us have in our water.
Is water fluoridation is like forcing people to take medication?
The answer to this can be broken down into two points. First, fluoride is not a medication but rather a mineral. The American Journal of Public Health summarized one of the more important US court decisions regarding water fluoridation by stating “fluoride is not a medication, but rather a nutrient found naturally in some areas but deficient in others.” Second, humans have found health benefits to adding Vitamin D to milk, folic acid to breads, and iodine to table salt. This concept is not foreign to us and many examples of which have proven beneficial in the past.
Is tooth decay in America enough of a problem to fluoridate the water?
Our country has seen significant reductions in the levels of tooth decay in recent decades. Still, dental caries (cavities) is the #1 chronic disease of childhood in our country. It is currently 5 times more common than asthma. Tooth decay is still a significant problem in our country. When comparing fluoridated communities vs. non fluoridated communities, we find a decrease in tooth decay in children from 18-40% in those with water fluoridation. Studies have shown that there is a direct correlation between the parts per million of fluoride in drinking water and tooth decay in different communities as well as increases in tooth decay each year after discontinuance of fluoride in drinking water. What this shows us is that tooth decay most certainly still is a problem in our country and it could be a much larger problem if fluoride was not utilized.
What is our opinion?
The above facts are far from comprehensive. There are mountains of evidence, studies, and facts about fluoride and how it pertains to dentistry. After thorough review, seeing the benefits of fluoride for oral health is unavoidable. It is important to remember that fluoride in drinking water is only .7-1.2ppm. The average fluoride containing toothpaste is 1000ppm. Simply drinking fluoridated water is not sufficient to obtain the optimal levels beneficial for oral health. We recommend using a fluoride containing toothpaste. Mouth rinses are optional, even those that contain fluoride. Most mouth rinses that contain fluoride have levels of fluoride that are less than toothpaste. After brushing, swishing with one of these mouth rinses can actually lower the levels of fluoride in the mouth and as a result have counterproductive results.
If you have children, we do recommend placing toothpaste or other products with high fluoride content out of their reach. A small child swallowing an entire tube of toothpaste could have detrimental effects. When brushing an infant or a child’s teeth it is important that you know how much toothpaste to use. For a child under 3 the amount of toothpaste on the brush should be about the size of a grain of rice. For toddlers it should be about the size of a pea. Children of these ages have not adequately developed the muscle control to spit out all of the toothpaste so some swallowing is inevitable. Using these small amounts will protect that child from potential harm.
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