FLUORIDE AND FLUOROSIS

Many people have asked us, "So what's the deal with fluoride?

Most often, we find there is confusion about fluoride.  Why is it recommended that we use this modality to strengthed our teeth?  Some of the messages we see in the media and online can add to the confusion about what actually is its purpose.  What is the benefit?  Why do we sometimes hear "more is better" and then "too much isn't good for your teeth".

In an effort to clear up misconceptions, here are the basics.  In the dental industry, there are two general categories of fluoride:

  1. Systemic - This is fluoride that we ingest or swallow through drinking water supplied to our homes by our municipality.  This fluoride is added to the water supply in an amount that is optimal for the area.  In the greater Chicago area, it is one part per million.  In warmer climates, where people drink more water, the concentration of fluoride is lessened to keep the amount we consume at optimal levels.   After we ingest fluoride, it is incorporated into our tooth enamel as it forms and strengthens the enamel crystal itself at the molecular level.  Fluoride occupies voids in the crystal making it more difficult for acids from bacteria to demineralize (or "melt away") the enamel, hence, avoiding the formation of a cavity.
  2. Topical - This is fluoride that we put into our mouths "onto" our teeth and then expectorate or spit out, this fluoride is found in toothpaste or a rinse.  We do not swallow this type of fluoride, if swallowed, it then becomes systemic.  Too much systemic fluoride is undesirable which is addressed in the following section.  Topical fluoride "attaches" to the outside of the enamel and functions in the same way as systemic fluoride, rendering the enamel crystal at the surface, more resistant to acids from bacteria in plaque.  However, this attachment is not permanent.  Slowly but surely, this fluoride diffuses or oozes out of the enamel.  For this reason, topical fluoride is recommended daily to keep the concentration at the surface high enough to inhibit cavities.  This fluoride is found in toothpastes and fluoride rinses and especially in fluoride treatments applied by your dentist or hygienist. 

With topical fluoride, more is better, as long as one spits it out and does not swallow it.  For this reason, we recommend toddlers and young children use toothpaste that does not contain fluoride (ie. toddler/training toothpaste).  This should continue until it is certain that the child can effectively spit out. 

With systemic fluoride, we want the optimal amount - more is not better!  If one has well water that does not contain fluoride, fluoridated bottled water can be purchased and used.

What happens if too much systemic fluoride is ingested?

This is the problem known as Fluorosis.  If too much fluoride is ingested during enamel formation, a hyopmineralization (porosity of the enamel) occurs with increasing severity based on how much is ingested.  Enamel Fluorosis is characterized by stages.  The very mild and mild stages appear as chalk-like, lacy markings across the enamel surface.  They are not readily apparent to the affected person or the casual observer.  In the moderate form of Fluorosis, more than 50 percent of the enamel surface is opaque white.  With severe Fluorosis, the enamel becomes pitted and brittle and may develop brown staining. 

The risk of dental Fluorosis increases if fluoride, beyond the recommended optimal dose, is ingested during the time enamel is forming.  This is the period between birth and about 8 years of age.  While the vast majority of Fluorosis is in the very mild to mild range, it is important to be award of fluoride intake to minimize this.  At normal everyday levels of water ingestion, there is nothing to worry about.

Here at McElroy Pediatric Dentistry, we review and evaluate your child's fluoride intake history and consult with parents on how to regulate to the optimal level.  In achieving optimal levels, we can ensure your children's teeth are both resistant to decay and esthetically pleasing in appearance.