Fluoride

There are so many opinions on dental fluoride out there and I promise to respect yours. But I like people to know my feeling on fluoride based on my 30 some years of experience in the dental field.

I have seen the results of people using fluoride long term and people who never have used fluoride. I am also now seeing the results of people using fluoride as part of their adult dental regimen.

I am a believer that fluoride works and benefits people of all ages for different reasons at different times in their life.

Let’s begin with children. Systemic fluoride for children while their teeth are forming under their gums is a double edged sword. It MUST be given in controlled dosages. Too much systemic fluoride can cause fluorosis which is a change in the enamel composition and appearance. Their permanent teeth could end up having white opaque spots or a mottled look to them that does not go away. Also, it could cause a brown stain to appear, known as Colorado Brown Stain due to areas of Colorado having high levels of naturally occurring fluoride in the water. So, yes, Systemic fluoride IS a concern. We can discuss where you live and decide if you should give your younger children bottled water vs drinking the tap water in your home.

The ideal level of systemic fluoride in your drinking water is 1 part per million (ppm), so it’s good to have a water analysis done of your water if you have small children no matter where you live.

Next topic for fluoride is “Topical Fluoride”.  This is the fluoride in your toothpastes, OTC fluoride rinses, and the fluoride used in the dental office.  I am a believer in topical fluoride use. I’ve witnessed first hand how it benefits people, young and old. It is important not to ingest this topical fluoride. If you have small children at home, keep your tubes of toothpaste out of their reach because, they make these to taste good and many children will “eat” a whole tube of toothpaste which is NOT a good thing.

Topical fluoride treats the teeth that are currently in your mouth. Systemic fluoride no longer is a benefit to your teeth once they erupt in your mouth.  Over time, acids from foods you eat or just your own body chemistry can start to decalcify your teeth and start decay. Also, when you eat or drink sugary things, the bacteria in your mouth eats this sugar and then creates an acid which cause the decay as well. Most of us have sugar in some form on a daily basis. It may not be refined sugar, but even carbohydrates which break down into sugars can contribute to this acid producing effect as well. So, it’s very hard to avoid.  The fluoride in your daily toothpastes and rinses can counteract this effect the acid has on the teeth by strengthening the enamel of your teeth. It actually changes the molecular structure of your teeth to a harder more decay resistant structure, thus less likely to being able to decay.

People never outgrow the ability to get decay. Even an adult who has never had a cavity might succumb to decay at some point due to a medical change or medications they start to take. Dry mouth is a huge contributor to tooth decay and many, many adults struggle with dry mouth issues. So Fluoride is not just for kids.

Another reason why the American Dental Association has begun to recommend fluoride for adults is due to the fact that as we age, most of us get recession of our gums surrounding our teeth. Recession can be caused by many different things. You might brush too aggressively and actually brush away the gums little by little over the years. This is very common especially if you brush incorrectly.  (by the way, Lori will show you how NOT to brush and make this happen)

Recession can also be caused by a problem with your bite which causes you to grind your teeth. This not only wears away your enamel on your chewing surfaces, but it puts stress on the entire tooth and causes your gums to recede around the tooth.

When your gums recede, this means they drop down lower on the tooth. The enamel only covers the crown portion of your tooth, the root is covered by cementum.  The cementum is not nearly as protective against decay as the enamel is because it isn’t as hard. It has a different molecular structure. Once again, the fluoride changes this molecular structure to make it harder and resist decay. Root decay is a huge issue for older adults in their 70’s and older.  Research shows if fluoride is used throughout adulthood, these root surfaces can become more calcified and not decay as easily.

There are different types of topical fluorides. Most people are familiar with the over the counter (OTC) kind of fluoride. This is the fluoride toothpastes you buy in the grocery store or retail pharmacy stores. Typically, these products contain about 500 parts per million (ppm) of fluoride to the other ingredients. For someone with a high decay susceptibility or cold sensitive teeth, I like to recommend a prescription strength fluoride toothpaste. This has a 5,000 ppm of fluoride and is extremely effective at preventing future decay. This is a toothpaste which I recommend you brush with before going to bed. Basically you apply it to your toothbrush and brush like normal with it for 2-3 minutes without rinsing your brush or your mouth. Then you spit it out, don’t rinse your mouth, and go to bed with the fluoride coating your teeth oral tissue. This is basically giving you a fluoride treatment while you sleep and helping to remineralize your tooth structures.

Another very effective type of topical fluoride I recommend to most children and adults is an in office fluoride treatment. There are different types of applications of in office fluorides. I use a fluoride varnish which is 75% more effective the than foam/tray version used in past years by most dental offices. The varnish is painted on your teeth. It is a sticky gel and adheres to the teeth until it is brushed off at bedtime. It is recommended that you do not eat or drink anything hot enough to melt it off the teeth for 2-4 hours following treatment, nor should you eat hard, crunchy foods or chew gum for 2 hours after, as that can remove it from the teeth. Water is fine to drink immediately after as water helps it to “set up” on the teeth. Soft and cold foods and drinks are generally fine to eat in the first 2-4 hours as well. The 2-4 hour time frame is set because the majority of the ‘uptake’ of fluoride into the teeth happens in that time.

Insurances generally will pay for children to receive in office fluoride treatments and more and more insurances are paying for adult fluoride treatments as well.  American Dental Association has been recommending fluoride for both children and adults for fluoride due to the research done which shows how effective it is at preventing decay and helping people with sensitive teeth. I follow this recommendation whether your insurance wants to pay for it or not. It is inexpensive and I truly believe it is worth the cost to prevent future dental problems.

I am willing to discuss my beliefs with you, but please know I will always respect your own opinions about fluoride and will never be pushy about doing fluoride if you do not want it.