Introduction

Fluoridation is one of the most effective and economical methods of protecting the tooth against decay and is one of the greatest achievements in the history of public health.

Like vaccination and chlorination, this is one of the more controversial public health measures of its time. Let's, however, try and unravel the mystery of

Fluoride, solve some of the queries and dispel some of the myths surrounding its misuse.

Commonly asked Questions

What is fluoride? What does it do? How is it used? How safe is it? Does it do adults any good?

These are some of the commonly asked questions people ask regarding fluoride. I am particularly interested in answering them, as a practicing pediatric dentist, I am asked these questions very often by parents.

What are Fluorides?

Fluorides are a large group of chemical compounds formed when fluorine combines with other elements. Fluorine is never found by itself in nature. Fluorides are found everywhere - in soil, air, and water, as well as in plant and animal life. That's why most foods contain some amounts of fluoride.

How does Fluoride Work?

The hardest substances in the body are bones and teeth. When the teeth are forming, the minerals needed are brought to the jaw and deposited in the tooth buds by the bloodstream. When one of these minerals, fluoride, is an inadequate supply, it is incorporated into the enamel of the tooth, and the resulting mineral structure is stronger than it would be without the fluoride. As a result, the enamel will be more resistant to attack by the acids that form in the mouth and set the stage for decay.

It's important, then, to get fluoride to the teeth when they are mineralizing. That means from birth, when the primary teeth are forming, right through the development of the adult molars and even later.

The Fluoride Reservoir

Years ago, it was believed that the fluoride incorporated in the teeth at the time they formed was the most important in terms of future resistance to cavities. The theory was that if fluoride was an integral part of the tooth structure, the tooth would be less susceptible to decay for a lifetime. Now we've revised our thinking about that.

Recent research has shown that the major action of fluoride takes place not inside the tooth, but at its surface when the fluoride comes in contact with saliva and plaque. Fluoride from all sources is stored in the mouth and on the teeth, in the plaque, in saliva and the soft tissues, ready for action. This is your fluoride reservoir.

Normally, there is an ongoing exchange of minerals between the enamel and the saliva. But when you eat, decay-causing bacteria in your mouth begin to feed, producing acid as a byproduct. That acid can upset the balance of mineral exchange, causing the tooth enamel to lose more mineral than it takes up. This results in a net loss of mineral for the tooth or "demineralization," and is the start of a cavity. BUT, if the fluoride reservoir is full, then this is a different story. The same acid that leads to demineralization triggers off a release of fluoride, which then becomes available "when" and "where" it is needed. This fluoride not only inhibits demineralization but also promotes remineralization, rebuilding and reinforcing the tooth enamel, so that it is stronger. In effect, the fluoride "heals" the cavities in the early stages of development.

Many parents are often surprised that the pediatric dentist may recommend a topical fluoride application to remineralize an initial cavity. Only if that approach doesn't work, then the dentist will recommend filling the cavity.

There are two basic ways to get fluoride:

• Swallow it: as with supplements, or fluoridated water (Systemic fluoride)

• Topical application: as with daily fluoride toothpaste, mouth-rinses, or gel treatments at the dentist's office.

Systemic Fluoride

Fluoride taken internally is systemic fluoride - it is incorporated into the system as building blocks, and some of it will return to the mouth in saliva.

There are several ways of getting into the teeth systemically. In the western world, the drinking water contains fluoride that has been adjusted to a therapeutic level; the effect then is both systemic and topical. Where this is not possible, daily fluoride supplements are available as liquid solutions, in tablet form, and in preparations that combine fluorides with other vitamins and minerals.

Do consult your dentist regarding these supplements. If it is prescribed, then they will determine the proper dosage for you, and teach you how to use it. Remember to treat the supplements like medicine and keep out of reach of children, and use only as directed.

Topical Fluoride

There is another way to get fluoride to your teeth. In a topical solution - gel, paste, or liquid - the fluoride can be wiped, painted, or swished around the tooth surfaces.

Topical Fluoride Treatments

These are applied by a dentist following a professional cleaning. Most preparations have a pleasant taste and the treatment takes only a few minutes.

Fluoride Toothpastes

Daily use of fluoride toothpaste is an excellent way to replenish the fluoride reservoir, even if your child is going to the dentist for routine fluoride application. You must have your child brush twice a day, after breakfast and before bedtime, and supervise the younger children to ensure that they do a thorough brushing and don't swallow too much toothpaste while brushing.

Fluoride Mouth Rinses

Be sure to use these under the guidance of your dentist.

Fluoride and Teeth - Summary

Let us recapitulate the ways to get fluoride to your child's teeth:

• Encourage your child to drink water; all water contains trace amounts of fluoride.
• If prescribed by the dentist, give your child dietary supplements of fluoride in liquid or tablet form
• Have your child brush twice daily with a fluoride toothpaste - once after breakfast, and again before bedtime
• Take your child to the dentist's office for regular check-ups. The dentist may recommend a topical fluoride application.