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General Oral Health

What’s the Fuss About Flouride?

 

Much has been written about and discussed on the issue of fluoride.  Parents are often confused and concerned about this issue and come to the dentist for some clarity.

Fluoride is a mineral which is found in nature.  When applied to teeth, fluoride strengthens tooth enamel (the hard outer layer of teeth) making it more resistant to tooth decay.  Flouride can also prevent or reverse existing decay.

Flouride can be found in a variety of sources.  For instance, many municipalities fortify the water supply with fluoride as it is considered to be an effective way to provide oral health protection to the public at a considerably lower cost than the cost of treating oral health problems after they develop.  Flouride can also be found in most toothpastes, some foods and beverages, in fluoride supplements such as rinses and lozenges as well as topical fluoride administered by a dentist.

 

At this point you may wonder what’s the fuss?

Exposure to more fluoride than required, particularly by toddlers who tend to swallow toothpaste rather than spitting it out can, over time, lead to a condition called flourosis.  Children with flourosis can develop white spots on their adult teeth.  In most cases, flourosis is mild and often, neither children nor parents can notice the spots.

In addition to these concerns, a minority of dentists and academics have advocated against fluoride in public drinking water arguing that there are other health risks associated with the over-ingestion of fluoride by children.  The Canadian Dental Association supports the use of fluoride and has noted that scientific studies have not found any credible link between water fluoridation and adverse health effects other than fluorosis

(see:  http://www.cda-adc.ca/en/oral_health/faqs_resources/faqs/fluoride_faqs.asp).   However, many parents are rightfully concerned about risks both from exposing their children to fluoride and abstaining from such exposure.

In my own personal experience working in both fluoridated and non-fluoridated communities (in respect of water supply), I have observed that people living in communities with fluoridated water do show less severe patterns of tooth decay.  However, while the reduction in cavities in undeniable in fluoridated communities, other socio-economic factors may also be at play affecting diet, oral hygiene, etc. making it difficult to draw general conclusions about the effectiveness of fluoridated water.

The best advice that I can give parents is to do what they are comfortable with when it comes to fluoride and their children.  Tooth decay in toddlers can be extremely serious – it can result in infection and often children have to be anesthetized in order to fill the cavities, which also poses some risk.  Thus, to the extent that the appropriate amount of fluoride may be able to prevent tooth decay in your child’s mouth, it should be given fair consideration.

Not every child requires the same amount of fluoride.  There are many risk factors which affect the likelihood of tooth decay, for example:

  • lack of fluoridated water supply in a community;
  • lack of consumption of fluoridated water (e.g. children consuming non-flouridated bottled water);
  • diet (including the frequency of consumption of sugary or acidic foods and/or beverages);
  • the frequency of tooth brushing;
  • the condition of the child’s teeth; and
  • the child’s familial oral health history (including frequency of cavities/decay of parents and other family members).

 

At my office I assess an individual’s risk of cavities and prescribe the appropriate in-office or home treatment, which in many cases, includes no fluoride at all for low risk individuals.  Some children brush only with water or fluoride-free toothpaste for many years.  Other children brush with toothpaste with fluoride but in an amount directed by the dentist and strictly supervised by their parents to minimize swallowing of toothpaste.  Other children as they age, have fluoride applied topically to their teeth by the dentist.  For individuals concerned about fluoride, there are also fluoride alternatives such as xylitol productions and CPP-ACP products which, when used properly and in appropriate circumstances, also prevent tooth decay.

 

It is a question of parental comfort, and needs of the child, having regard for the risks and consequences of not properly addressing the risks.  My wife and I allow my three-year old daughter to drink fluoridated tap-water and we brush her teeth once a day with a rice-sized amount of fluoridated toothpaste.  We are comfortable with this approach having considered the above-noted risk factors but this is not the right solution for every child.  This is why it is important to discuss your concerns with your dentist and allow him/her to suggest the appropriate strategy for caring for your child’s teeth. If you have concerns about fluoride, don’t hesitate to talk to your dentist about them.  And remember, both you and your dentist have a common interest – caring for your child’s happy and health smile for many, many years to come!

 

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