Fluoride

Think of fluoride as part of the "antidote" to the sugar in a poor diet. Fluoride comes in many different forms and reduces tooth decay. It is important that it be used PROPERLY by those who need it. Combined with good oral hygiene, proper diet and new anti-cavity treatments, correct fluoride use is making tooth decay a disease of the past. Most children today will never get a cavity! Proper fluoride use is also known to reduce tooth sensitivity.

Topical Fluoride

Topical fluoride works only on the outer surface of teeth already visible in the mouth. It is not taken internally. Topical fluoride can be found in rinses, toothpastes, varnishes, sealants and fluoride gels. School rinses are no longer offered in this area. Correct fluoride exposure with toothpaste is now more important than ever, and protection with topical or chewable fluoride for children at high risk for decay.

Toothpastes with fluoride have made a huge difference in reducing decay world-wide. For maximum effect, toothpaste should be in contact with teeth for 4 minutes. Care should be used, especially with children, to prevent swallowing of the toothpaste. No more than a pea-sized smear of toothpaste should be used (see photos below). For very young children who have difficulty avoiding swallowing, reduced-fluoride toothpastes are available.

Correct toothpaste amount (Left) vs Excess toothpaste (Right)

Topical fluoride gel is the strongest topical fluoride. It is applied in the dental office every three to six months. We now apply it to any patient experiencing ongoing decay. If a patient has been totally decay free and is at very low risk, we now suggest no topical fluoride treatment is necessary, even for children. There are home rinses and gels for fluoride which are useful for patients experiencing decay. They are available in drug stores without a prescription.

High Strength Fluoride Toothpastes "Prevident 5000+" is an example of a high strength fluoride toothpaste good for adults at high decay risk. It is best brushed on in the evening. Be sure to spit it out completely, but do not rinse for at least a half an hour. Avoid swallowing.

Fluoride Varnishes are applied to cavity-prone areas of teeth. They are very good for kids that can't tolerate a fluoride gel application. They can be applied to hard-to-reach early decay too.

New for 2003 Fluoride-releasing Sealants (Fuji Triage) are placed on the grooves of teeth in cavity-prone patients. They slow-release fluoride into these areas of the teeth that are most prone to decay, and recharge with fluoride when you brush. They come in pink and white.

Triage Pink Fluoride-releasing Sealant

Fluoride Rinses There are home rinses and gels for fluoride which are useful for patients experiencing decay. "Fluorinse" is an example of a daily rinse. It and others are available in drug stores without a prescription.  For patients who are at high risk for decay, we recommend rinsing for 4 minutes daily, perhaps while shaving or applying make-up. Avoid swallowing. For patients with dry mouth problems and very high decay rates, we recommend a quick rinse every time you visit the bathroom.

New for 2007 Anti-decay Fluoride rinse system
We now have a special anti-cavity mouth rinse system that changes the entire environment of the mouth so "bad" bacteria cannot grow and "good" normal bacteria can take over.
There is an extra strong 2-part rinse to "shock" the bad bacteria, which is used for 1 minute a day for 2 weeks.
There is also a maintenance fluoride rinse that helps keep the bad bacteria down. Unlike other fluoride rinses, this one neutralizes acid and contains Xylitol for extra protection.

Dietary (Systemic) Fluoride

Dietary fluoride gives teeth low but prolonged fluoride exposure, which provides good protection for patients at risk of decay. In Bolton, Toronto, Mississauga, and Brampton (south of 18th Sideroad) tap water has fluoride added. No supplement is recommended.

In Palgrave and surrounding communities, there is almost no fluoride in the water. We recommend that patients prone to decay get supplements from pharmacies, or from our office.With fluoride supplements instead of water fluoridation, it is possible to carefully regulate how much fluoride is used. We recommend chewable tablets for children over 18 months of age who are at risk for decay. This includes:

Children who have had any cavities
Children where other siblings have had decay, or whose parents are prone to cavities
Children who are "poor eaters" and have many sweets and/or drinks of juice or pop

Chewing the tablets puts fluoride directly in the grooves on the chewing surfaces of teeth which are most prone to decay, giving extra protection. Although there is no need to swallow the tablet, the dosage we recommend (1/4-1/2 mg) is quite a low daily dose and won't cause problems. It is much lower than that ingested through water fluoridation or overuse of toothpaste.

Pedi-dent Chewable Flouride

"Pedi-Dent" and "Fluor-a-day" (see picture above) are examples of chewable tablet fluoride supplements. Please note the new dosages we advise. These may be different from that on the bottles:

18 months - 3 years: 1/4 tablet per day
3-12 years: 1/2 tablet per day

Another option is to put fluoride drops in juice or drinking water, at a rate of 0.5 to 1.0 mg. per litre.

Hidden Sources of Fluoride: Too Much of a Good Thing?

Fluoride is very effective in the correct dosage. However, excess fluoride does not give additional benefit. In fact, in young children, it may case superficial white spotting of teeth (called "fluorosis"). Very high swallowed doses can cause serious health problems. We still feel that the benefits of fluoride far outweigh the risks for those prone to decay. It is still necessary to be aware of the major sources of excess fluoride.

Example of mild fluorosis.
Note white spots on lower edge of upper incisors.

The largest source of excess fluoride is toothpaste "abuse." Unsupervised children may use large amounts of toothpaste, especially kid-flavoured pastes. This can be a major source of excess fluoride if they swallow some. Limit the amount of paste used to a small pea-sized smear. Some bottled waters contain very high natural levels of fluoride. One PPM (part per million) is the optimum concentration of fluoride for tap water. However, some mineral water can contain 5 PPM or more. Check the labels, and avoid those with over 1 PPM.

Palgrave and the area has no fluoride added to the water. Bolton's water does have fluoride added.

Children attending school in Bolton, Brampton or Toronto may be drinking fluoridated water during part of the day. Also, bottled or canned drinks and processed foods from Toronto and other major centres are made with 1 PPM fluoridated water. For this reason, even in our non-fluoridated area there is some fluoride exposure. To compensate for these other sources of fluoride, we have reduced our recommended doses of fluoride supplements. This gives the best protection from decay with the fewest side effects. We are eliminating them completely now for children with no decay and low risk.

People drinking fluoridated water can get excess exposure too. If you consume 1L a day, you receive the recommended 1mg. If however you drink several litres a day, as many athletic people do, and consume some more through food and cooking, you may be receiving many times this amount. You may consider drinking some fluoride-free bottled water, distilled or reverse-osmosis water. You should still receive enough fluoride from food and other sources, especially if you are at low risk for decay. Water fluoridation gives good benefit especially to those who do not or cannot brush their teeth often, such as elderly and disabled people, socio-economicaly disadvantaged people, or for other people at high risk for decay.