Fluoride

Fluoride

As the teeth develop and mature, fluoride is incorporated into the enamel and dentine, making the teeth more resistant to cavities.

Fluoride also plays a role when the teeth are fully developed by penetrating the top layer of the teeth to form fluorapatite.

In the first instance, fluoride is given in pill form or as drops and can also be found in tap water. In the second instance, fluoride is found in most toothpastes, some mouthwashes, and in treatments provided by dentists.

The combined effects of these two sources of fluoride reduces the incidence of cavities by 60%.

Optimal fluoride dose for children

Total daily ingestion of fluoride from all sources – tap water, toothpaste, mouthwash, vitamin supplements, and food – should not exceed 0.05 to 0.07 mg per kilogram of body weight.

For children less than two years of age, use only minimal amounts of fluoride toothpaste, since they are likely to swallow as much toothpaste residue as they spit out. For children two years of age and up, a small pea-sized quantity of toothpaste should be used.

In Québec, the optimal concentration of fluoride for the prevention of dental cavities is a regulatory matter. The government’s health and social services department has established a provincial water fluoridation program in which a number of municipalities participate.

The Ordre des dentistes du Québec supports the judicious use of fluoride for the prevention of dental cavities and believes this measure has historically been one of the most successful initiatives in dental care.

Fluoride is naturally present in our environment

Fluoride is a mineral compound containing fluorine. It is found naturally in the soil and water (lakes, rivers and oceans) and in some food we eat.

How fluoride protects teeth?

Fluoride has the ability to strengthen the crystalline structure of tooth enamel, making it more resistant to acids excreted by bacteria that dissolve the enamel and cause cavities.

Fluoride also acts as a catalyst in increasing the deposition of calcium and phosphate on teeth, which helps to renew and constantly remineralize enamel and prevent tooth decay.

Direct application of fluoride on teeth (e.g.: toothpaste) and constant intake of fluoride from fluoridated water contribute significantly to the prevention of tooth decay. To a lesser extent, the ingestion of fluoridated water during tooth development (during childhood) also helps to make teeth more resistant to cavities.

History of water fluoridation

Research on the effects of fluoride on teeth started in the early 20th century. Frederick McKay, a dentist, and his collaborator G.V. Black, discovered that children born in Colorado Springs had mottled teeth and that these teeth were more resistant to decay. This phenomenon was later linked to an abnormally high level of naturally occurring fluoride in the water of this area. When consumed before the eruption of permanent teeth, a high concentration of fluoride causes what is called dental fluorosis.

Dr. H.T. Dean determined that concentrations of fluoride that are higher than 1 mg/l could cause fluorosis. He also studied the beneficial effects of fluoride on teeth. Thanks to his work and that of other researchers, municipal water fluoridation was introduced in 4 communities in the United States and Canada in 1945. The results were conclusive: there was a dramatic decline in tooth decay in communities where the water was fluoridated.

Water fluoridation in Quebec and Canada

The fluoridation of drinking water is now widespread in North America. In the United States and Canada, it benefits respectively 75% and 45% of the population. While more than 70% of Ontarians, Albertans and Manitobans consume fluoridated water; it is only accessible to 3% of the Quebec residents.

The decision to fluoridate water supplies falls upon municipalities and is normally concluded after a public consultation. The Federal-Provincial-Territorial Committee on Drinking Water (CDW), meanwhile, makes recommendations about the optimal fluoride levels in drinking water to prevent tooth decay.

Is fluoride safe?

For more than 60 years, considerable research demonstrated the effectiveness and safety of fluoride for the prevention of dental caries. So far, no credible causal link was established between fluoridated water and health in general.

Although we know that high concentrations of fluoride can be harmful to health, drinking water that is adjusted to 0.7 mg/l of fluoride is safe and beneficial; this concentration takes into account the intake of fluoride from other sources (e.g.: fluoridated toothpaste, mouthwash, food, etc.).

Water fluoridation is approved and recommended by the World Health Organization (WHO), the Canadian Dental Association, Health Canada, the “Institut national de santé publique du Québec”, the “Direction de la santé publique du Québec”, the American Dental Association and nearly 100 other national and international organizations.

An excess of fluoride causes fluorosis

Dental fluorosis can occur in individuals who have ingested large doses of fluoride in childhood, during the period of dental development. In its lightest form, fluorosis causes small white spots on the teeth. The risk of fluorosis is low in Canada and this disease very rarely occurs in its severe form.

With respect to skeletal fluorosis (weakening of bone structure of the skeleton), it happens only in cases where the person has been exposed to very high concentrations of fluoride, i.e. 4 mg/L or more, on the duration of an entire lifetime. This represents almost 6 times the concentration of fluoride found in fluoridated drinking water.

Is municipal water fluoridation worth the cost?

Some people wonder about the relevance of water fluoridation as it entails a monetary cost. It should be noted that the cost for fluoridation of the water consumed by a person in a full lifetime is less than the cost of a single dental filling. For most cities, each dollar invested in water fluoridation saves $38 in dental treatment costs.

As this measure benefits people of all ages and economic classes, it is considered a good way to improve the dental health of communities.

Fluoride toothpastes and mouth rinses: from what age?

Fluoridated toothpastes and mouth rinses are recommended by the Canadian Dental Association as a means of preventing dental caries.

In children, fluoridated toothpaste can be used from the age of 3 in small quantities (pea-sized amount). Between the ages of 3 and 6, an adult must supervise tooth brushing because young children tend to swallow toothpaste while brushing their teeth. The adult can therefore make sure that the child brushes all their teeth, spits out the toothpaste and rinses well their mouth later.

Between ages 0 and 3, teeth must be brushed by an adult using a toothbrush and water. The toothpaste will be used only if the child is considered to be at risk of developing cavities as determined by a professional.

The use of fluoridated mouthwash is discouraged before the age of 6.

Application of fluoride by professionals

Among those at risk, dental health professionals can proceed with applications of fluoride directly on the teeth in the form of gel, foam or varnish. This procedure can be repeated 2–4 times per year.

Fluoridated supplements

In some cases, health care professionals may prescribe fluoridated supplements (pills, tablets or drops) for patients with a high risk of tooth decay. These people include those who do not brush their teeth two times a day with fluoride toothpaste and/or have a strong predisposition to cavities (high occurrence of tooth decay in their family, their community or their geographical area).

It is usually not advised to take these supplements before the eruption of the first permanent teeth to minimize the risk of dental fluorosis.

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