Fluoride is controversial subject for many people. Many patients oppose the use of fluoride in any form. Fluoride is used in two different ways, 1) Systemic- taking in fluoride in drinking water whether it is added by the Public Health Department or occurs naturally 2) Topical- where it is applied directly on to the surface of the teeth. Research has shown however that drinking fluoridated water (.7-1.0 ppm) reduces tooth decay by up to 60%, with little proof of harmful side effects.

Systemic Fluoride

Systemic fluoride involves the introduction fluoride into the bloodstream through drinking water, at a level of seven tenths to one part per million – a level shown to significantly help prevent tooth decay. Fluoride joins with the enamel as it forms within the tooth bud (a sack within the jaw bone where the tooth grows) and helps prevent tooth decay by making the enamel more resistant to the acid made by bacteria.

If the water supply where you live does not contain fluoride, your doctor should supply the necessary concentration of fluoride, in a dietary supplement, for infants and toddlers. Once your child is old enough to start seeing a dentist, usually at about the age of two, your dentist or physician should monitor your child’s fluoride levels to prevent discoloration of enamel due to a higher than recommended fluoride intake (see Enamel Fluorosis).

Topical Fluoride

Topical fluoride is a gel, foam, or varnish applied to surface of the teeth. Use of topical fluoride should continue as long as you have teeth. It “soaks” into enamel, microscopic cracks and exposed root surfaces, further protecting against tooth decay. This is most important in later years, when many people experience a decline in saliva production. Topical fluoride does not cause enamel fluorosis once the enamel is fully formed.

From the Centers for Disease Control and Prevention:

There is some potential for developing enamel fluorosis when children consume fluoride during the time when teeth are forming under the gums (birth through age eight). Primary, or “baby,” teeth begin to develop at about the fourth month of gestation. Development of the “permanent” teeth begins at about the age of three to four months and continues to about 12-16 years of age. To help prevent both tooth decay and enamel fluorosis, the Centers for Disease Control and Prevention (CDC) recommends the following:

For parents:

Children younger than six have a poor swallowing reflex and tend to swallow much of the toothpaste on their brush, which can contribute to a child’s total fluoride intake. Therefore, as soon as the first tooth appears, begin cleaning by brushing without toothpaste with a small, soft-bristled toothbrush and plain water after each feeding. Begin using toothpaste with fluoride only when the child has reached two years of age, but only in pea-sized amounts. Use toothpaste with fluoride earlier if your child’s physician or dentist recommends it.

  • Do not brush your child’s teeth more than two times a day with fluoride toothpaste.
  • Apply no more than a pea-sized amount of toothpaste to the toothbrush.
  • Supervise your child’s tooth brushing, encouraging the child to spit out toothpaste rather than swallow it. Additional information is available online at the CDC.
  • If your child’s pediatrician or dentist prescribes a fluoride supplement (or a vitamin supplement that contains fluoride), ask him or her about any risk factors your child has for decay and the potential for enamel fluorosis. If you live in an area with fluoridated water, fluoride supplements are not needed.
  • You can use fluoridated water for preparing infant formula. However, if your baby is exclusively consuming infant formula reconstituted with fluoridated water, there is an increased potential for mild enamel fluorosis. Additional information can be found in a CDC fact sheet on infant formula @ CDC.org.

For health professionals:

  • Fluoride supplements can be prescribed for children at high risk of tooth decay whose primary drinking water has no or a low fluoride concentration. For children under age eight, weigh the risk for decay without fluoride supplements, the decay prevention offered by supplements, and the potential for enamel fluorosis.
  • Counsel parents and caregivers on the use of fluoride toothpaste by young children, especially those younger than two years old. Fluoride toothpaste is a cost-effective way to reduce the occurrence of tooth decay. However, because they do not have a well- developed swallowing reflex and may like the taste of the toothpaste, young children often swallow a large portion of it from their brush.

The prescription dose of fluoride supplements should be consistent with the standards established by the American Dental Association, the American Academy of Pediatric Dentistry, and the American Academy of Pediatrics.

Fluoride Centers for Disease Control and Prevention. Recommendations for using fluoride to prevent and control dental caries in the United States. MMWR Recomm Rep. 2001;50 (RR-14):1–42. PMID 11521913. Lay summary: CDC, 2007-08-09.Up to 42% caries reduction

Fluoridation Basics
Water fluoridation prevents tooth decay mainly by providing teeth with frequent contact with low levels of fluoride throughout each day and throughout life. Even today, with other available sources of fluoride, studies show that water fluoridation reduces tooth decay by about 25 percent over a person’s lifetime.