Cavities were once a fact of life, but over the past few decades, tooth decay has be been reduced dramatically. The key reason for this change is fluoride. Research has shown that fluoride reduces decay in both children and adults. It also helps repair the early stages of tooth decay often before the decay is visible. Unfortunately, many continue to be misinformed about fluoride and fluoridation. Fluoride, like any other nutrient, is safe and effective when used appropriately. This article will help explain more about the oral health benefits of fluoride.

Fluoride: Nature's Cavity Fighter
Fluoride is a mineral that occurs naturally in all water sources, even the oceans. The fluoride ion comes from the element Fluorine. Fluorine, the 17th most abundant element in the earth's crust, is never encountered in its free state in nature. It exists only in combination with other elements as a fluoride compound.

Fluoride is effective in preventing and reversing early signs of dental caries (tooth decay). Research has shown that there are several ways that fluoride achieves its decay-preventing effects. First, it strengthens tooth structure so that teeth are more resistant to acid attacks. Acid is formed as a byproduct of plaque breaking down consumed sugars and carbohydrates. Repeated acid attacks break down tooth enamel which causes cavities. Fluoride also acts to repair, or remineralize, areas where acid breakdown has already begun. The remineralization effect of fluoride is important in reversing the early decay process as well as creating a tooth surface that is more resistant to decay.

Fluoride is may be obtained in two forms: topical or systemic. Topical fluorides strengthen teeth already present in the mouth making them more resistant to decay. Topical fluorides include toothpastes, mouthwashes, and professionally applied fluoride therapies.

Systemic fluorides are those that are ingested into the body and incorporated by forming tooth structures. Systemic fluorides can also give topical protection because fluoride is present in saliva, which continually bathes the teeth. Systemic fluorides include water fluoridation or dietary supplements in the forms of tablets, drops or lozenges.

As a result of the widespread availability of these various sources of fluoride, the rate of decay in both U.S. and other countries has been greatly reduced.

The proper mix is key
It is important to note that the effective prevention of dental decay requires that an appropriate combination of both forms of fluoride (topical and systemic) be made available to individuals. Your dentist can help you assess whether adequate levels of fluoride are being received by all family members.

Topical Fluorides
Self-Applied
The use of toothpastes with fluoride are responsible for a significant decrease in cavities since the 1960’s. The American Dental Association recommends that children (over two years of age) and adults use fluoride toothpaste displaying the ADA Seal of Acceptance or consult. It is also recommended that parents consult with a child's dentist if considering the use of toothpaste before the age of two. Mouthrinses, either prescribed by your dentist of an over-the-counter variety, are an additional source of self-applied fluoride. The ADA does recommend the use of fluoride mouthrinses, but does not recommend the products be used by children under six years of age because of the risk of swallowing.

Professionally-Applied
Professionally-applied fluorides are generally found in the form of a gel, foam or rinse, and are applied by a dentist or dental hygienist during dental visits. These fluorides are more concentrated than the self-applied fluorides, and therefore are needed less frequently. The ADA recommends that dental professionals use only professional strength, tray-applied gels or foam products caring the ADA Seal of Acceptance. The ADA is yet to approve professional fluoride rinses for use in a dental office.

Systemic Fluorides
Systemic fluorides such as community water fluoridation and dietary fluoride supplements are also effective in reducing tooth decay. These fluorides provide topical as well as systemic protection because fluoride is present in the saliva.

Community Water Fluoridation
Fluoride is present naturally in all water sources. Community water fluoridation, which has been around for over 50 years, is simply the process of increasing the fluoride content of fluoride deficient water to the recommended level for optimal dental health. The recommended level is 0.7-1.2 parts fluoride per million parts water. Water fluoridation has been proven to reduce decay in both children and adults. While water fluoridation is an extremely effective and inexpensive means of obtaining the fluoride necessary for optimal tooth decay prevention, not everyone lives in a community with a centralized, public or private water source that can be fluoridated. For those individuals, fluoride is available in other forms.  

Dietary Fluoride Supplements
Dietary fluoride supplements (tablets, drops or lozenges) are available only by prescription and are intended for use by children ages six months to 16 years living in communities that do not have fluoridated water. Your dentist or physician can prescribe the correct dosage. The prescription is based on the natural fluoride concentration of the child's drinking water and the age of the child. For optimal benefits, the dietary fluoride supplements should be used when a child six months old and continue until the child is 16 years old.

*The need for taking dietary fluoride supplements over an extended period of time makes dietary fluoride supplements less cost-effective than water fluoridation; therefore, dietary fluoride supplements are considerably less practical as a wide-spread alternative to water fluoridation as a public health measure. Fluoride supplements are recommended only for children living in non-fluoridated areas.

It is important to note that fluoridated water by be consumed from sources other than the home water supply, such as in the workplace, school and/or day care, bottled water, filtered water and/or from processed beverages and foods prepared with fluoridated water. For this reason, dietary fluoride supplements should be prescribed by carefully following the recommended dosage schedule. Dietary fluoride supplements are not recommended for children residing in a fluoridated community.

Conclusion
Regardless of how fluoride is obtained, whether is be through drinking water, taking supplements, using toothpaste, mouthrinse or by a professionally applied fluoride, you can be confident that fluoride is silently at work fighting decay. Safe, convenient, and effective, however you describe it; fluoride fits naturally into any dental care program. For more information about the oral health benefits of fluoride, just ask your dentist.

Important Consideration

• If fluoride levels are unknown, drinking water should be tested for fluoride content before supplements are prescribed. For testing of fluoride content, contact the local or state health department.
• All sources of fluoride should be evaluated with a thorough fluoride history.
• Patient exposure to multiple water sources can make proper prescribing complex.
• Ingestion of higher than recommended levels of fluoride by children has been associated with an increase in mild dental fluorosis in developing, or unerupted teeth.
• Fluoride supplements require long-term compliance on a daily basis.