Lauded by many for it’s cavity-fighting properties, fluoride also has its detractors. As pediatric dentists, we field many questions about flouride usage. Below we share important fluoride benefits and risks to help caregivers understand how this common toothpaste ingredient works.
What is fluoride anyway?
Fluoride is a naturally occurring trace mineral. In its free elemental form, it’s known as fluorine. It occurs naturally in the bones in our bodies, as well as in freshwater, oceans, and even the air we breathe! Fluorine doesn’t like to stay alone, however. It’s a negatively charged ion that looks for positively charged ions to team up with. As a result, in nature, it’s found in the compound form known as fluorspar (calcium fluoride). We find this compound in rocks and soil. The fluoride compound found commonly in fluoridated toothpaste is sodium fluoride. Or in other words, its fluorine attached to sodium.
How does fluoride help teeth?
The outer layer of our teeth–our enamel–is incredibly strong! Indeed, it’s stronger than our bones. Your child’s baby teeth, however, have weaker enamel than adult teeth. Fluoride helps make tooth enamel even stronger. How? The answer lies in understanding the chemistry behind how your child’s teeth undergo demineralization and remineralization daily.
Mouth pH and Demineralization
Stated simply, fluoride strengthens tooth enamel during remineralization. To break this down, first we need to understand that the fancy name for our enamel is hydroxyapatite. A compound, hydroxyapatite consists mainly of two minerals: calcium and phosphate. Our saliva also consists largely of calcium and phosphate, so our teeth bathe all day in a healthy, strengthening environment.
When we eat, though–especially when we eat sugary and starchy foods–our saliva pH balance gets thrown off. In addition, our food not only feeds us, but it feeds bacteria in our mouths as well. These bacteria produce acids that strip calcium and phosphate off of our teeth, leaving weakened spots in the enamel. This process occurs daily, and dentists refer to it as demineralization.
The good news is that once our saliva’s pH balance gets restored, remineralization can begin. Our saliva can, and does, bathe our teeth again in calcium and phosphate to fix the weakened, or demineralized, spots. When fluoride is present during the remineralization process, it makes tooth enamel even stronger than it was before. The fluoride in your toothpaste and in the fluoride varnish applied by your child’s dentist accomplishes this amazing feat by bonding with the calcium and phosphate of your enamel. In doing so, it forms a new compound: fluorapatite. Fluorapatite is even stronger than your original hydroxyapatite because it is less soluble. In other words, acids have a harder time dissolving the calcium and phosphate in fluorapatite. As a result, the amount of demineralization decreases, and cavities can’t form as easily.
In sum, cavities occur, then, when there is more demineralization than remineralization happening in your child’s mouth. Fluoride helps teeth get even stronger and more cavity resistant during the remineralization stage!
What are the risks of fluoride?
Using fluoride toothpaste is extremely safe when children use the correct amounts (see the chart below) and spit out any excess.
Remember, toothpaste is NOT what cleans your child’s teeth: brushing and flossing clean your child’s teeth! The toothpaste simply provides the fluoride boost to strengthen tooth enamel and fight cavities!
So why are some families still afraid to let their child brush with a fluoride toothpaste? The worry is children receiving too much fluoride. Dental Fluorosis. If your child receives too much fluoride before the age of 8, it can lead to dental fluorosis. Dental fluorosis is the appearance of white lines or streaks in the tooth enamel. Only teeth that have not erupted from under the gums can get fluorosis. Thus, only children are at risk. It’s important to note, though, that fluorosis is only a cosmetic concern. Also, often, only a dentist can see the spots or streaks. Tooth functioning is not harmed, and tooth enamel remains strong. Nonetheless, parents should closely monitor their child’s fluoride consumption while teeth are developing. An excess of fluoride can come from any source. Skeletal Fluorosis. If a child receives extremely large doses of fluoride for an extended period of time during bone development, skeletal fluorosis can occur. This painful condition is extremely rare in the United States, however. The problem exists largely in India and China where water from deep ground wells contain very high levels of fluoride. Fortunately, in the US, officials carefully monitor fluoride levels in our water and keep them 1 ppm (part per million) or less.
How to Maximize the Benefits and Minimize the Risks of Fluoride
The science demonstrating the benefits of fluoride is clear. Children who brush with a fluoridated toothpaste and drink fluoridated water experience 40-60% fewer cavities. Healthier teeth mean a healthier child and adult. To make sure you get the benefits while minimizing the small risks of fluoride, follow these guidelines:
1. Take Your Child to a Dentist by Their First Birthday or First ToothA pediatric dentist can help you assess your child’s sources and level of fluoride consumption while teeth are still forming. Together, you can make a plan for toothpaste use and dental fluoride treatments that give your child the most beneficial levels possible.
2. Make Sure Your Child Uses the Right Amount of Toothpaste. The AAPD recommends you start using fluoridated toothpaste as soon as baby’s first tooth erupts. From the first tooth to three years of age, only use a smear of toothpaste, though. A smear is the size of a single grain of rice. For children ages 3-6, use a pea-sized dollop of toothpaste. Both of these amounts are safe for your child if they decide to swallow during brushing.
3. Supervise Brushing Until Child Can Tie Their Own Shoes. Your child may be tempted to add more of that yummy bubble gum flavored toothpaste if you’re not looking! In addition, children who lack the fine motor skills need to do a thorough job of brushing their teeth until they can write their name or tie their shoes on their own. Your best bet is to help them brush until then, so you can help and make sure they don’t overdo the toothpaste. (Read our blog: At What Age Should Kids Brush Their Own Teeth? for more ways to tell if your child is really ready.)
4. Learn About Your Water Supply. In order for your pediatric dentist to make the best recommendations for fluoride treatments for your child, they need to know about the water your child is drinking. Is it fluoridated city water or is it well water? Do you only give your child bottled water? To learn about your water supply, contact your local water department (you can find information on your bill). If you’re using a well or spring as your water source, you may want to contact the Ohio EPA to learn about having your water tested and analyzed. This information is important to share with your child’s dentist, so they can recommend fluoride treatments for your child’s specific situation.
5. Take Your Child to the Dentist Twice a Year. A pediatric dentist monitors all of your child’s teeth as they develop. Bi-annual check-ups and cleanings let them check for any signs that your child is getting too little or too much fluoride. Additionally, your child’s dentist can apply professional-grade levels of fluoride to your child’s teeth in varnish, gel, or foam form to give teeth an added layer of cavity-fighting protection between visits.
Fluoride Benefits Far Outweigh the Risks for Most
For most children in the US, using fluoride comes with far more benefits than risks. The amount of fluoride added to our city water supplies gets close, routine monitoring to ensure unsafe levels are never present. Furthermore, strong, healthy teeth improve overall health, and a bright smile boosts everyone’s confidence. For parents who fear fluoride health risks, we encourage you to talk to your dentist about your child’s specific situation. Together, you can make an informed plan backed by decades of science to keep your child’s teeth strong and cavity free.
Talk About Fluoride Safety with One of Our Pediatric Dentists
If you’re in the Solon, Aurora, Hudson, or Twinsburg, Ohio area and are looking for a pediatric dentist for your child, we invite you to give Great Beginnings Pediatric Dentistry a call. Our dental practice utilizes fluoride varnish, silver diamine fluoride, minimally invasive dentistry, other cavity-fighting measures to help keep your child’s smile as healthy as possible. Dr. Laura Adelman, DMD, and Dr. Rachel Rosen, DDS, are both accepting new patients under the age of 12. They are happy to discuss fluoride benefits and risks with you in depth.