Who needs celebrity feuds when you can have the drama, controversy, and debate that surrounds toothpaste ingredients instead? Public opinion on fluoride has been one bumpy roller-coaster ride since the mid-1950s when fluoride was first introduced into drinking water after a large study on children showed improved oral health outcomes. When public health officials tried to introduce fluoride in a small Wisconsin town, for example, a local poet named Alexander Y. Wallace wrote an anti-fluoride song called, “Goodbye, Fluorine.” Before you knew it, a political society claimed fluoride was a communist plot. Today, some people refuse to use fluoride and opt into “fluoride free” toothpaste, despite most dental professionals, the American Dental Association and almost all studies suggesting that fluoride is so essential to the prevention of cavities, that brushing with fluoride free toothpaste may not do anything at all to prevent cavities. So, what’s the real deal on fluoride?
What is fluoride?
Fluoride is a natural mineral which can be found in the earth's crust and throughout nature in different kinds of foods, lakes, oceans, and rivers. If you want to get really scientific, fluoride is actually the chemical ion of the element fluorine, which is one of the top 20 most common elements in the earth’s crust.
Does it really stop cavities?
Because fluoride is an ion (ions are positively or negatively charged atoms) it helps elements combine with each other. When fluorine, which is negatively charged, meets a positive ion like sodium, it forms a cavity-fighting property. When fluoride compounds are introduced into the mouth, they can actually make your enamel stronger, which helps prevent cavities and can even help reverse early tooth decay.
Why that’s a big deal
To understand why fluoride is so significant, it’s important to understand what it’s protecting. Each tooth has a thin layer of protection on the outside, called enamel. Enamel is made up of calcium and phosphate and is actually stronger than bone, making it the strongest substance in the human body! However, due to the typical American diet being very cariogenic, which is dental talk for “cavity causing,” enamel is under attack almost every single day. Sugars and acids that are found in various foods (even foods you wouldn’t think would cause cavities, like pretzels, crackers, diet sodas, etc.) can lower the pH levels in the mouth, making it an acidic environment. Once it’s acidic in there, the enamel will actually start to break down, which is what starts a cavity. If a cavity goes untreated, it can progress into the nerve of the tooth, and cause the tooth to die and lead to loss of the tooth. Scary stuff, right? Well, this is where fluoride can help save the day. When fluoride enters the mouth, either from toothpaste, water, or other sources, and mixes with the ions in the saliva, your enamel actually absorbs it. Once it’s in your enamel, fluoride pairs up with calcium and phosphate and creates a powerful and strong defense system, which helps remineralize early cavities and keeps them from progressing.
Why are some people against fluoride?
The use of fluoride has been widely discussed, especially in recent years as more people have access to the internet and come across articles that claim fluoride has negative side effects. Fluoride is found in community water systems around the world, and because of this, people who read claims about this have questions about why the water needs to be fluoridated. The truth is, the inclusion of fluoride in public water systems has actually been called one of the “Top Ten Greatest Health Achievements of the 20th Century" by the Centers for Disease Control, along with “Recognition of tobacco use as a health hazard” and “motor vehicle safety”. Fluoride in the water systems is at a safe level to be consumed and is recommended by nearly all public health, medical, and dental organizations, like the American Academy of Pediatrics, US Public Health Service, World Health Organization, and the American Dental Association.
A report from the U.S. Surgeon General estimated that 51 million school hours are lost per year because of dental-related illness. Without water fluoridation, that number would likely be much higher. Additionally, the rate of cavities has gone down 25% in adults and children since including fluoride in public water systems.
There is a condition called “fluorosis” where teeth receive too much fluoride in the formative years, causing them to have white spots on them. However, this is only relevant when the teeth are forming. Permanent teeth cannot get fluorosis once they are formed. This is why it can be helpful to visit a pediatric dentist if you have children. A pediatric dentist can help determine how much fluoride is in your child’s water and provide fluoride supplements as needed to help prevent cavities without the negative side effects.
Your personal dental pro knows your needs best.
While the water you drink may be fluoridated, it is still important to consult your dentist about how to best prevent cavities and keep your teeth healthy. The amount of fluoride in water is minimal, which is why it’s often helpful to choose a toothpaste with fluoride, to help keep your enamel strong by using it twice a day.
Additionally, your dentist or hygienist may want to put an additional layer of fluoride on your teeth at your dental visit via a foam or a varnish, or prescribe a toothpaste with high amounts of fluoride depending on your risk for developing cavities. Talk your dentist about any concerns you have about fluoride or cavities so that they can help provide the resources and dental treatment you need to have a healthy smile for life!