The Role of Fluoride in Dentistry

PART 2

Fluorides play a central role in the prevention of dental caries and are also used therapeutically for the inactivation of incipient carious lesions. The effect of fluoride is mainly achieved when applied topically, which is further enhanced when accompanied by good oral hygiene.

USES OF FLUORIDE – COMMUNITY-BASED METHODS

Community water fluoridation has been used for over half a century, and results show that the greatest effect of fluoridated water on tooth protection is in deciduous and mixed dentition. Water fluoridation is a simple, cost-effective method to prevent caries, and it is less than the cost of one dental restoration per person in their lifetime. The US Public Health Service recommends a fluoride concentration of 0.7mg/L of water to prevent caries while reducing the risk of dental fluorosis.

Recently, there has been a rise in the consumption of bottled water that usually contains an insufficient concentration of fluoride. In this case, alternative sources of fluoride supplementation should be considered. Also, over the decades, the protective benefits of water fluoridation have declined as other forms of fluoride delivery spread. For example, fluoride supplements are prescribed for children whose primary source of drinking water is deficient in fluoride.

INDIVIDUAL METHODS

There are several ways in which fluoride is used by individuals on a daily basis. They include:

Fluoride Toothpaste

Fluoride toothpaste delivers fluoride to dental surfaces, and it presents mainly as sodium fluoride (NAF). It has been effective in caries prevention of both primary and permanent teeth for decades. Brushing with fluoride toothpaste increases the fluoride concentration in saliva by 100- to 1,000-fold. After one to two hours following the usage of fluoride toothpaste, the saliva concentration returns to the baseline level.

Toothbrushing must start when the first tooth erupts, usually as early as six months. Brushing twice a day with fluoride toothpaste lowers the risk of dental caries by 14%. Efficient plaque removal is attainable only while toothbrushing is supervised in children under four.

Fluoride toothpaste containing 1,000 ppm of fluoride prevents dental caries in the permanent and primary dentition. In the US, the standard concentration of fluoride in toothpaste is 1,000 to 1,100 ppm. Doses of 1,350 to 1,500 ppm are advised for children at high risk of developing caries and seven years of age upwards.

In the early years of childhood, the swallowing reflex of children is not well controlled. For this reason, toothpaste containing 1,500 ppm fluoride is contraindicated in children under six to minimise the risk of fluorosis due to swallowing. The recommended amount of toothpaste for toothbrushing according to age is only a smear of toothpaste in children less than three years of age, and from three to six years of age, a pea-sized amount.