The Great Dental Debate: Fluoride

Every dental professional has an opinion on fluoride and most seem to be on the pro fluoride team. Recently, some dental professionals seem to be switching sides. As a parent, how do we know which side we should be on? Of course, we want to protect our children’s teeth, but could we also be harming them at the same time?

What is Fluoride?

The scientific definition: Fluoride, the 13th most abundant element on the earth’s crust, is a chemical ion of the element fluorine, but fluoride has one extra electron that gives it a negative charge.

Fluoride is found naturally in soil, water, foods, and minerals.  In fact, in some parts of the world, fluoride is so abundant in the fresh water that it can actually be dangerous and cause health problems.

What is the Connection Between Fluoride and Our Teeth?

Fluoride helps teeth in two ways. When children eat or drink fluoride in small doses, it enters the bloodstream and becomes part of their developing permanent teeth. Swallowed fluorides also become part of the saliva and strengthen teeth from the outside. Acids are less able to damage tooth enamel strengthened by fluoride.

In addition, people apply fluoride directly to their teeth when they use a fluoride toothpaste or rinse. Both children and adults also can receive fluoride treatments from the dentist. Fluoride applied to the outside of the teeth helps to speed remineralization.

When Did We Add It To Drinking Water And Toothpaste?

Public water fluoridation was first practiced in the U.S. where fluoridation became an official policy of the U.S. Public Health Service in 1951.  In 2014, 74.4% of the U.S. population had access to public water systems with fluoridated water, a total of over 211 million people. Around 144 U.S. cities have rejected or removed fluoridation since 1990 after some of these cities had fluoridated their water systems for over 40 years.

Fluoride toothpaste was introduced in 1914 and over 95% of toothpastes now contain fluoride. A single strip of toothpaste covering the length of a child’s brush contains between 0.75 to 1.5 mg of fluoride. This exceeds the amount of fluoride in most prescription fluoride supplements (0.25 to 1.0 mg). The FDA now requires a poison warning on all fluoride toothpastes sold in the U.S.

What is the Controversy?

In 2011, the US Department of Health and the US Environmental Protection Agency announced that they wanted to set the recommended level of fluoride to the lowest end of their currently recommended optimal range, which caused some raised eyebrows for people who wondered why these departments were revising their views.  

It is hard to determine how much fluoride a person ingests from all environmental and dietary sources. Because of this, many believe that the fluoride in toothpaste and drinking water is overkill and can lead to dental fluorosis, which is a cosmetic condition case by overexposure to fluoride during the first eight years of life.  This is the time when most permanent teeth are being formed.   In extreme cases fluorosis can result acute fluoride toxicity, specifically in cases where small children swallow toxic amounts of toothpaste.  Fluoride toxicity usually doesn’t have serious health consequences, but the U.S. does see several hundred children each year in the emergency room for fluoride toxicity.

You should monitor your child’s use of fluoride toothpaste and only place a pea-sized amount on the toothbrush.  Also teach your child to spit out the toothpaste after brushing and remind them not to swallow it. 

What Should I Do?

Ultimately the decision is up to you.  There is more than enough information out there supporting both sides of the debate, but the adage “moderation in all things” continues to be relevant advice.  There are also many choices of toothpaste, both with fluoride and fluoride free options.   Consider consulting your dentist or hygienist who might be able to help you understand your child’s current fluoride intake based on your water source, diet, and other daily habits.

Let us know what you think in the comment section below.