How does fluoride prevent tooth decay?
Fluoride (F-) helps by inhibiting demineralisation and promoting remineralisation of the enamel, inhibits acid production and ability for bacteria to process the dietary sugars
F- systemically is transported in saliva and crevicular (gum) fluid
Is there a recommended amount of fluoride?
Recommended F- supplementation is 1mg per day over the age of 6. Even if you are drinking the tap water it is best to supplement it with a daily fluoride toothpaste and/or mouthwash.
You can measure your dosage if you calculate the amount of water you drink (0.5-0.8 ppm in Perth metropolitan) and the amount of topical fluoride you put on your teeth (in the form of mouthwash or toothpaste).
Does it change for age or pregnancy?
The changes in recommendation are for children under the age of 6, which 0.5mg per day is recommended and if they are under 3 then it is reduced to 0.25mg.
Pregnancy doesn’t change as the placenta doesn’t allow much to cross and pre natal fluoride is relatively ineffective but there is trace amounts of F- in breastmilk.
How much fluoride is in toothpaste and mouthwash?
Toothpaste is usually 1000-1500ppm so is 1-1.5mg/ml. Mouthwash at a concentration of 0.05% equates to 0.23mg F-/ml.
What is a safe dose?
A safety tolerated dose of fluoride is 1mg/kg of body weight. A toxic dose is considered to be 5mg/kg for a standard person. This means that a 60kg would have to ingest 300mg so 300ml of toothpaste to requires hospitalisation.
Do I really need fluoride if my teeth are good?
Recommended amounts do change depending on your risk factors.
In higher socioeconomic populations that have good oral hygiene the benefits of fluoride in the water are less because they are lower risk for decay BUT fluoride in the water has shown to decrease decay rates in children by 50% in high risk populations.
I do not use fluoride and don’t want it used on me. Can I still come to your practice?
As an open minded dentist I believe that everyone should have a choice as to whether to have fluoride or not. There are measures you can take to ensure a non mains or filtered water supply ie rainwater tanks, use of reverse osmosis machines, water filters if you feel strongly about this. I you are someone who doesn’t eat decay causing foods (ie refined sugars or even carbohydrates), has good oral biology (some people have more “bad” bacteria present than others) and good oral hygiene and visit the dentist for regular check ups then fluoride will have limited benefit for you. If you are one of these people who are therefore lower risk, then the need for fluoride supplementation is minimal and I support using fluoride free toothpastes and filtering the water (we actually have a reverse osmosis system in the practice). We actually have herbal toothpaste samples and I don’t have fluoride in our prophy paste or routinely apply it during a check up.
BUT for those who are higher risk it is a very effective widespread measure to prevent all the problems that come with dental decay in children. I’ve had to do fillings in 3 yr olds and also send 2 yr olds to have general anaesthesia to have their teeth taken out due to decay. I believe that this is FAR worse than the supposed ill effects which fluoride may have. WA has 15000 hospitalisations due to dental abscesses and 2 people a year still die from dental infections. People dying from preventable diseases is ridiculous in a first world, educated country. If fluoride in the water would prevent these things then I am a supporter of it.
