What role does fluoride play in preventing tooth decay?

You've probably heard that fluoride is a good thing for teeth. This is true. Fluoride, in moderation, is a very good thing for teeth for people of all ages.

An exposure to fluoride (like that contained in toothpaste and city tap water) is probably the most effective cavity prevention treatment available today. Dental researchers have shown that just introducing fluoride into a (previously unfluoridated) city's drinking water supply can reduce its inhabitants' rate of tooth decay between 40 and 70 percent. Those are giant numbers.

Are you curious if city's water supply is fluoridated? Click this link for information about your town provided by the US Centers for Disease Control and Prevention. [A new browser window will be opened.]

How does fluoride help to prevent tooth decay?

Fluoride combats the formation of tooth decay in three principle ways:

A) Fluoride promotes tooth remineralization.
Fluoride promotes the remineralization process. Tooth decay forms under dental plaque.

Researchers have discovered that fluoride enhances the tooth remineralization process. Fluoride found in a person's saliva will adsorb onto the surface of a tooth where demineralization (tooth decay formation) has occurred. The presence of this fluoride then in turn actually attracts other minerals (such as calcium), thus helping to speed up the rate or degree to which remineralization (reformation of tooth mineral) will occur.

To receive the benefit of this process fluoride must be present in a person's saliva. This is why drinking fluoridated tap water throughout the day would be a better choice (in regards to cavity prevention) than unfluoridated bottled water. This is also a reason why brushing with a fluoride toothpaste three times a day would be better than brushing just once a day.

B) Fluoride can make a tooth more decay resistant.

Amazingly, the new tooth mineral that is created by the remineralization process when fluoride is present is actually a "harder" mineral compound than the one that was present when the tooth initially formed.

Teeth are generally composed of the minerals hydroxyapatite and carbonated hydroxyapatite. The tooth mineral that is created during the remineralization process when fluoride is present is fluorapatite. Fluorapatite is "harder" than other tooth minerals in the sense that it is more resistant to damage caused by acids (demineralization). So, astoundingly, not only does fluoride promote the tooth's remineralization but it also helps to create a tooth surface that is even more resistant to the formation of tooth decay.

C) Fluoride can inhibit oral bacteria's ability to create acids.

Dental researchers have found that fluoride can decrease the rate at which the bacteria that live in dental plaque can produce acids. This is because fluoride disrupts the bacteria's ability to metabolize sugars. The less quantity of sugar that the bacteria can consume, the less acidic tooth demineralizing waste products they will produce.

Factor in the formation of tooth decay :
Fluoride helps to provide protection from tooth decay in a variety of ways.

Cavity prevention suggestions :

* In regards to cavity prevention, what you want is for your saliva to contain a low level of fluoride over a prolonged period of time. Brushing three times a day with a toothpaste that contains fluoride can help to provide this. So can drinking fluoridated tap water, as opposed to unfluoridated bottled water.
* Look for toothpastes that have the American Dental Association's (ADA) "Seal of Approval." This seal indicates that the ADA has evaluated the product and found its fluoride content to be appropriate.
* Read your toothpaste's instructions and ask your dentist for their recommendation in regards to its use with children. Toothpaste should always be spit out and never swallowed. In all cases fluoridated toothpaste should be kept out of the reach of children and only dispensed to them by an adult. [More information about the use of fluoride toothpaste with children.]

On to page 5 and more about tooth decay formation. >

What is dental fluorosis?

Teeth with fluorosis staining.

Dental fluorosis is a condition that is caused by the chronic ingestion of too much fluoride during that time period when a child's tooth enamel is forming. This condition is evidenced by the tooth staining that it causes.

The vast majority of dental fluorosis that occurs in the United States is a mild form characterized by the appearance of chalky-white lines or opaque-white patches in a tooth's enamel. More severe forms of fluorosis can occur however. In extreme forms the affected areas have a yellow or brown discoloration. In some cases severe forms of fluorosis will result in a pitted tooth surface. [For a real life example of fluorosis, see our Cosmetic Dentistry section, case # 8.]

In order to cause dental fluorosis the fluoride must be ingested (swallowed) during that time period when the child's tooth enamel is forming. The most critical years associated with the formation of dental fluorosis lie between birth and age 6 or 7. Because the fluorosis staining occurs while the teeth are developing, evidence of this stain cannot be visualized until the affected teeth have erupted, which is typically between the years 6 through 12.

Swallowing toothpaste can cause dental fluorosis.

A common source of ingested fluoride is toothpaste. All small children, but especially those younger than age 6, may not be able to reliably spit out toothpaste when brushing. That fluoride toothpaste which is swallowed can lead to the causation of dental fluorosis.

The following suggestions can help to minimize the risk for developing dental fluorosis from the ingestion of fluoride toothpaste:

* Children should be instructed in good brushing and rinsing habits and then supervised when brushing, so to avoid toothpaste swallowing.

* Read your toothpaste's instructions. Typically only a small dab of toothpaste is needed, one the size of a green pea. Fluoridated toothpaste should be dispensed by an adult.

* As your dentist for their recommendation but in most cases an unfluoridated baby tooth cleanser should be used with children 2 years and under.

* Store fluoridated toothpaste out of the reach of children.

* When a fluoridated toothpaste is used look for one which has the American Dental Association's (ADA) "Seal of Approval." This indicates that this organization has evaluated the toothpaste and found its fluoride content to be at both a safe and effective level.

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