• Fluoride Information 

• • What is Fluoride: Fluoride is nature's cavity fighter and occurs naturally in varying amounts in water sources such as rivers, lakes and even the oceans. Fluoride is naturally present to some extent in certain foods and beverages but the levels vary widely. To help protect teeth from cavities, fluoride is also added to some dental products such as toothpaste. 

• • How does it help your teeth: Fluoride benefits both children and adults. Here's how: 
    Before teeth break through the gums (erupt), the fluoride taken in from foods, beverages and dietary supplements makes tooth enamel (the hard surface of the tooth) stronger, making it easier to resist tooth decay. This provides what is called a "systemic" benefit. 

• • After teeth erupt, fluoride helps rebuild (remineralize) weakened tooth enamel and reverses early signs of tooth decay. When you brush your teeth with fluoride toothpaste, or use other fluoride dental products, the fluoride is applied to the surface of your teeth. This provides what is called a "topical" benefit. 

• • In addition, the fluoride you take in from foods and beverages continues to provide a topical benefit because it becomes part of your saliva, constantly bathing the teeth with tiny amounts of fluoride that help rebuild weakened tooth enamel. 

• Public Health Fluoridation 

• • Benefits of Fluoridated Water: Fluoridated water helps prevent tooth decay in children and adults. Studies prove water fluoridation continues to be effective in reducing tooth decay by at least 25% in children and adults, even in the of era widespread availability of fluoride from other sources, such as fluoride toothpaste. Simply by drinking water, people can benefit from fluoridation's cavity protection whether they are at home, work or school. 

• • Because of its role in the prevention of tooth decay, the Centers for Disease Control and Prevention has proclaimed community water fluoridation as one of ten great public health achievements of the 20th century. 

• Fluoride Toothpaste Quantity 

• • Fluoride Toothpaste Quantity: For children younger than 3 years, parents and caregivers should begin brushing children’s teeth as soon as they begin to come into the mouth by using fluoride toothpaste in an amount no more than a smear or the size of a grain of rice. 

• • For children 3 to 6 years of age, parents and caregivers should dispense no more than a pea-sized amount of fluoride toothpaste. 

• • Teeth should be brushed thoroughly twice a day (morning and night) or as directed by a dentist or physician. Children’s brushing should be supervised to ensure that they use the appropriate amount of toothpaste. 

• Over-exposure to Fluoride 

• • Over-exposure to fluoride: Chronic over-exposure to fluoride in high doses during early childhood can cause dental fluorosis, or the presence of white or discolored spots in the enamel layer of teeth. This is harmless and can actually make teeth less prevalent to superficial decay. Exposure to higher levels of fluoride throughout the rest of adolescent and adult life and make someone prone to skeletal fluorosis, which is accumulation of fluoride in bone structure throughout the body. In severe cases, this can cause symptoms like soreness or stiffness in joints.  

• • Acute ingestion of high doses of fluoride such as a child eating a large amount of prescription fluoride toothpaste, can cause nausea, vomiting, or death if the ingested amount exceeds 5mg/kg of bodyweight. This kind of reaction would be almost impossible with over-the-counter fluoride products, as it would require consumption of multiple full tubes of toothpaste, which would make most people vomit before they consume a lethal dose.  

• • Some studies have shown an association between high maternal consumption of fluoride and neurodevelopmental effects or cognitive delays in young children. Most experts agree that the evidence in these studies is not very high quality, and the methods used in the studies are flawed. However, more research is needed to determine the impact of high levels of fluoride use during pregnancy and breast-feeding. Normal use of over-the-counter fluoride products, prescription fluoride products, and water fluoridated to acceptable levels is safe and helpful for preventing cavities. 

• • Resources: https://www.ada.org/resources/community-initiatives/fluoride-in-water/fluoridation-faqs#:~:text=Fluoride%20at%20the%20much%20lower,body%20weight%20of%20sodium%20fluoride). 

• • https://ods.od.nih.gov/factsheets/Fluoride-HealthProfessional/ 

• Fluoride alternatives (Hydroxyapatite) 

• • Nano-Hydroxyapatite is the best available fluoride alternative that can be added to toothpaste to make it more effective at preventing decay, decreasing sensitivity, and preventing the growth of harmful bacteria in the mouth. Hydroxyapatite is the mineral responsible for forming the structure of tooth enamel naturally. Nano-hydroxyapatite is a synthetic version that can be added to oral care products. While it is still relatively new on the market, it has been around in some forms for over 10 years now and has been studied well. It has been shown to eliminate the risk of dental fluorosis while providing similar benefits like arresting superficial decay in the enamel, remineralizing enamel structure, and preventing plaque formation. The other advantage is that it has no toxic effects, so it is safe to swallow, which can be helpful for children and people with behavioral disorders who might swallow toothpaste when their teeth are being brushed. It can also be used in very young children before they develop the ability to spit out toothpaste. 

• • While all toothpastes are designed to remove plaque, without an active ingredient to rebuild enamel like fluoride or hydroxyapatite, they will not be as effective in preventing decay. If fluoride cannot be used for either personal reasons or due to safety concerns with ingestion of excess fluoride, we recommend using a remineralizing alternative toothpaste with hydroxyapatite. 

• • For more information on how it works and studies that have been done, you can explore this review of nano-hydroxyapatite studies: https://pmc.ncbi.nlm.nih.gov/articles/PMC8930857/ 

Infants and Young Children

• Check out our Povidone Iodine Handout
• Povidone Iodine is a water-based liquid that can be applied to the teeth to prevent tooth decay. It prevents tooth decay by mixing with your saliva and killing cavity-causing bacteria. It has also been shown to make plaque less likely to stick to teeth. Reactions or allergies to it are very rare and it has been used in the dental setting for over 50 years. For more information on how to use it, check out our Povidone Iodine handout above.

• Water flossers, or oral irrigators, are very useful as a supplement to dental hygiene. They are very effective at cleaning smaller and harder to reach areas of the teeth and gums and can help reduce inflammation of the gums when used correctly. They are recommended especially for patients with dental implants, bridges, braces, and crowns and may be recommended for patients with periodontal disease. They are not a substitute for string floss, which is still the only way to fully clear the contact point between your teeth.  

• For more information on how to use them, please visit: https://oralb.com/en-us/oral-health/why-oral-b/floss/how-to-use-water-flossers 

• Oil pulling involves the daily use of edible oils like coconut, sunflower, or sesame oil to clean the teeth and gums. The technique is to swish 1 teaspoon of oil through the teeth and gum for 15-20 minutes. As the process is done, the oil will change from thick oil to thin white liquid. The process can help to neutralize some types of bacteria and inhibit bacterial growth. Many studies have been done on its effectiveness, only a handful of which have held up to scrutiny within the scientific community. The consensus, as seen in the meta-analysis linked below, is that the potential benefits can involve soothing the gum tissue, killing bacteria that cause bad breath, and decreasing some overall bacterial colony formation in the mouth. However, it has not been shown to reduce plaque index on teeth or to gingival scores (pocketing related to gingival inflammation). It is not an alternative to normal daily brushing and flossing. The side effects are usually negligible, with only upset stomach from swallowing some amount of oil during the process. So, it is considered safe and a potentially helpful oral health adjunct, but compared to regular essential oil mouthwashes, it takes a longer time and is no more effective.  

• https://pmc.ncbi.nlm.nih.gov/articles/PMC9602184/ 

• Chewing sugar-containing gum can lead to cavities, as the exposure to sugar can be for a very long duration when chewing it, which can increase acid production in the mouth by cavity-causing bacteria. Chewing gum with sugar is not recommended for anyone at risk for developing dental decay. 

• Chewing sugar-free gum, however, is a great way to increase the flow of saliva in two ways. First, the chewing motion of the mouth will increase saliva flow. Second, the activation of taste receptors with the flavor of the gum will also increase saliva flow. This can be a great way to reduce risk of cavities in people with dry mouth, especially when saliva flow is decreased by medicines.  

• Additionally, gum sweetened with xylitol, a sugar-alcohol that does not cause cavities, can have a protective effect on teeth. Xylitol has been shown to reduce the number of cavity-causing bacteria (S. mutans) in saliva. Since it is a powerful sweetener, it also further stimulates saliva production. 

• https://www.ada.org/resources/ada-library/oral-health-topics/chewing-gum 

• https://pmc.ncbi.nlm.nih.gov/articles/PMC4232036/#:~:text=An%20anticaries%20effect%20of%20xylitol,xylitol%20positively%20impacts%20permanent%20teeth.