Understanding Fluoride: Benefits and Concerns

Should you use toothpaste with or without fluoride?

To help decide if fluoride is something you want in your toothpaste, first let’s answer the question, ‘What is fluoride?’

What is Fluoride?

Fluoride is a naturally occurring mineral found in various sources such as soil, rocks, water bodies, and certain foods. It is also synthetically produced for various applications.

In oral health, fluoride is commonly used to prevent tooth decay and strengthen enamel. When applied to the teeth, fluoride can remineralise areas of enamel that have been weakened by acids produced by bacteria in the mouth. This remineralisation process helps to prevent cavities and makes teeth more resistant to decay.

In addition to toothpaste, fluoride is often added to drinking water in many communities to enhance dental health on a broader scale. This practice, known as water fluoridation, has been shown to significantly reduce the incidence of tooth decay in populations where it is implemented.

Is There Fluoride in UK Water?

In many cities and countries, local authorities add fluoride to the drinking water, which has been shown to reduce tooth decay by at least 25%. Fluoride toothpaste provides an additional layer of protection against dental decay and plaque buildup.

In the UK, the decision about whether to add fluoride to the water supply is made by individual local authorities. Areas in the UK where water fluoridation schemes are currently in place include parts of:

• the West Midlands
• the North East
• the East Midlands
• Eastern England
• the North West
• Yorkshire and Humber

Currently, nearly 6 million people in England get artificially fluoridated water. This brings the fluoride level up to around 1mg of fluoride per litre of water, which is the level found to reduce tooth decay levels.

When it comes to toothpaste the concern is that the daily addition of brushing your usual twice a day may add to the amount of fluoride someone is exposed to in a day, however, there are several reasons why some people prefer not to use fluoride.

Dental Fluorosis

A condition called dental fluorosis can sometimes occur if a child’s teeth are exposed to too much fluoride when they’re developing. Mild dental fluorosis can be seen as very fine, pearly white lines or flecking on the surface of the teeth. Severe fluorosis can cause the tooth’s enamel to become pitted or discoloured.

A range of toothpastes are available containing different levels of fluoride. The amount of fluoride in the toothpaste can normally be found on the side of the tube.

However, other than the possible effect on young children, reviews of the risks of fluoride so far have found no convincing evidence to support concerns of being linked to any health conditions.

It’s uncommon in the UK for fluorosis to be severe enough to seriously affect the appearance of teeth. This is because fluoride levels in water are carefully monitored by the Drinking Water Inspectorate (DWI) and adjusted if necessary.

In truth during the early 20th century, research found people who drank water with naturally occurring fluoride had better dental health than people in areas without fluoride in their water supply.

Reducing the Risk of Dental Fluorosis

Fluorosis usually occurs when children who are in the teeth-forming years (before the age of 8) swallow toothpaste rather than spitting it out. Most cases of dental fluorosis are very mild to mild.

In moderate to severe cases, more noticeable and extensive enamel changes happen, including dark spots and pits in the teeth.

The risk of getting too much fluoride from toothpaste is low and primarily a risk for children, who are more likely to swallow toothpaste.

To reduce the risk of dental fluorosis, parents should:

• Supervise children aged 6 and under to discourage swallowing toothpaste.
• Children under 3 years old should brush twice daily, with a smear of toothpaste containing at least 1,000ppm fluoride.
• Children between 3 and 6 years old should brush at least twice daily with a pea-sized amount of toothpaste containing more than 1,000ppm fluoride.
• Children over 7 and adults should brush at least twice daily with a toothpaste containing 1,350-1,500ppm fluoride.

Benefits of Fluoride

To determine whether to use fluoride, it’s good to know what fluoride actually does.

Fluoride strengthens the enamel, making it less receptive to acids, and it promotes the recovery of surface cavities. If you have a high caries susceptibility (i.e. many cavities), brushing with fluoride toothpaste can be beneficial.

Brushing your teeth thoroughly with fluoride toothpaste is one of the most effective ways of preventing tooth decay. Using fluoride toothpaste as part of a regular oral hygiene routine is a cost-effective way to prevent tooth decay and the need for more expensive dental treatments such as fillings, crowns, or root canals.

Fluoride can also help reduce tooth sensitivity by strengthening enamel and blocking microscopic tubules that lead to nerve endings in the teeth.

In addition, fluoride toothpaste not only benefits teeth but also helps maintain gum health. By preventing tooth decay, fluoride reduces the risk of gum disease, as bacteria from decayed teeth can contribute to gum inflammation and infection.

Due to concerns with the levels of fluoride in toothpaste, there is a readily available range of fluoride toothpaste in various formulations and strengths. Bluem® Toothpaste uses calcium fluoride, which is the natural version of fluoride.

Another one of the most common types of fluoride is sodium fluoride. This is a synthetic, industrial version and has been shown to be far more harmful. Bluem toothpaste with calcium fluoride contains only essential, natural ingredients which can help prevent and treat, bleeding and infected gums, as well as other oral complaints such as peri-implantitis and periodontitis.

Unlike many of the unproven risks of fluoride toothpaste, the positive effect of fluoride is supported by decades of scientific research and clinical studies that have demonstrated the effectiveness of fluoride in preventing tooth decay and promoting oral health.

The overwhelming evidence supports the use of fluoride toothpaste as a cornerstone of preventive dental care.

Fluoride’s Effect on Dental Implants

One good reason to avoid fluoride in your toothpaste is when it comes to dental implants.

Most implants are made with titanium, and research has shown that fluoride reacts to the titanium surface layer in implants. This can corrode and damage your implant.

This is why it is recommended that people with implants brush with a toothpaste that contains no fluoride to avoid this corrosive effect.

To summarise, the high fluoride concentration and the acidic pH in toothpaste used to prevent caries may modify the surface structure of implants made of titanium.

Oxidative agents thicken and condense the titanium dioxide layer on the surface of titanium and improve its stability against corrosion effects, while reductive agents like fluoride may have the opposite effect and attack this layer.

Results from tests have demonstrated that fluoride strongly binds to the titanium surface and modifies its structure in the case of fluoride-containing gels.

A dental professional will likely recommend using a fluoride-free toothpaste to help maintain implants or other oral prosthesis.

Overall…

While fluoride toothpaste can contribute to overall oral health and may indirectly support the success of dental implants, it’s essential to follow the specific care instructions provided by your dentist or oral surgeon.

This may include using specialised oral hygiene products recommended for dental implants and attending regular dental check-ups to monitor the health of your implants and surrounding tissues.

Though the debate will continue if fluoride is needed or not needed in our toothpaste or even water supply, there is an abundance of information and research that supports focusing on your oral health, as keeping a healthy mouth helps keep a healthy mind and body.

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Remember; healthy mouth, healthy body.