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Family Health Magazine - DENTAL HEALTH

Fluoride
Why you need it

Fluoride is a mineral essential for forming and maintaining sound teeth and bones. Since the early 1940s, fluoride has been one of the most effective ways to control and prevent dental cavities.

The carbohydrates and sugar you eat mix with bacteria in your mouth, creating acids that attack tooth surfaces. Minerals are then lost from both enamel and cementum, the bone-like connective tissue that covers roots, helping keep teeth in their sockets. If left undisturbed, bacteria can eventually penetrate the tooth forming a cavity. Fluoride helps prevent and reverse the process by coating tooth enamel, making it harder.

Fluoride can be absorbed in two ways: systemically (from foods we eat or drink) or through topical application (being put on the teeth). Drinking water from a fluoridated community water supply or bottled water is the most common source. Supplements, including tablets, lozenges or drops, can also provide fluoride.

Fluoride content is low in most foods, and varies from place to place depending on soil mineral content. Food sources of fluoride include tea, seafood, mechanically separated (canned) chicken, and some fruits and vegetables. In some areas, foods are processed using fluoridated water. Depending on the amount consumed, such processed cereals, juices, and carbonated soft drinks may contain sufficient fluoride to make supplements unnecessary.

Topical fluoride can be applied directly to tooth enamel in toothpaste, mouth rinse, gel and foam. It can also be done with a fluoride varnish in the dentist's office.

Most of us get fluoride daily in our toothpaste when we brush our teeth. But is that enough? Your dentist and dental hygienist weigh many factors when deciding your risk of cavities. They take a thorough medical and dental history, review medication, and do an oral health examination, considering your age, your diet, your lifestyle, how often you get cavities, and how well you clean your mouth. This information allows your dentist and hygienist to plan a fluoride program tailored to you.

Fluoride through the ages

Fluoride is important for everyone. Across the span of a lifetime, we experience oral and dental changes. Dental professionals plan individual strategies for each client, considering conditions that can be present at various stages of life. They also look at common patterns that show up at specific ages.

As baby teeth erupt during infancy and early childhood, each tooth is at risk. Poor nutrition, bad habits and lack of early dental care can mean early childhood cavities. Since small children are unable to swish and spit well, fluoride mouth rinses cannot be used at this age. Parents should supervise or do daily brushing, using a pea-sized amount of fluoridated toothpaste. Dental professionals can also 'paint' fluoride on young children whose mouths are too small to fit the fluoride tray usually placed over the teeth.

As children grow into the teen years, baby teeth are replaced by permanent ones. These teeth are also at risk. The hormones of puberty can contribute to gum disease. Nutrition and lifestyle play a role in dental health - for instance, many teens consume excess soft drinks. Using tobacco products increases the risk of oral disease. Braces and appliances make cavities more likely. All adolescents can benefit from daily brushing with fluoridated toothpaste. If the water supply is low in fluoride, tablets or lozenges are recommended. Fluoride rinses are another option for those old enough to swish and spit.

From young adulthood through middle age, cavities, crowns, and even root canals are all possibilities. In midlife, bone around teeth tends to deteriorate, often coupled with gum disease and recession. Tooth sensitivity is common. Prolonged tobacco use increases the risk of oral cancer and further destruction of bone and gum tissue. Dental office fluoride treatments should continue for those at risk of cavities. Fluoridated water and daily use of fluoride toothpastes, mouth rinses and gels can also help.

For those aged sixty to seventy-nine, root cavities and recurring cavities are common. Since this group is more likely to be ill and taking medication, dry mouth, tooth sensitivity, further deterioration of bone, and oral infections are all possibilities. Dentures, whether permanent or removable, may affect teeth. Professional fluoride treatments are recommended for those with a moderate to high risk of cavities. Fluoride gels or varnish can help if teeth are overly sensitive.

Many over the age of 80 are not only living longer but have kept their natural teeth. Root cavities, reoccurring cavities, and further destruction of bone and gum tissue can all be problems. Dental office fluorides should be applied to exposed root surfaces. Fluoride gel in trays and mouth rinses for home use may be recommended. Fluoride varnishes and toothpastes designed for sensitive teeth are highly effective.

The following basic guidelines can be used for starting a fluoride routine.

• Follow your dentist's instructions when using fluoride at home. Ask for printed directions if you need them.
  
• Supervise the daily care of your child's teeth and mouth. Teeth should be brushed with a pea-sized amount of toothpaste to prevent excess fluoride being swallowed.
• Keep all fluoride products out of the reach of small children.
• Brush your child's teeth before using chewable fluoride tablets. Avoid eating and drinking for at least 30 minutes after use. It's best to do this just before going to bed.
• Control dietary sugars, particularly between meals.
• See your dentist and hygienist regularly.
• Use fluoridated drinking water where available.
• If you drink bottled water, check the label to see if it is fluoridated. If it is not, fill your own bottles from a fluoridated water supply.

Fluorosis

Whatever your routine, the use of fluoride should always be supervised by your dentist. Enamel fluorosis can affect children who swallow too much fluoride while teeth are developing. In mild cases, small white flecks or spots can appear on tooth enamel. Moderate fluorosis can emerge as mottling and mild staining, while severe cases show marked staining and pitting.

Several situations encourage the development of enamel fluorosis. A child may take more of a fluoride supplement than directed. Supplements may be taken when there is already enough fluoride in the drinking water. It can also result from kids liking the taste of toothpaste, using too much and swallowing it instead of spitting it out.

How can enamel fluorosis be prevented?

Your dental professional can tell you how much fluoride is already in your drinking water. Armed with this information, you can decide together whether your child needs a fluoride supplement.
Monitor your childÕs use of toothpaste. Make sure only a pea-sized amount is used, and teach your child to spit it out rather than swallowing it.

Should I avoid fluorides for my child?

No. Fluoride prevents cavities, helping your child maintain a healthy smile for a lifetime. Just make sure that your child is getting enough, but not too much. Your dentist or hygienist can provide more information.

Fluoride is an important part of preventive oral health care. Without frequent exposure to fluoride, many people would suffer from unnecessary oral health problems. While some live in areas where the water has fluoride, others may need to supplement. Caring for teeth from childhood on remains the most effective way to combat cavities. Using fluoride appropriately throughout life is a key part of today's preventive approach to oral care.

Cavity risk assessment Once you know whether your risk of cavities is low, moderate, or high, you can determine the fluoride routine that is best for you.
	CHILDREN	ADULTS
LOW RISK	No new cavities in the past year	No new cavities in the past year
MODERATE RISK	One new cavity in the past year Deep grooves and pits on chewing surfaces High cavity risk in siblings or parents Malformed enamel or dentin Early childhood cavities Decrease in saliva flow Not brushing or flossing well Few regular visits to the dentist or hygienist Lack of fluoride Cavities between teeth on x-rays	One or two new cavities, or a reccurring cavity in the past three years History of many or serious cavities Deep grooves and pits on chewing surfaces Malformed enamel or dentin Frequent eating of sugar Decrease in saliva flow Not brushing or flossing well Few regular visits to the dentist or hygienist Lack of fluoride
HIGH RISK	Two or more new or reccurring cavities in the past year, or two or more of the following:	Three or more new or reccurring cavities in the past year, or two or more of the following:
	Deep grooves and pits on chewing surfaces Malformed enamel or dentin Siblings or parents with many cavities History of cavities in grooves and pits on chewing surfaces Early childhood cavities Frequent eating of sugar Not brushing or flossing well Few regular dental visits Lack of fluoride Cavities between teeth on x-rays High numbers of bacteria in mouth Braces or orthodontic appliances	History of many or serious cavities Malformed enamel or dentin Deep grooves and pits on chewing surfaces Lack of saliva Frequent eating of sugar Not brushing or flossing well Root surfaces exposed by gum recession High numbers of bacteria in mouth Braces or orthodontic appliances
	DENTAL OFFICE THERAPY	HOME THERAPY
LOW RISK	No fluoride treatment required for adults Fluoride treatment recommended twice a year for children regardless of cavity risk	Use toothpaste with fluoride two to three times per day
MODERATE RISK	Fluoride treatment once or twice a year or fluoride varnish twice a year Reduce sugar intake and modify diet Seal deep grooves on chewing surfaces with pit and fissure sealants	Use a fluoride supplement as directed or recommended by your dental professional Use toothpaste with fluoride two or three times a day Use a fluoride rinse for one minute once a day
HIGH RISK	Fluoride treatment two to four times a year or fluoride varnish two to four times a year Reduce sugar intake, modify diet Seal deep grooves on chewing surfaces with pit and fissure sealants	Use a fluoride supplement as directed or recommended by your dental professional Use toothpaste with fluoride two or three times a day Use fluoride gel in a tray from your dental office as directed Use a saliva substitute if you suffer from dry mouth

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While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specifid medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physican promptly. Copyright 2006, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1  [DH_FHa06]