General Dentistry Concepts: Fluoride therapy
Fluoride therapy involves the use of fluoride for medical reasons. Fluoride is recommended in children over the age of 6 months to prevent tooth decay in areas where the fluoride drinking water is low. It is typically consumed as a liquid, pill or paste and taken orally. In instances where the public water supply is fluoridated, additional fluoride is not normally needed. Fluoride has also been used as a treatment for a number of bone diseases.
Standard doses of fluoride can occasionally result in white marks across the teeth. Excessive doses can cause brown or yellow discoloring on the teeth. Fluoride therapy typically uses the sodium fluoride form. Stannous fluoride can also be used for therapy. Fluoride helps to decrease breakdown by acids, increase remineralization, and decrease the amount of bacteria present. It is believed to to be most effective through direct contact with the teeth once they have emerged.
In the 1940s, fluoride was introduced as a way to prevent tooth decay. Fluoride, such as sodium fluoride, is included on the World Health Organization's list of essential medicines, the most effective and safe medicines needed in a health system. It is very inexpensive. Sodium fluoride was the 215th most prescribed medication in the United States in 2016, with over 2 million prescriptions.
Fluoride therapy has been proven to be an effective way of prevention dental cavities. Robust evidence also supports the use of fluoride toothpaste which contains a concentration of 1000 ppm or more. Fluoride supplements, consumed as drops or tablets has also been found to reduce the risk of dental cavities in both school-aged children and adolescents. Ingesting fluoride as the primary teeth are developing has resulted in the teeth forming stronger and being more resistant to cavities. Water and milk fluoridation are two forms of systemic fluoride therapy which have been effective in the prevention of dental cavities.
Fluoride supplementation has also been studied extensively in the treatment of postmenopausal osteoporosis. While sodium fluoride increases bone density, it does not appear to be effective in preventing osteoporosis as it does not lower the risk of fractures.
Delivery: Water fluoridation
Water fluoridation involves the addition of fluoride in a controlled manner to a public water supply. Water fluoridation is conducted in an effort to reduce the risk of tooth decay. Water fluoridation in the United States began in the 1940s, after studies were conducted of children in a region where water is naturally fluoridated. In 1945, Grand Rapids, Michigan was the first city in the world to proactively fluoridate its drinking water. The Grand Rapids water fluoridation study was initially sponsored by the U.S. Surgeon General, but was eventually taken over by the NIDR shortly after the institute was created in 1948. It is now used for about two-thirds of the U.S. population who uses a public water system and for about 6% of the population worldwide.
Most toothpastes contain between 0.22% and 0.312% fluoride. Toothpastes usually contain the form of sodium fluoride or sodium monofluorophosphate (MFP). Frequent use of a toothpaste which contains 1,100 ppm fluoride content has shown to enhance the remineralization of enamel and help prevent the demineralization of enamel and root surfaces. Most toothpastes that contain fluoride, also contain a mild abrasive in order to remove heavier debris and any light surface staining. These abrasives that are commonly used include calcium carbonate, silica gels, magnesium carbonates and phosphate salts.