Fluoride is a naturally occurring mineral that protects the teeth from decay. It stops the demineralization of the good enamel and helps enhance the remineralization of bad enamel on the teeth.

It seems that there is a complex relationship between systemic (body concentration) and topical (on the surface of the teeth) fluoride, as the concentration of fluoride in the enamel does not completely explain how we achieved such a marked reduction in cavities by adding fluoride to water. There seems to be at least some level of topical protection from the systemic fluoride from salivary secretion of fluoride as well. And, who’s to say that some of the topically applied fluoride doesn’t get into our system as we swallow a small amount?

Here in Hawaii, we do not add fluoride to the water. So, the fluoride needs to come from either your doctor or your dentist. According to the American Academy of Pediatric Dentistry 2014 update, there are three recommended ways to provide fluoride to your child:
1. Oral supplementation – This dose is based on the age (and on the amount of fluoride in your water) and can be combined with a multiple vitamin. I’ve been advised by several experts in the area (taste-testers under the age of 6) that the fluoride only is palatable, but the multiple vitamin combination is quite “icky.”
2. Professionally applied treatments – These are usually done by a dentist in his office every 3-6 months.
3. Fluoridated toothpaste – This is my least favorite of the options as a stand-alone source of fluoride. It is the most cumbersome for parents as it does require ensuring the correct amount of fluoride – in the toothpaste, the amount of toothpaste used, the frequency of the brushing, and avoiding rinsing after brushing. And all of these factors need to change with age.

As with everything, there is always a risk. Excessive fluoride can cause dental fluorosis, which can cause irregular coloration of the teeth. This usually presents as white lacey spots on the surface of the tooth, but a stronger form can appear as an opaque white area. A very severe, very rare form can cause some brownish discoloration or pitting of the teeth. This is why it is important to get the correct dosing; as the severe form usually occurs when the community has water fluoride levels greater than 2 mg/L (current recommendations are 0.7 mg/L).

Babies will get some fluoride via breast milk if mom is drinking fluorinated water. Bottle fed babies will get fluoride from two separate sources – a small amount from the formula and from the water used for preparing a concentrate. Most of the fluoride found in infant formula will come from the water, as the amount in the formula itself is quite small. To avoid giving the baby too much fluoride, a low-fluoride bottled water can be used to mix the formula; these are labeled as purified or demineralized and can be purchased at most stores.

I like my teeth. I like my teeth intact. I have paid extra, even when I was living on noodles and butter in medical school, just to have a cavity filled with tooth-colored filling instead of the silver. My waistline may have paid the ultimate price, but I’d be certain my smile wouldn’t.
We’ve seen more studies linking periodontal disease and systemic diseases (cardiovascular, infection, diabetic, etc). Perhaps we’ll see studies linking fluoride into the picture as our knowledge continues to grow. For now, I’ll continue to request tooth-colored fillings on the rare occasion they are needed. But I’ll do everything in my power to prevent cavities from appearing in the first place, for both me and your child.


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