Fluoride Treatment: Types, Benefits & Risk Factors

What Is Fluoride?

Fluoride is a naturally occurring mineral found in rocks and soil. It helps prevent tooth decay.

The mineral is found naturally in:

• Water
• Soil
• Plants
• Air
• Rocks

Over the last 70 years, small amounts of fluoride have been added to the following to help strengthen tooth enamel:

• Drinking water
• Toothpaste
• Mouth rinses
• Professional dental materials

Once ingested, your blood absorbs the mineral through the digestive tract. It collects in the bones and teeth.

In young children, fluoride is especially useful in preventing dental caries (cavities). This is because baby tooth enamel is thinner and more prone to decay.

Since the introduction of added fluoride, there has been a dramatic decrease in dental caries in children and adults.

Benefits and Dangers of Fluoride

There are both benefits and dangers of fluoride use.

Benefits of Fluoride

Concerning cavity prevention, there are three main benefits of fluoride:

1. It increases the resistance of tooth structure to demineralization. This resistance reduces the content of mineral substances in teeth.
2. The mineral also enhances remineralization. Remineralization is the process of rebuilding tooth structure and enamel strength. It is the opposite of demineralization.
3. Lastly, it reduces the risk of dental plaque formation and buildup. Plaque leads to the formation of cavities and tooth decay.

Dangers of Fluoride

Fluoride is a highly toxic substance on its own. Excessive consumption can cause a range of adverse health effects.

For example, common conditions include:

Dental Fluorosis

Excess fluoride intake from water with more than 0.7 ppm of fluoride can cause dental fluorosis.

Fluorosis is the hypomineralization of tooth enamel.

This leads to abnormal enamel development and the formation of the following on the teeth:

• White streaks
• Yellow stains
• Brown stains

Skeletal Fluorosis

Excessive fluoride exposure can also lead to skeletal fluorosis. This condition damages the parathyroid glands. These are glands in the neck that control calcium levels.

Further, the condition may cause the following in older adults:

• Joint stiffness
• Joint pain
• Weak bones
• Fractures

Other Health Conditions

Long-term exposure of fluoride may link to other health conditions, including:¹⁰

• Dermatological (skin) conditions, such as acne
• Weakened bones
• Bone fractures
• Osteosarcoma (bone cancer)
• Diabetes
• Osteoarthritis
• Thyroid dysfunction
• Weakened immune system
• Hypertension
• Heart issues, such as cardiac failure and cardiac insufficiency
• Neurotoxic effects, such as ADHD
• Temporomandibular joint disorder (TMJ)

Fluoride Treatment Types

The effects of fluoride are either topical or systemic:

Topical Fluoride

Topical effects are obtained through the use of:

• Fluoride toothpaste
• Mouth rinses
• Other concentrated forms of the mineral used at home or professionally in a dentist’s office

Fluoride also strengthens teeth and makes them less susceptible to decay-causing bacteria.

Dentists recommend this type of treatment for children's teeth between three and six years.

Adolescents, teens, and adults also benefit from topical fluoride treatment.

This includes:

• Self-applied toothpaste
• Professionally applied treatments. For example, gels, pastes, and varnishes.

Self-Applied Topical Treatments

You can use self-applied fluoride dental products at home every day. The most common forms include toothpaste and mouthwash:

Fluoridated Toothpaste

Fluoridated toothpaste is the most popular form of self-applied fluoride in the world. It is available over-the-counter.

Children and adults should brush their teeth with fluoridated toothpaste twice a day for the best protection. Parents should consult their child's dentist about the use of fluoridated toothpaste if they are under two years old.

Children under six years of age should use only a pea-sized amount of toothpaste every time they brush to prevent dental fluorosis.

Mouthwash

Similar to fluoridated toothpaste, rinsing with mouthwash reduces the chance of decay in children and adults.

The most common compound used in mouth rinse is sodium fluoride.

Sodium fluoride is retained in saliva. It reduces dental plaque and helps prevent tooth decay.

Professionally Applied Topical Treatments

Professional topical treatments are completed in a dentist’s office at least twice a year:

Mouth Rinses, Foams, and Gels

Professional foams, rinses, and gels contain more fluoride than self-applied toothpaste and mouthwash.

This treatment is only necessary a few times a year. As such, fluoride gel poses little risk for dental fluorosis. This is even for patients under six years of age.

Professional treatment is typically beneficial for people who have a high risk of tooth decay.

Those living in areas with low water fluoridation and patients who do not brush with fluoridated toothpaste also benefit from this treatment.

Systemic Fluoride

Systemic effects are obtained through the ingestion of liquids with natural fluoride levels. This includes water containing natural fluoride and water with added fluoride.

Patients can also obtain fluoride supplements.

In addition, supplemental fluoride is commonly prescribed to children between six months and 16 years who live in areas with drinking water low in fluoride or those with a high risk for tooth decay.

Systemic forms of the mineral helps form tooth structure. It also provides topical protection against tooth decay.

Community Water Fluoridation

Water fluoridation is the foundation of cavity prevention in children and adults.

Fluoride is the most efficient way to help communities in the following ways:

• Strengthen tooth enamel
• Reduce tooth decay
• Improve overall dental health

Some communities in the United States have natural sources of fluoride. However, most municipal water sources add the mineral into tap water as a public health measurement.

The Department of Health and Human Services (DHHS) determined the optimal level of fluoride concentration in drinking water to be 0.7 parts per million (ppm).²

The amount of fluoride in water depends on the depth where the water is found. It also depends on how many fluoride-bearing minerals are present in the area.

For example, water supplies in the southwestern and midwestern sectors of America have high natural fluoride levels. Low-income areas typically have low levels.

Proper water fluoridation is backed by over 70 years of research.⁸

Community water fluoridation is:

• Safe
• Effective
• Healthy
• Cost-saving
• Cost-effective
• Reliable

Many national and international organizations support the fluoridation of public water supplies, including:

• World Health Organization (WHO)
• American Medical Association (AMA)
• American Dental Organization (ADA)
• U.S. Centers for Disease Control and Prevention (CDC)

Fluoride reduces the risk of decay by up to 50 percent in primary (baby) teeth. It reduces the risk of decay up to 60 percent in permanent teeth.

Aoun, Antoine et al. “The Fluoride Debate: The Pros and Cons of Fluoridation.” Preventive nutrition and food science vol. 23,3 (2018): 171-180

The Centers for Disease Control and Prevention (CDC) has a Water System Information Tool.

The tool provides you with information about your community water system. This includes the fluoride content of your community.