Fluoride is a hot topic among green dental patients—and with good reason. Many studies indicate that fluoride is an effective method for preventing tooth decay and remineralizing enamel. However, a steady stream of research suggests that ingesting too much fluoride can have negative effects. The evidence is conflicting and can be confusing for parents and patients who want to make the best decision for long-term cavity prevention. Regardless of your position on the matter, it’s not a simple “good or bad” answer, and green dental patients will appreciate the time you take to explain the issue fully.
I always start by explaining that it’s important to differentiate between topical fluoride use and community water fluoridation as a method of reducing tooth decay. There are a growing number of US and European countries removing fluoride additives in community water supplies, which I think is a good decision.
On the other hand, toothpaste containing fluoride is an excellent way to prevent tooth decay with no known adverse health risks, as long as an excessive amount of the toothpaste isn’t ingested. Ingesting fluoride at levels greater than 1.2 parts per million causes fluorosis (or white spots) in the teeth. Other anecdotal evidence of harmful systemic health problems isn’t well documented, so prevailing health authorities have ruled that the benefits of reducing tooth decay outweigh any possible side effects.
According to the Center for Disease Control and Prevention, the recommended guideline for fluoride ingestion is between 0.7 and 1.2 ppm, and anything above that amount should be considered toxic. While most adults are aware that they shouldn’t swallow toothpaste while brushing, it is much harder for children to avoid (especially when brushing with the flavored types made especially for kids). This can be worrisome, especially with dental decay ringing in as the number one disease amongst children.
I recommend to parents that only a “pea” sized or smaller amount of toothpaste is used and that they make sure their children know not to swallow the toothpaste, as they guide them in brushing properly.
Green dental patients will appreciate an approach to fluoride that allows individual patients and parents to decide what’s right for themselves and their children. Our role as their wellness practitioners is to provide as much information as we can, so they can make the best decision based on their values.
I always remind them that the approach to preventive oral wellness is no different than the rest of our bodies. It’s always best to start with diet and hygiene! Minimize sugary drinks and be sure that your family is getting plenty of vitamins from their meals. Regularly brush, particularly before bed. And see the dental hygienist according to your team’s recommendation. I share with them how this will help us achieve our common goal: setting their child up for a lifetime of good oral health habits.
How do you handle this controversial issue in your practice? Please share! Your advice could help other green dentists and EDA members.
EDA Co-Founder, Dr. Fred Pockrass