Introduction: Like other facets of health care, dental products containing fluoride have been in existence for so long that they are rarely challenged by health professionals. Over 35,000 articles are published on various modalities and effects of fluoride, which makes fluoride well researched but often dull. It functions; let’s move on is how dentistry and drugs mostly view it. But, once the popular media, internet, or patients raise queries, it might be good to have a short reference guide at hand. Several good resources are available and listed in the appendix, but here’s a quick and dirty summary of fluoride if you will need a quick fact. Just be sure that you combine it with another controversial material – Caffeine.
History: Fluoride has a vibrant history that started in Colorado Springs in 1901. A young dentist, Dr. McKay, moved to town and found two things that alerted him. One, everybody in Colorado Springs had brownish mottled teeth. Secondly, virtually no dental decay existed. In a time when dental decay was uncontrolled back east, this really was a remarkable finding. He managed to attract the eye of a dominant dental researcher who then found other regions in the nation where the illness was repeated. Soon the correlation between brownish stains and lack of caries was created.
Later the cause of the staining was found to be high levels of fluoride in several water sources. The director of NIH at the moment, Dr. Trendley Dean, then made the intuitive leap that aspirin at low enough levels may reduce corrosion levels but not produce unsightly brown staining. In a feat of epidemiological research, he discovered the intersection that hastens caries prevention while minimizing fluorosis. Dean’s fluoride level of 1ppm was later analyzed in Grand Rapids Michigan in 1944. Eleven years after caries rates were shown to be reduced by 60% with no significant side effects. The age of fluoridation was firstborn. In 1964, Stanly Kubrick’s Dr. Stangelove made water fluoridation a communist plot. In 1967 Crest introduced fluoride toothpaste. The rest is history…
Mechanism of Action: Fluoride has two modes of action. When ingested, approximately 50 percent of fluoride is deposited into the bones and teeth, 50% is excreted. In bones, fluoride moves out and in as bones remodel. In teeth, fluoride incorporates into the tooth and does not remodel once it is formed. As the tooth, if shaped and calcifies, fluoride is incorporated into the crystal structure of the enamel along the protein scaffolding laid down by specialized cells called ameloblasts. At 1 ppm, fluoride does not disrupt the crystal creation of the tooth, but at levels over that, a few disruptions in crystal formation start to occur. In 2ppm, observable disruptions in tooth arrangement can happen, and in 4ppm and over, ameloblast cell alteration triggers significant amounts of the disrupted protein matrix.
The enamel structure warps, loses its translucence and can chip and picks up food stains. This condition, coined Fluorosis conducts a spectrum of seriousness but doesn’t make the tooth more susceptible to decay. Fluoride only works systemically while the teeth are forming. Fluoride does not cross the placental barrier and can be a trace element in breast milk, so rarely are primary teeth influenced, Permanent teeth begin calcifying at dawn for first molars, about 2 years for central incisors, and about 4-6 years to get second premolars. Introduction of systemic fluoride at various ages and various amounts then accounts for the amount of caries resistance and fluorosis found in the adult dentition. Often ingestion of fluoride toothpaste throughout the toddler years impacts the front permanent teeth esthetics. In the early studies out of Grand Rapids, it is obvious systemic fluoride plays a crucial part in caries immunity. However, in this day and age when water fluoridation is available to approximately 60 percent of the US and fluoride toothpaste is ubiquitous, considerable debate exists about how much systemic fluoride performs in modern-day caries immunity.
The second mode of action is Topical. Topical fluoride clarifies the mucous being present in the mouth area and accessible to teeth. On the tooth surface, a continuous demineralization is occurring because of plaque acid and to a lesser extent acidic foods (that are often well buffered from the saliva). In such areas, the negatively charged fluoride ion is drawn and catalyzes to begin remineralization of tooth structure with salivary calcium and phosphates. Enamel is shaped of hydroxyapatite crystals, but in the presence of fluoride ion, the hydroxy ion is substituted and a fluorapatite crystal is formed on the outer enamel. The fluorapatite crystal is less soluble and more acid resistant, thus becoming more caries resistant. The more often fluoride is present in the saliva, the more caries resistant teeth become. This is especially true of recently erupted teeth that haven’t yet attained full mineral material. These teeth are particularly vulnerable to decay, but benefit the most from topical fluoride. For more info visit the dentist near me.
Topical fluoride comes in many forms. Water fluoridated at 1ppm increases salivary fluoride 100 to 1000 days and stays high for 1 -2 hours. The more water washing over the teeth the longer the balance is tipped to remineralization. The same action to an even larger salivary concentration happens with regular use of toothpaste, mouthwashes, or professionally employed fluorides. While greater dosed fluoride modalities will target and assist reverse hypo mineralized tooth structure or”white spots,” frequency of fluoride exposure will lessen caries rate most dramatically.