Do Teeth Need Fluoride?

For such a seemingly simple question, the answer is actually quite complicated.  As dental health professionals, we understand our responsibility to provide excellent care to our patients, and that includes providing trustworthy information.  While there is compelling evidence on both sides of this issue, we hope to present a relatively unbiased perspective in the information we provide regarding fluoride.

How Does Fluoride Affect Teeth?

There is no question that fluoride improves the strength and health of teeth.  Fluoride is a naturally occurring mineral, and when incorporated into enamel and dentin (the hard tissue that lies just beneath enamel in the teeth), it creates tooth structure with greater resistance to damage from bacteria and acid.

When someone receives fluoride, either in drinking water or a supplement, during the time of tooth formation, the teeth are able to resist cavities by virtue of their stronger foundation.  When we apply fluoride to teeth after tooth formation (called topical fluoride), the result is an improvement in a vital cavity-fighting process called remineralization.

Cavities occur through a process called demineralization.  This is when bacteria living within dental plaque ingest sugar and produce acid.  The acid weakens and dissolves enamel, in the same way that strong acids etch glass.  This softening is an undoing of the hard mineral in the tooth, which is why we call it demineralization.

The good news is that we have the potential to remineralize areas damaged by demineralization.  Fluoride is our most powerful remineralizing agent!

Why is there a Controversy over Fluoride?

Fluoride, like many other vitamins and minerals, can be toxic in excessive amounts.  You can get too much of a good thing, and it can cause some health concerns.  Scientific research has linked fluoride toxicity to weakened bones and kidney problems.  There are claims of impaired brain development, but there is not enough scientific evidence to support these claims.

And while a little fluoride is a great benefit for teeth, too much actually causes unsightly brown or white spots on the teeth.  This is a common phenomenon in areas where fluoride is at a very high level in the natural soil and the drinking water.

Opponents of fluoride claim that all fluoride is bad.  Proponents of fluoride claim that fluoride is all good.  The truth is somewhere in between.  Fluoride, at optimal levels, provides a significant improvement in dental health with no risk for toxicity.

What Alternatives to Fluoride are Available?

While we believe that fluoride is safe when used in the correct amounts, we understand that some of our patients prefer to avoid fluoride completely.  For patients with a low risk for cavities, this is not a problem.  Many people are able to maintain good dental health without fluoride.

However, there are some people who have naturally weaker enamel or particularly strong cavity-causing bacteria, placing them into a higher risk category.  These people need some remineralizing agent. While fluoride is the most readily available, there are other products you can find that show remineralization potential!  (Note: the ingredients that promote remineralization are also the ingredients that fight sensitivity!)

Look for these ingredients to help you promote remineralization without fluoride.

• Amorphous Calcium Phosphate (ACP) – Unfortunately, the only products containing ACP over-the-counter also contain fluoride. However, there are prescription only products available through a dentist that contain ACP without fluoride.  The most popular is MI Paste by Recaldent.
• Arginine – Another potent remineralizer, arginine is currently available in a fluoride-free toothpaste (Tom’s of Main Rapid Relief), a gel (Colgate’s Anywhere Anytime serum), and a soft chew (BasicBites).
• Nanohydroxyapatite – This ingredient is available in toothpastes made in Canada and Japan. One of our favorites is Premio by Apagard, available for purchase on Amazon.

These products, and those including fluoride, can help you keep your teeth healthy and strong during this time of no preventive care.

We are looking forward to resuming your care and answering all of your questions soon!