Many of our patients know that we consider fluoride an amazing tool. The increased use of fluoride has Fotolia_21298027_XS1-213x300changed dentistry radically over the past forty years or so. So although you probably are familiar with fluoride, this post is really to answer the question: Why do I need fluoride?  What are the benefits? What are the risks? So lets start with the facts:

Fluoride is a naturally occurring compound found in water, soil and food.

Fortifying drinking water has been recommended by the U.S. Public Health Service to aid in the prevention of tooth decay, they recommend adjusting the naturally occurring fluoride level of existing public and private water sources to reach the optimal level of fluoride which is 0.7-1.2 parts per million or milligram per liter. Fluoride helps prevent cavities by being absorbed into the enamel of the your teeth and fortifying it, making the enamel more resistant to decay and demineralization. This can help in preventing early weakening in the tooth structure and early decay.

What are the risks of using fluoride?

The CDC has done numerous studies, the most common risk noticed is dental fluorosis if fluoride is consumed in a high amount for a long period of time during the development of the adult teeth. Dental fluorosis is pitting or mottling of the enamel of the teeth. Children 8 and younger are the most at risk for dental fluorosis. Also, There has been some speculation about a link between fluoride and osteosarcoma however over the past 60 years of fluoride use and studies no link has been established between bone health and fluoride.
  • The CDC has listed water fluoridation as one of the 10 greatest public health achievements of the 20th century
  • The first city to adjust the level of fluoride in its water supply was Grand Rapids, Michigan on January 25, 1945
  • Although not all water supply is fluoridated around 72.4% of the U.S. population receive fluoridated water.
  • Aside from fluoridated water  you can obtain fluoride from a multitude of sources. Such as, fluoride multivitamins for children, in some foods, as well as many mouth rinses and toothpastes.
  • Fluoride is endorsed and recommended by the American Dental Association as well as many other state and local dental societies.

Fotolia_40413702_XS-200x300The studies were spurred on by the increase in consumption of sports and energy drinks, especially by adolescents. The study warned that both sports drinks and energy drinks have pH levels that are at a level of acidity that can cause demineralization or weakening of the enamel. Also, they found that they both contain citric acid, included to help improve the taste and shelf life of the drink, which can also have an effect on enamel. The study showed, that although both sports and energy drinks are acidic enough that if  excessively consumed they can cause damage to dental enamel, energy drinks have a “significantly greater potential for enamel dissolution than sports drinks”. The study also brought to light some interesting information:

  • ” Approximately 30-50%  of adolescents and young adults in the U.S. consume energy drinks and that 51-62% of adolescents consume at least one sports drink per day”
  • Energy drinks are a fairly new and quickly growing product and there haven’t been many studies on the effects of energy drinks. One statistic showed that energy drinks are such a growing market that “200 new brands of energy drinks were launched in 2007 alone”. Also, because of new flavors and formulations are being created so frequently and the vast differences even between effects of flavors of the same brand, it is very difficult to generalize about these effects.
  • Different flavors within the same brand had different levels of acidity.
  • Of all the drinks tested “Gatorade Blue was found the highest titratable acidity” Also, Red Bull Sugar Free, Monster Assault, 5-Hour Energy, Von Dutch, and Rock Star had higher acidity than Red Bull, Rip It, Full Throttle Fury and MDX.
So what does this mean, should we stop drinking energy drinks? In my opinion that is not what this study means at all. These products when consumed excessively have the potential to create a more cavity prone mouth. So like all things they should be consumed in moderation. Also, due to the acidity of these products it is recommended by the Academy of General Dentistry to wait at least an hour to brush your teeth after consuming a sports or energy drink.    
A comparison of sports and energy drinks—Physiochemical properties and enamel dissolution; By Poonam Jain, BDS, MS, MPH; Emily Hall-May, MS; Kristi Golabek; Ma Zenia Agustin, PhD

In the dental field there are many types of dentists, they can range from extremely  conservative to extremely aggressive. And depending on where your dentist falls in that range you may find that accompanying your routine dental exam your dentist will say, ‘ok lets watch that spot’, or ‘its a small cavity but I recommend filling it before it becomes something bigger’. So what exactly does that mean? dental treatment Teeth have different layers to them, the outer enamel layer, the softer inner dentin layer and the innermost layer where the nerve and blood supply to the tooth resides, the pulp chamber. When diagnosing a cavity we look at what damage has been done to these layers and from there decided what procedure needs to be done. A microcavity or incipient decay, is a cavity that is in the enamel layer but has not passed into the dentin layer. The question is, what are the risks of filling it vs. not filling it? Recent studies have shown that filling microcavities may not help in preventing further decay or breakdown of the tooth. However, treating cavities at this stage has not shown any increase of decay or damage to the tooth either. It is our belief that when a microcavity is noted while we may not recommend placing a filling immediately, we do recommend treating the area by other means. Small cavities such as microcavities often times can be abated or avoided by maintaining a good home care regimen. This includes keeping the area clean as well creating a healthy oral environment to help stop the cavity from progressing. This can be done by stabilizing the pH in the mouth as well as using fluoride to help strengthen the enamel. To learn more about how to maintain great oral health follow this link. The way it stands there are many viewpoints on how aggressive to be with decay. You as a patient may not want any decay in your mouth no matter how small. Or vice versa you may not want to begin removing tooth structure for something that may be maintained for a number or years. The best option for every patient is to find a dentist that feels the same way you do, whether it be conservative or aggressive.

Early treatment of incipient carious lesions: A two-year clinical evaluation; JAMES C. HAMILTON, D.D.S., JOSEPH B. DENNISON, D.D.S., M.S., KENNETH W. STOFFERS, D.M.D., M.S., WILLIAM A. GREGORY, D.D.S., M.S. and KATHLEEN B. WELCH, M.P.H., M.S