Fluoride as a preventive compound
Fluoride is a chemical compound that is widely recognized for its role in preventing dental cavities. It is derived from fluorine, which is a member of the halogen group of elements. The primary use of fluoride in dentistry stems from observations that communities with fluoridated water have lower rates of cavities. This led to the practice of using fluoride to strengthen tooth enamel, especially during the early stages of tooth development. However, further research indicated that fluoride is most effective on teeth that have already erupted, enhancing their resistance to decay when applied directly.
Fluoride is commonly found in toothpaste and mouth rinses, with strong evidence supporting their effectiveness in cavity prevention. While fluoride treatments at dental visits can benefit children and adults, excessive fluoride exposure may have adverse effects, particularly in young children. In addition to its dental applications, there has been some discussion about fluoride's potential role in preventing osteoporosis; however, research suggests that water fluoridation does not significantly impact osteoporosis rates. Recent studies have raised concerns about high fluoride exposure leading to cognitive issues in children and pregnant women, emphasizing the importance of using fluoride within recommended safe levels.
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Subject Terms
Fluoride as a preventive compound
DEFINITION: Chemical compound used to prevent specific medical conditions and diseases.
PRINCIPAL PROPOSED USE: Cavity prevention
OTHER PROPOSED USE: Osteoporosis prevention
Overview
While conventional dentistry tends to regard the use of fluoride to prevent cavities as a remarkable triumph of preventive medicine, proponents of alternative medicine have long taken the opposite view. To them, water fluoridation, in particular, is a form of medically sanctioned environmental pollution. These strongly emotional and diametrically opposed views have created a murky world of charges and countercharges. This article is limited to the scientific evidence regarding fluoride and cavities and avoids delving into the numerous myths, rumors, exaggerations, and conspiracy theories associated with the topic.
Therapeutic Uses
Fluorine is an element in the family of chlorine, bromine, and iodine. A “fluoride” is a specific type of chemical compound containing fluorine. The most common forms of fluoride used to prevent cavities are sodium fluoride (analogous to sodium chloride, or common salt), sodium monofluorophosphate, and sodium hexafluorosilicate. Stannous fluoride, a compound containing tin, was once popular, but it is now seldom used. Fluoride is also available in some foods, such as tea and coffee.
The use of fluorine for preventing cavities was derived, at least in part, from the observation that people who grew up drinking water high in fluorides, but not too high, had a much-reduced incidence of cavities. This observation led dental researchers to conclude that if fluoride is present during the initial stages of tooth formation, those teeth will emerge with stronger enamel. Direct fluoride application to teeth was also thought to provide benefits but to a lesser extent. Therefore, it became common practice to recommend that infants and young children receive fluoride supplementation through either the water supply or fluoride supplements.
However, subsequent evidence has shown that these early researchers had it backward. It appears that fluoride acts only on teeth that have already erupted. When fluoride comes in direct contact with tooth enamel, it replaces some of the calcium in the enamel, forming a surface more resistant to cavities. Therefore, the only dental value of fluoridated water occurs during actual drinking, when the fluoride in the water bathes the surface of the teeth.
However, there are more direct ways of introducing fluoride into contact with tooth enamel. The most common of these is the use of fluoride toothpaste. Very strong evidence shows that such toothpastes help prevent cavities. These toothpastes are so widely used, in fact, that water fluoridation is probably of little to no value except in poorer, less-developed countries, where the use of fluoride toothpastes is not universal.
Fluoride mouth rinses, available over the counter, may offer additional benefits to fluoride toothpastes. However, little to no scientific support exists for using the much more expensive, professionally applied fluoride varnishes. When children visit the dentist, they may receive a fluoride treatment from their dentist, where it is applied directly to the teeth.
While it is almost universally recognized that children from six months up to sixteen benefit most from fluoride, adults may also benefit. Fluoride has been proven beneficial to patients suffering from xerostomia, or dryness of the mouth, as well as adults with gum disease and dental implants. Further, while there are proven benefits to fluoride treatment, such as remineralizing tooth enamel, reversing tooth decay, and preventing bacteria growth, too much fluoride can be toxic to small children, and care should be used when giving flavored toothpaste with fluoride to children.
Just as fluoride replaces some calcium in dental enamel, fluoride can also replace calcium in bone. This has led to the hypothesis that fluoridated water may prevent osteoporosis. On the other hand, when too much calcium is replaced by fluoride, bone strength decreases. For this reason, it has been suggested that water fluoridation may increase the risk of osteoporosis. However, a reasonable examination of the evidence indicates that neither of these outcomes occurs in real life: water fluoridation appears to have little or no effect on osteoporosis rates, one way or the other.
In the twenty-first century, studies indicated that high fluoride exposure levels could lead to cognitive disabilities and lower IQ in children. Additionally, a May 2024 study published in JAMA Network Open found that pregnant women exposed to high amounts of fluoride may have an increased chance of bearing children with neurobehavioral problems. It is important to note that fluoride remains safe at recommended levels, and the individuals in these studies were exposed to unusually high amounts.
Bibliography
Abrams, Zara. "Fluoride Exposure During Pregnancy Linked to Increased Risk of Childhood Neurobehavioral Problems, Study Finds." USC Keck School of Medicine, 20 May 2024, keck.usc.edu/news/fluoride-exposure-during-pregnancy-linked-to-increased-risk-of-childhood-neurobehavioral-problems-study-finds. Accessed 13 Sept. 2024.
Demos, L. L., et al. "Water Fluoridation, Osteoporosis, Fractures: Recent Developments." Australian Dental Journal, vol. 46, 2001, pp. 80-87.
"Fluoride Exposure: Neurodevelopment and Cognition." National Toxicology Program, 22 Aug. 2024, ntp.niehs.nih.gov/whatwestudy/assessments/noncancer/completed/fluoride. Accessed 13 Sept. 2024.
"Fluoride - Fact Sheet for Health Professionals." NIH Office of Dietary Supplements, 26 June 2024, ods.od.nih.gov/factsheets/Fluoride-HealthProfessional. Accessed 13 Sept. 2024.
"Fluoride: Uses, Benefits & Side Effects." Cleveland Clinic, 9 Feb. 2023, my.clevelandclinic.org/health/drugs/11195-fluoride. Accessed 13 Sept. 2024.
Pizzo, G., et al. "Community Water Fluoridation and Caries Prevention." Clinical Oral Investigations, vol. 11, 2007, pp. 189-193.
Yawn, Andrew J. "Excess Fluoride Linked to Cognitive Impairment in Children." Tulane News, 26 Oct. 2023, news.tulane.edu/pr/excess-fluoride-linked-cognitive-impairment-children. Accessed 13 Sept. 2024.