What the pediatric dentist says: Fluoride and your child

A few days ago we shared a link via social media to a New York Times article regarding new guidelines from the American Dental Association recommending the use of fluoride toothpaste at an earlier age. One of our wonderful, bright and involved parents responded immediately, posting: “But fluoride is TOXIC! Or is that hippie propaganda?”

We love it when our families are engaged and asking important questions!  Here is what Dr. Catherine Quas posted in response:

“Great Question! Fluoride isn’t toxic except in extremely high doses and it isn’t hippie propaganda — I think that the answer to the question lies in the quality and quantity of fluoride. Fluoride, like many things, is beneficial in moderation. A little bit is good, a lot-a-bit is not better and can in fact be worse.

There are many sources of naturally occurring fluoride that make tracking the quantity of fluoride consumption difficult. For example, there are certain baby food formulas that add fluoride. If you then add in other sources of fluoride unknowingly, a young child can be exposed to excessive fluoride amounts. These amounts can be far from toxic but still produce tooth development challenges in the integrity of the tooth surface.

The maximum benefit of fluoride is in its topical (or surface acting) ability to strengthen the tooth surface. In essence it makes the tooth surface or enamel less able to be eroded by the acid produced by cavity causing bacteria.

In scientific lingo, fluoride lowers the dissolution Ph of enamel and renders the outside of the tooth more resistant to decay. The benefit of fluoride in toothpaste is that it is topical, much more consistent and very localized in application. People may forget vitamins, but tooth brushing is a highly consistent behavior across populations.

What is really nice in the article is that the ADA and the New York Times are differentiating in the size of the appropriate dose of fluoridated toothpaste. We used to routinely say “pea” size. That is way too much toothpaste for young children, particularly when we are advocating that the parents do a touch up course of brushing once the children are in their beds. A smear of toothpaste is a more appropriate representation of the minute amount necessary to provide the teeth with a protective benefit at night while we sleep.

It is important to remember that this is for kids who are not on systemic fluorides in drops or tablets. In fact, at Bluefish we do not advocate for systemic fluorides because the true benefit of fluoride is topical, meaning on the teeth not in the stomach.

The take home here is moderation. I encourage everyone to research the information with an open mind. Beware of the evangelical opinions on both ends of the fluoride spectrum. If at the end of the day, you are still uncomfortable with fluoride toothpaste, then I recommend that you understand thoroughly how cavities form so that you can take aggressive stances in other areas to reduce the risk of cavities. This could include eliminating juice, goldfish crackers, gummy bear vitamins, natural fruit roll ups, dried fruit, soda, vitamin water, etc. from the diet. It could include incorporating zylitol into the diet to combat the virulence of cavity creating bacteria.  Generally speaking, reducing fluoride tends to require an increase in effort on multiple levels. Not an impossible task, but it does necessitate a number of go-arounds.

I hoped I helped. Please know that I am always available for other questions — on or off Facebook.”

For those interested in learning more about fluoride, we recommend starting with a review of the ADA publication, Fluoridation Facts.  The booklet is in pdf format and includes more than 350 scientific references. Another great resource is this Guideline of Fluoride Therapy for parents and practitioners published by the American Academy of Pediatric Dentistry.

As always, everyone here at Bluefish Dental & Orthodontics welcomes your thoughtful questions and comments.

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