Introduction: Like other aspects of health care, dental products including fluoride have been around for so long that they are seldom questioned by health professionals. Over 35,000 articles have been published on various modalities and effects of fluoride, which makes fluoride well studied but frequently boring. It works; let’s move on is how dentistry and medicine largely view it. However, when social media, the internet, or individuals raise questions, it might be useful to have a brief reference manual accessible. Several good resources can be found and listed in the appendix, but here is a quick and dirty overview of fluoride when you need a quick fact. Just be certain you combine it with another controversial material – Caffeine.
History: Fluoride has a vibrant history that began in Colorado Springs in 1901. A young dentist, Dr. McKay, moved to town and found two things that alarmed him. One, everybody in Colorado Springs had brown mottled teeth. Second, almost no dental decay existed. At a time when dental decay was rampant back east, this really was a remarkable finding. He was able to draw the attention of a prominent dental researcher who then found other regions in the nation where the illness has been replicated. Shortly the correlation between brown stains and lack of caries has been established.
After the reason for the staining was shown to be high levels of fluoride in several water sources. The director of NIH at the time, Dr. Trendley Dean, subsequently made the intuitive leap that fluoride at low levels may reduce decay rates but not create unsightly brown staining. In a feat of research, he discovered the junction that maximized caries prevention while minimizing fluorosis. Dean’s fluoride level of 1ppm was later tested in Grand Rapids Michigan in 1944. Eleven decades after caries rates were shown to be reduced by 60 percent without substantial side effects. The era 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 includes two modes of action. When ingested, roughly 50% of fluoride is deposited in the teeth and bones, 50 percent is excreted. In mucus, bones move in and out as bones remodel. In teeth, fluoride integrates to the tooth and does not remodel once it is formed. As the tooth, if formed 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 interrupt the crystal formation of the tooth, but at amounts above that, a few disruptions in crystal formation start to occur. At 2ppm, visible disruptions in tooth arrangement can happen, and in 4ppm and above, ameloblast cell alteration causes considerable amounts of this disrupted protein matrix.
The enamel arrangement warps lose its translucence and can chip and pick up food stains. This condition, coined Fluorosis conducts a range of seriousness but does not create the tooth more vulnerable 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, therefore rarely are primary teeth influenced, Permanent teeth start 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 different ages and various levels then accounts for the amount of caries immunity and fluorosis found in the adult dentition. Often ingestion of fluoride toothpaste during the toddler years impacts the leading permanent teeth esthetics. In the early studies out of Grand Rapids, it’s obvious systemic fluoride plays a part in caries resistance. But in this day and age when water fluoridation is available to about 60 percent of their US and fluoride toothpaste is omnipresent, considerable debate exists about how much systemic fluoride performs in modern-day caries immunity.
The next mode of action is Topical. Topical fluoride describes the mucous being present from the mouth area and available to teeth. On the tooth, a constant demineralization is occurring due to plaque acid and to a lesser extent acidic foods (which are usually well buffered by the saliva). In these 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 along a fluorapatite crystal is formed on the outer enamel. The fluorapatite crystal is less soluble and more acid resistant, thereby getting more caries resistant. The more frequently fluoride is present in the saliva, the longer caries resistant teeth eventually become. This is particularly true of recently erupted teeth that have not yet reached full mineral content. These teeth are particularly vulnerable to decay, but benefit the most from benzoyl peroxide. Click here to know more about dentist ocean township NJ.
Topical fluoride comes in many types. Water fluoridated at 1ppm will increase salivary fluoride 100 to 1000 days and remain high for 1 -2 hours. The longer water washing on the teeth that the longer the balance is tilted to remineralization. The same activity to a much greater salivary concentration occurs with routine use of toothpaste, mouthwashes, or professionally employed fluorides. While higher dosed fluoride modalities will target and assist to reverse hypo mineralized enamel structure or”white stains,” frequency of fluoride exposure will reduce caries rate most radically.