Cavities are caused by acid-producing bacteria that collect around the teeth and gums in a sticky, clear film called plaque. Without good daily oral hygiene and regular dental visits, teeth become more vulnerable to cavities.
Brushing twice a day and cleaning between teeth with floss can help remove plaque. Regular dental examinations and cleanings are also important in keeping teeth healthy.
Another key to good oral health is fluoride. This mineral helps prevent cavities by interfering in the process by which bacteria produce acid. Fluoride can also help repair teeth in the very early stages of the disease process by being incorporated into the tooth and thus making it stronger.
Fluoride can be obtained in two forms: topical and systemic.
Topical fluorides are applied directly to the tooth enamel. Examples include fluoride toothpaste and mouthrinses, as well as fluoride treatments in the dental office. Systemic fluorides are those that are swallowed. Examples include fluoridated water and dietary fluoride supplements. The maximum reduction in dental cavities is achieved when fluoride is available both topically and systemically.
Water Fluoridation
For 65 years, community water fluoridation has been a safe and healthy way to effectively prevent tooth decay. Fluoridation costs an estimated $0.94 per person-year on the average. The Center of Disease Control has recognized water fluoridation as one of the 10 great public health achievements of the 20th century. The amount of fluoride in water is around 1 part per million, and research shows an 18-40% reduction in cavities since its implementation.
Adverse Effects
Fluoride’s adverse effects depend on total fluoride dosage from all sources. The only clear adverse effect is too much fluoride which can cause dental fluorosis. Excess fluoride can come from well water, toothpaste, fluoride supplements, or a combination. This can alter the appearance of children’s teeth during tooth development causing unsightly brown stains on the teeth. These teeth are highly resistant to decay, but the spots can be esthetically unpleasing. The best treatment for fluorosis is veneers, however, Deep Bleaching has proven to work in some cases.
Despite support by public health organizations and authorities, efforts to introduce water fluoridation have met considerable opposition whenever it has been proposed. Antifluoridationist literature links fluoride exposure to a wide variety of effects, including AIDS, allergy, Alzheimer’s, arthritis, cancer, and low IQ, along with diseases of the gastrointestinal tract, kidney, pineal gland, and thyroid. None of this has been proven in scientific literature.
Types of Fluoride
Stannous fluoride, sodium fluoride, and acidulated phosphate fluoride (APF) appear to be equally effective at preventing cavities. However, they differ in terms of application frequency, taste, cost, stability, gum tissue acceptance, and staining tendency.
Many stannous fluoride products have a bitter taste and some have been shown to cause tooth staining. Stannous fluoride may occasionally contribute to gum irritation. On the basis of available research, stannous fluoride appears to be the most effective type from a cavity prevention standpoint.
Sodium fluoride has an acceptable taste and does not cause staining or gum irritation. Its primary drawback is that it requires more office applications than APF. Neutral pH sodium fluoride preparations may be, on the basis of preliminary research findings, the treatment of choice for patients with extensive porcelain or composite restorations. Some investigators have cautioned against using low pH fluorides which may etch restorative surfaces.
Acidulated phosphate fluoride (APF) is usually applied biannually making it more convenient than sodium fluoride office topicals. APF is stable in plastic containers and is usually flavored for an acceptable taste.
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