The use of fluoride toothpaste has been recommended for more than 50 years to prevent and control dental decay, especially in children. Unfortunately, the lack of information regarding the safety and efficacy of fluoride for children younger than 6 years has resulted in inconsistent messaging in the dental community and also resulted in concerns amongst parents. The main concern is that children younger than 5 years of age tend to swallow more toothpaste while brushing as opposed to older children who are able to spit out the toothpaste more thoroughly after brushing. The ADA Council recently released their new guideline recommendations on fluoride use in toothpaste. With all of the information, and misinformation, available to us over the internet through social media, blogs, and alarmists, I felt that I should present the facts on this controversial subject as a dentist, and as a father, so that parents can make the right decision for their families.
Recommendations for the use of fluoride with infants and children have continually been modified over the years in order to maximize the cavity-preventing effect and minimize the risks. The main point I want parents to understand is that the amount of fluoride in toothpastes and dental rinses will not cause harm to your children, especially when used topically. The only risk that is possible is what is called dental fluorosis. Dental fluorosis is a defect of tooth enamel caused by too much fluoride intake during the first 8 years of life. Excessive exposure to high concentrations of fluoride during tooth development (during childhood) can result in tiny white streaks or specks in the enamel of the tooth in mild cases of dental fluorosis. In severe cases of dental fluorosis, the tooth has more evident discoloration and brown markings, but this is rare. Although fluorosis can be cosmetically treated, the damage to the enamel is permanent. So why do we take this chance with fluoride in our toothpastes and drinking water?
Fluoride protects the teeth in two ways:
- Protection from demineralization – when bacteria in the mouth combine with sugars they produce acid. This acid can erode tooth enamel and damage our teeth. Fluoride can protect teeth from demineralization that is caused by the acid.
- Remineralization – if there is already some damage to teeth caused by acid, fluoride accumulates in the demineralization areas and begins strengthening the enamel, a process called remineralization.