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Everyday I am asked the question about fluoride: do we or don’t we use it to prevent tooth decay?

It is a question that is of particular concern for parents with small children who are concerned about the safety of fluoride and their children’s health.

There is much that has been written about the health benefits of fluoride in reducing tooth decay. There are multiple studies that compare dental decay rates of populations that have fluoridated water supplies with those that don’t.
In Australia and many other countries, the results of these studies show that fluoride at 1ppm in town water supplies reduces tooth decay rates by up to 40% in children and teenagers. 

When you consider this with not using fluoride and then having 40 % more children suffering toothache, abscesses, or having fillings that are made of either dental amalgam (containing mercury) or white resins that have a multitude of complex chemicals, fluoride doesn’t seem to be a bad option or is it? 

On the other side of the debate is the anti-fluoridation movement where much has also been written that raises serious concerns about the dangers of fluoride toxicity, especially for the brain of the developing child. Excessive exposure to fluoride has also been reported to be associated with impaired cognitive function and has been compared to chronic lead toxicity. In China, altered kidney and liver function parameters were reported in children where fluoride occurred naturally in the water at 8 ppm. 

As a parent you are constantly juggling risks versus benefits for your growing child. To not use fluoride whilst permanent teeth are forming in the jaws (from birth to age 10), will possibly result in an increased risk of dental decay in later years. The treatment for dental decay during teenage years is 40 % more likely where fluoride is not added to the water supply and this treatment involves the use of procedures and materials that contain many chemicals that also have possible health risks. What is worse, fluoride exposure to the growing infant or having to resort to more complex materials and procedures for which we have limited long-term data?

Too much fluoride can also cause damage to the delicate growing tooth buds resulting in “fluorosis” which can range from mild (small white flecks) that are hardly noticeable to severe mottling with unsightly dark yellow or brown marks in the enamel. 

As an adult, you have a lot more leeway as to whether you choose to use fluoride. There are many things that you can do to reduce your risk of tooth decay without needing to use fluoride such as thorough oral hygiene and eliminating the consumption of sugar (cane sugar, brown sugar, coconut sugar, honey, maple syrup etc.), refined foods that stick to teeth and acidic drinks. You can do the same for your child if you are consistent in your own behaviors and encourage them from a young age to care for their teeth. This is fine whilst they are small and mostly under your influence.

As children go through puberty, in many cases sugar consumption also dramatically increases, especially the use of soft drinks and energy drinks that are all marketed heavily at this age group. It is often the case that the teenager or young adult has made it through childhood with no decay only to end up with a mouth full of fillings, root canals or extractions by the time they are in their early twenties, much to their parents dismay.

This situation is seen in cases whether fluoride is used in early childhood or not. Fluoride does not make teeth impervious to acid attack, it merely delays the damage caused by the continued abuse of high sugar and poor oral hygiene.

Post Script:
•    Brisbane’s water supply is now fluoridated. No additional fluoride supplementation is recommended for children and should therefore be avoided. 
•    Processed foods are often high in fluoride, including some baby formulas. Check labels before using and get advice if unsure, especially with baby formulas.
•    Children often love the taste of toothpaste and swallow it. Use toothpaste sparingly, if at all. Dry brushing can be just as effective at removing plaque.
•    Check the ingredients before using any toothpaste for children. Never let young children use adult toothpastes due to their high fluoride content. If ingested in large amounts, immediately contact the Poisons department at your local hospital.
•    Use only fluoride free toothpastes for very small children.  Never let them suck, hold the tubes or wander off with toothpaste.


NHMRC – Review of Water Fluoridation and Fluoride Intake from Discretionary Fluoride Supplements

Dose–effect relationship between drinking water fluoride levels and damage to liver and kidney functions in children.  XianZhi Xiong et al, Environmental Research Volume 103, Issue 1, January 2007, Pages 112–116

Impact of fluoride on neurological development in children www.hsph.harvard.edu › News › Featured News Stories July 25, 2012
NHMRC Public Statement: Efficacy and Safety of Fluoridation www.nhmrc.gov.au/publications/synopses/eh41syn.htm 
Outcome of fluoride consensus workshop 2012 to review Fluoride Guidelines from 2005 https://www.adelaide.edu.au/…/fluoride/Outcome_of_fluoride_consensus… 

Tooth decay

Plaque is a sticky deposit that forms on teeth all of the time. 
It is the main source of acid that softens tooth enamel and makes it rough. Once the enamel surface is rough, it traps even more plaque where bacteria such as Streptococcus mutans can happily grow making bigger holes in the surface of the tooth. 

These bacteria love sugar and sticky carbohydrates and they grow quickly when we eat or drink sweet foods. You can feel the furry feeling on your teeth especially after having sweets. These little fellows are having a party on your teeth, eating up the sugar. Unfortunately, these bacteria after eating sugar, release a lot of acid and this is the equivalent of their  “poo”.  This is what dissolves the surface of the tooth and is painless for months. Using their poo (acid) to soften the tooth, these little bugs make their way inside the next layer, called dentine causing pain with their toxins and eventually killing the nerve. After the nerve dies, the infection can spread, causing a painful abscess and sometimes spreading to important organs like the heart, brain, kidneys and sometimes joints.

*Thorough tooth cleaning using brushing and flossing to remove all plaque is essential to prevent tooth decay. Carefully removing the layer of plaque completely even just once per day using flossing and brushing has been shown to stop and even reverse early decay.

*Eliminating sugar from the diet significantly reduces tooth decay. Sugar in the form of sweets, cakes, donuts, soft drinks and lollies are obviously rich in sugar. However, sugar also comes in many disguises and is found in most processed foods. White sugar, brown sugar, castor sugar, icing sugar, icing mixture, coffee crystals, sugar cubes, coconut sugar, maple syrup, agave syrup, condensed milk and even honey are all sugars that increase tooth decay. Many “health foods” such as muesli bars, dried fruit bars, low-fat yogurts and fruit juices are also very high in sugar. 

Acidic foods that directly dissolve enamel should also be eliminated such as all diet soft drinks, energy and sports drinks, cordials and fruit juices including apple, orange or pineapple. Don’t be fooled by labels that offer 100 % natural, organic, preservative-free or with no “added sugar” – the potential to damage tooth enamel is the same.