Other than the controversy surrounding silver-mercury fillings, no other area of dentistry has fostered more debate.
First, a little background remains helpful. Organized dentistry and fluoride research first began in 1901 when a young dentist moved to Colorado Springs and soon noticed that the residents had brown stains on their teeth, strangely resistant to decay. The link between fluoride and resistance to decay did not become established for 30 years. Today, research demonstrates that fluoride reduces tooth decay. The National Institute of Health hails the discovery of the cavity fighting chemical as, “No less than a remarkable feat of science…an achievement ranking with the other great preventive health measures of our century.” They go on to say that, “Fluoride continues to be dental science’s main weapon in the battle against tooth decay.”
However, there is another side to this story. While it is settled that fluoride can remarkably re-mineralize teeth, what is not settled is whether or not fluoride is safe. In the US, water fluoridation is almost universally practiced. In certain doses, fluoride is a known toxin to bone, the kidney, liver, thyroid and the brain. The current recommended dosage of fluoride in water is 0.7mg/L of water. Is that level safe? For most, it seems that this level or fluoride is safe, and if there were no compelling evidence to suggest otherwise, there would be no argument. But, there are some individuals, including the very young and very old, who are more susceptible to the toxic effects of the chemical. Certainly, this is a question that has been debated for years and will not soon be settled.
While it is generally agreed upon in the biologic dental community that universal water fluoridation should be discontinued, there is continued discussion as to whether post-eruptive topical fluoride use is safe. Conventionally, fluoride is given to children once their adult teeth begin to erupt. Very often depending on an adult individual’s dental history, when risk for new decay is high, one may benefit from fluoride as well.
At our office, we believe that topical fluoride, still with risks, is beneficial to reduce decay, particularly for the following groups that tend to have a higher rate of tooth decay:
- Ages 6 through early adulthood
- Individuals with high caries risk
- People with extremely dry mouth (particularly those on many medications)