First about the fluorosis value at risk. For the average person eating normal foods and using typical dental care products there is a small risk of very mild to mild fluorosis. Very mild to mild fluorosis is tiny white specks on the teeth. They are typically not noticeable at conversational distance. Some people appreciate them because the teeth appear whiter. Often, photographs of severe fluorosis are published in fluoride warning publications. Severe fluorosis is a very disfiguring opaque white with brown blotches discoloration on the surface of the teeth. It is ugly. People at high risk for moderate to severe fluorosis live in areas were natural fluoride occurs in well water and public water in levels of three parts per million or higher (up to 10 parts per million in some regions of the country). Another group at risk is infants and toddlers allowed to brush their teeth with (and eat) a full squeeze of fluoride toothpaste. Fluoride toothpaste is for children age two and above and should be applied to the brush by an adult in the size of a split pea or grain of rice. Note: Topical fluoride like toothpaste and mouth rinses and gels present no risk of fluorosis unless they are swallowed.
Second: About the frustrating development of additional fluoride sources. The difficulty physicians and dentists have measuring and prescribing fluoride comes largely from our food industry. Fluoride is naturally found in all water supplies including oceans (two parts per million) and freshwater. Originally fluoride was primarily available in water supplies, naturally or added by water municipalities. It was easy to measure and estimate how much a typical person consumed. Today it is additionally and intentionally available in toothpaste, mouth washes, prescription dental gels and dental floss. If these are spit out they present no risk of fluorosis and don’t complicate the Dr’s prescription.
Fluoride is also unintentionally present now in many sodas, juices, baby formula, other beverages and other foods processed with or reconstituted with fluoridated water. The amount of fluoride that is present in these products depends on which bottling or processing plant made them. The amount is unknown, varies widely in the same products and is not labeled on the product. Due to the multiple unmeasured sources of fluoride, it is impossible for a physician or dentist to calculate an appropriate supplement of fluoride for a growing child.
Fluorosis comes from ingesting (swallowing) too much fluoride when a child is still developing teeth. Adults without fluorosis can never create fluorosis with any amount of fluoride. Topical fluoride applied to the surface of the teeth will not create fluorosis. The fluoride benefit for teeth is on the surface and can be maximized with topical products that are spit out and not swallowed. To improve the fluoride benefit to your teeth allow the fluoride to remain on the teeth longer by not rinsing your mouth after use and not eating right away either.
Suggestions to maximize the benefit and minimize the ingestion of fluoride: Starting with toothpaste, use a small amount on your brush approximately the size of a split pea or grain of rice. After brushing your teeth thoroughly spit out the foam and do not rinse your mouth afterwards. Also try to avoid eating or drinking anything for the next 30 minutes. This allows more time for the minute amounts of fluoride to incorporate in the surface of the tooth. If you have a history of cavities you may wish to talk to your dentist about using a prescription high fluoride concentration toothpaste (Not for children under 12 year old). If you have a history of cavities you may also wish to use a fluoride mouth rinse daily. This would best be done in the evening just before going to bed. Saliva flow, which would normally flush the fluoride rinse off your teeth, slows to nearly nothing while sleeping. This allows the rinse to remain on your teeth several hours. Also, for those with a history of many cavities, your dentist can provide fluoride varnish applications on a regular interval or prescribe fluoride gels which cling to the teeth better than the rinses.
In general, with the growing number of fluoride sources in our daily lives, dentists and physicians are moving away from attempting to calculate appropriate fluoride supplements and are moving toward the use of topical fluorides. This minimizes the risk of fluorosis and maximizes the benefit of fluoride protection from cavities.
And, still, the best way to administer fluoride for consistent prevention of cavities is with community water fluoridation. If your community has the opportunity to fluoridate its water, support it. Water fluoridation levels have been recently reduced to accommodate the “extra” fluoride in many food sources. Please note that the fluoride in foods is only present in processed foods. So if you primarily eat whole foods (whole fruit, vegetables, whole grains, meats and dairy) then your children are not at risk from the growing sources of fluoride in processed foods and beverages.
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