Let’s be honest, this post is going to cause waves no matter what I say because fluoride use is the vaccination of dentistry. Take a deep breath, open your mind, and hear me out.
Like most other integrative practitioners, I take the information from both the “pro” camp and the “anti” camp and look for a solution that makes the most sense. Most of the evidence against fluoride is discussing the systemic use of fluoride. This includes water fluoridation and fluoride supplementation. Caution should be taken in taking any drug or chemical or supplement systemically. The only benefit to consuming fluoride systemically for teeth is during tooth formation. In other words, the benefit ends at approximately age 15.
The caution of systemic use of a supplement increases with kids, since they are more vulnerable due to their size and rapid growth. So I don’t recommend ingestion of fluoride for dental health. It’s in most of our water, and I don’t love bottled water for other reasons, so it’s difficult to avoid ingestion altogether. There are filters that can remove it from tap water, this is your best bet, but also expensive.
The benefit to dental health is mainly topical. The enamel in teeth is being broken down and reformed at different rates all the time. When the enamel gets remineralized with fluoride, it becomes stronger to future acid attacks.
The research showing the efficacy of fluoride for strengthening the teeth is strong. The highest level of evidence is a systematic review. The Cochrane database is a collection of health related systematic reviews. Also Cochrane doesn’t take any commercial or conflicted funding to decrease chance of bias. If Cochrane says that the evidence for something is strong, you can bet it’s strong. Cochrane found that the use of fluoride toothpaste to prevent cavities in children and adolescents is strong. They found that the use of fluoride varnish to prevent cavities to be moderate. This is actually still pretty strong evidence in favor of varnish, as Cochrane has very high standards and many of their studies conclude with weak evidence in favor of a treatment.
There is no treatment out there now that can compete with fluoride in its ability to reduce cavities. And this is important in an era where we eat on average 100 lbs of sugar a year, and caries, the disease that causes cavities, is the number one chronic disease in children. This is why I still recommend fluoride.
Still, I am cautious. I recommend a very small amount of fluoride toothpaste in young children who aren’t great at spitting only if there are cavities starting and the child is high risk. My 3 year old son with low cavity risk is using non fluoridated toothpaste. I did just start him on fluoride varnish, which I will do every 6 months. This is the lowest dose of professionally applied fluoride we have and I love it because it sticks to the teeth and slowly releases fluoride around the tooth in doses very small. I have a protocol that makes it even smaller dose than usual. After application, the fluoride becomes stuck to the tooth. I rinse the mouth with water after applying, using suction. This removes any excess fluoride not stuck to the tooth and prevents it from being swallowed. Then I warn against hot drinks and abrasive foods which may dissolve or scrub off the coating. I recommend brushing off the varnish the next day or late the same day. The varnish comes off in chunks which can be spit out or wiped away by a gauze by a parent for non-spitters.
Even the Fluoride Action Network recognizes that fluoride varnish is one of the safest fluoride forms, as long as it is not swallowed. Some anti-fluoride resources talk about absorption of fluoride through the mucosa (cheek tissue). There is only one study I could find that looked at absorption through the mucosa in rats. It looks like it’s possible, but not a hugely effective way of having systemic absorption of fluoride. Ingestion is the biggest factor.
So there you have it! My philosophy on fluoride. I will always respect a patient’s and/or parent’s opinion on fluoride use. If you are not wanting any fluoride, I will respect that and work with you to disclose which materials we use that contain fluoride or fluoride releasing action. As always, your health is your decision!