A Little Fluoride Goes a Long Way

Q: I have read fluoride is toxic and should not be used at all. My 3-year-old daughter does not eat sweets, drink sodas, etc., yet she has two cavities. I have not given her toothpaste with fluoride due to what I have read, and our water does not contain fluoride. The Food and Drug Administration indicates fluoride is not harmful, but the package says to call a poison control center if toothpaste is swallowed. Why do most naturopaths say fluoride is harmful to the body?

A: This is a controversial topic. We do know that children less than 6 years of age who frequently swallow fluoride toothpaste, have high levels of fluoride in their drinking water (greater than two parts per million and ideally should be no more than 1.2 parts per million), or who are given excessive doses of fluoride supplements can develop dental fluorosis, which is mottled, chalky white or brown appearance on the teeth. There is even concern high doses over many years can lead to the development of brittle bones.

However, let me reassure you that very reputable organizations including the Centers for Disease Control and Prevention, the American Academy of Pediatric Dentistry and the Canadian Dental Association recommend fluoride for children. These organizations state that the absence or too small amount of fluoride may leave a child unprotected against the development of tooth decay. When fluoride use is monitored and given at the proper dose, it has been shown to help maintain good oral health. This is especially important since dental decay is one of the most common childhood diseases.

Fluoride is a naturally occurring mineral that is found at various concentrations in the soil and in many sources of water. When used to fight cavities, it is given in two forms: topical (toothpastes, mouth rinses, for example) and systemic (fluoridation of the water supply and supplements such as lozenges or chewable tablets). The topical form is less controversial than the systemic form. The topical form appears to be very effective in providing cavity protection by repairing tooth enamel damaged by the acidic bacteria in the mouth. Fluoridated water and supplements seem to provide protection by being absorbed into the tooth structure and saliva.

I understand your frustration as you are keeping your daughter away from sweets and sugary drinks. However, there are other risk factors that may be contributing to the development of her cavities, such as:

• Frequent dry mouth.
• A mom or dad with a history of tooth decay.
• A diet high in 100 percent fruit juice.
• A pattern of sleeping with a bottle or pacifier, or children who are breastfed several times at night without proper dental hygiene after feedings.
• Orthodontic appliances (braces, others).
• Low socioeconomic status.
• Poor oral hygiene. 

Gentle daily cleaning of a baby’s gum tissue using a soft washcloth or warm water soaked gauze can start in the early months of life. Brushing should begin with the appearance of the child’s first tooth, and should be done two times per day.

Regarding the use of fluoride toothpaste in children, recommendations include:

• Consultation with a child’s dentist before using fluoride toothpaste in any child less than 2 years of age (not for use in infants less than 6 months old).
• Parental supervision of tooth brushing in any child less than 6 years of age to ensure and encourage the spitting out of excess paste. Ideally, the parent will do the brushing for children in this age group.
• Use of no more than a pea-sized amount of fluoridated toothpaste for any child less than 6 years of age.

Other effective measures in the fight against dental decay include the use of sealants, regular dental check-ups, good flossing and brushing technique, and healthy dietary habits. Additionally, a non-fluoridated toothpaste containing the natural sugar Xylitol has been used in the Scandinavian countries and may provide protection against tooth decay.

Since your daughter has already experienced two cavities, I would strongly encourage another visit to a pediatric dentist. Discuss the pros and cons of fluoride treatment with the dentist. If this is the agreed upon approach, a thorough accounting of all sources of fluoride (water supply, food, toothpaste, supplements) should be added up to ensure that safe levels are maintained.

Find More on MSN Health & Fitness:

• What Toothpaste Do You Use?
• Bad Breath: Five Causes and Five Cures
• Dental Care: 22 Tips to Chew On
• Conquering Canker Sores
• A Bad Taste in Your Mouth?
• MSN Health Centers: Oral Health

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)