Dr. Christina Binert & Associates
700 Coxwell Avenue, Toronto,
Ontario M4C 3B9
Phone: 416 - 461 - 2273

Coxwell Dental Care is a Dentist in East York, Ontario.

Fluoride & Your Health

What is Flouride?
Fluoride is a mineral found in nature. There is fluoride in the ocean, in the earth's crust and in fresh water.
How does Fluoride prevent tooth decay?
Fluoride works by making the outer layer of teeth (called tooth enamel) stronger. When the outer layer is strong, teeth are less likely to get cavities. Fluoride also reduces the amount of acids produced by plaque, a clear and sticky film that builds up on your teeth every day.
Where do I get the fluoride that prevents tooth decay?
Fluoride is provided mainly through drinking water, toothpaste, mouthwash, supplements (chewable tablets or drops), and other materials such as gels and rinses that may be applied during your visit to the dentist.
Why is flouride added to drinking water if it is available in other ways?
Adding fluoride to the water is the best way to provide fluoride protection to a large number of people at a low cost. That's why many towns and cities put fluoride in the water in a controlled manner. The U.S. Centers for Disease Control recently named fluoridation of drinking water one of the 10 most successful public health measures in this century.
Who watches the fluoride levels in drinking water?
Health Canada, through a federal/provincial committee, is responsible for watching the level of fluoridation in water supplies. In recent years, this committee has recommended that optimal levels of fluoride should be between 0.8 and l.0 parts per million. This recommendation is based on the fact that many Canadians receive fluoride from many sources. As a result, some communities have lowered the levels of fluoride in their water supply, in keeping with this recommendation.
What does "optimnal levels" of water fuoridation mean?
Optimal levels of water fluoridation means finding the right balance between putting enough fluoride in the water to maximize the benefits of fluoride exposure while minimizing potential to contribute to dental fluorosis.
What is Dental Fluorosis?
Dental fluorosis occurs when white specks appear on a child's teeth and is the result of a child getting too much fluoride. There is recent evidence that dental fluorosis is not health threatening. It is mainly a cosmetic condition and in more severe cases, it can be easily treated by the dentist. Dental fluorosis is not a problem for older children or adults.
Why is Dental Fluorosis Increasing?
Today's young children are getting fluoride from a variety of sources, including drinking water and toothpaste, as well as foods and beverages that are made with fluoridated water. Children who show signs of dental fluorosis are generally being exposed to more fluoride than is required simply to protect their teeth.
Should we stop drinking fluoridated water because dental fluorosis is occuring?
Fluoridation of drinking water is still the most economical means of getting the proven protection that fluoride gives to teeth. Where fluoride has been added to municipal water supplies, there has been a marked decline in tooth decay rates - between 35 and 50% in children and 30% in adults. Children need fluoride protection while their teeth are developing. Adults also need it since the possibility of foot cavities (tooth decay in the roots of the teeth increases as they get older).
Should my child stop using fluoridated toothpaste?
It is best to try to limit exposure from all sources of fluoride to the optimal levels required for protection against tooth decay. Children should use only a small amount of toothpaste (the size of a pea) and avoid swallowing. A non-fluoridated tooth paste may be helpful with children under three years as it is more difficult for them to avoid swallowing.
How do I know if my child is getting enough fluoride protection?
Your dentist is aware of the fluoride levels in the water in your area. He or she will try to estimate your child's total fluoride intake and risk of cavities before prescribing fluoride supplementation. Supplementation, in liquid or chewable format, has proven useful in protecting patients at high rates of cavities or living in areas with high rates of cavities. Whatever you dentist decides, he or she will discuss any treatment option with you.
ARE THERE ANY HEALTH RISKS ASSOCIATED WITH WATER FLUORIDATION?
Many studies have looked at this topic. A United States committee on environmental health that has reviewed many of these studies has concluded that there is no link between cancer in humans and fluoride levels. And although some studies suggest that increased bone fragility may be linked to higher rates of exposure, we don't know yet for certain, as there are too many factors involved. Like many natural substances, fluoride can be harmful in excessive amounts. Even table salt can be harmful if take in large quantities. However, we are typically exposed to acceptable amounts of fluoride, even though it is available from a number of sources.
THE BOTTOM LINE ON FLUORIDE AND DENTISTRY
The bottom line is that fluoride prevents cavities. Dentists and the CDA are well aware of its value. The CDA's position on water fluoridation encourages the protection of those most in need. "The CDA supports fluoridation of municipal water supplies as a safe, economical and effective means of preventing dental caries in all age groups. Fluoride levels in community water supplies should be monitored and adjusted to ensure consistency in concentrations and avoid fluctuations". · The CDA emphasizes that the need for fluoride depends on overall exposure, including place of residence, diet and oral health habits. · The DDA encourages research to assess minimal optimal levels of fluoride that can maintain effectiveness while taking into account the many sources of fluoride and the prevalence of dental fluorosis. · The CDA supports the cautious use of supplementation in liquid or chewable format (for individuals or groups at special risk for caries) as long as the water supply is not fluoridated and overall exposure to fluoride from all sources is not adequate. · The CDA recognizes and continues to support the contribution to cavity prevention of fluoridated toothpastes and mouthwashes. · The CDA recognizes the need to continue to monitor studies on fluoride and general health. For more information on fluoride and dentistry, please talk to your dentist. The DCA encourages you to be an active partner in your oral health care and to discuss any issues of concern with your dentist.
APPENDIX III
Canadian Dental Association (CDA)

Considerations re: Fluoride Supplementation

The CDA supports the appropriate use of fluorides in the prevention of dental caries as one of the most successful preventive health measures in the history of health care. The availability of fluorides from a variety of sources, however, is a current reality that the practicing dentist needs to take into account in dealing with patients. This is particularly true of children under the age of six, where exposure to more fluoride than is required simply to prevent dental caries can cause dental fluorosis. There is no evidence of any health problems being created by such exposure, but it is prudent to attempt to limit exposure to the optimal levels required for continuing dental caries protection. Current levels of fluoride intake from all sources are difficult to establish for any given area, but the dentist should consider general intake to the extent possible in recommending fluoride supplementation.

The following suggestions are consistent with these principles:

1) Fluoride supplementation should be recommended only for individuals or groups at high risk for dental cavities where the estimation of the mean fluoride exposure from all sources indicates a need. A qualified professional should determine risk for dental caries by reviewing the history, conditions and circumstances of individuals or groups.
2) The Canadian Consensus Conference on the Appropriate Use of Fluoride Supplements for the Prevention of Dental Caries in Children, held in November 1997, suggested that high caries risk individuals or groups may include those who do not brush their teeth (or have them brushed) with a fluoridated dentifrice twice a day, or those who are assessed as susceptible to high cavity activity because of community or family history, etc.
3) The estimation of the mean fluoride exposure from all sources should include use of fluoridated dentifrice and all home and child care water sources. Dentists should be aware of the average fluoride exposure in their area. The possible impact of fluoride reducing factors within the home such as the use of unfluoridated bottled water of some reverse osmosis devices should be taken into account.
4) Lozenges or chewable tablets are the preferred forms of fluoride supplementation. Drops may be required for individual patients with special needs.
5) Fluoride supplementation dosages for individuals or groups at high risk for dental caries, is based on the age of the individual and the fluoride level of their water supply.
6) The parent(s) or guardian(s) should receive information necessary to provide for their informed consent prior to prescription of fluoride supplements for the patient.
APPENDIX I
CDA MEMBER INFORMATION BULLETIN: FLUORIDE AND DENTISTRY
The Therapeutic Products Program of Health Canada regulates the uses of fluorides as drugs. Fluoridation of drinking water is governed by the Guidelines for Canadian Drinking Water Quality, which are developed and maintained by the Bureau of Chemical Hazards in the Environmental Health Directorate. The dental profession, however, recognizes an obligation to provide general information on preventive and therapeutic materials used in dentistry, including fluoride. This information bulletin provides some background on the use of fluoride in dentistry and in public health, and describes some developing issues.
WHAT IS FLUORIDE?
Fluoride is a compound of the element fluorine (F). Fluorine is found in nature only in combination with other elements, An example of such a compound substance id sodium fluoride (NaF). Fluoride compounds are very common and occur in the oceans (at a concentration of about 1 part per million), the earth's crust and fresh water supplies in many areas.
WHY IS FLUORIDE IMPORTANT IN DENTISTRY?
Scientific literature verifies that fluoride reduces cavities in children and adults. I can help repair early dental caries even before signs of decay become visible. When used effectively, fluoride is a powerful preventative agent. In fact, the U.S. Centers for Disease Control and Prevention recently manner fluoridation of municipal water supplies as one of the 10 most successful public health measures of the 20th century.
HOW IS THE FLUORIDE WHICH PREVENTS DECAY PROVIDED?
Fluoride is provided mainly through drinking water, toothpaste, mouthrinses, supplements (lozenges, tablets, drops), and materials that are applied during a visit to the dentist.
HOW DOES FLUORIDE WORK TO PREVENT DECAY?
Fluoride works in three ways. First, and most important, it actually helps the remineralization of tooth enamel that has been demineralization of tooth enamel that has been demineralized by acids. Secondly, it reduces the ability of dental plaque to produce the acids that contribute to the decay process. The fluoride ions that make remineralization possible are provided by fluoridated water and products such as fluoridated toothpaste. Thirdly, it makes teeth stronger by converting hydroxyapatite, a component of enamel, into fluorapatite, a less soluble substance. Over a number of years, studies have suggested that benefits occur from both the topical and systemic application of fluoride. Topical application occurs whenever the teeth are bathed in a fluid material containing an appropriate amount of fluoride. Fluoride is provided systemically whenever it is swallowed, as in the case of fluoride supplements. Recent evidence indicates that action. Topical application is effective starting immediately after our teeth have first emerged (post-eruptively). And throughout our adult lives.
IF THE SYSTEMIC APPLICATION OF FLUORIDE (INGESTION) PLAYS A SMALLER PART IN PREVENTING TOOTH DECAY, WHY CONTINUE TO USE IT?
Systemic application is the only application possible when teeth have not yet emerged (pre-erupively). There is some evidence that the ingestion of fluoride when teeth are developing contributes to the deposition of fluoride through the entire tooth surface and may provide linger protection than topical application, Systemic fluorides also contribute to the topical effect because ingested fluoride is present in the saliva that bathes teeth. Ingested fluoride may also become incorporated in dental plaque and contribute to remineralization.
WHY THEN HAS CDA GENERALLY REDUCED THE LEVELS OF FLUORIDE SER OUR IN ITS TABLE ON FLUORIDE SUPPLEMENTATION OVER THE LAST DECADE?
CDA's table on fluoride supplementation attempts to reflect the fact that fluoride is currently available from a variety of sources. Fluoride supplementation has traditionally been defined as tablets, droplets and lozenges that individuals chew and swallow. Although some water supplies were naturally fluoridated when these supplements were first introduced, fluoride was not easily available in many locations. In today's world, however, fluoride may be added to water supplies that are not naturally fluoridated. Individuals knowledgeable about dental health are using fluoridated toothpastes. Manufactured foods and beverages are frequently made with fluoridated water . There is recent evidence that the prevalence of dental fluorosis among children is increasing. Dental fluorosis is a condition in which a child's teeth become marked with lines or specks of white enamel. Most dental fluorosis is mild and barely visible. Moderate to severe cases can be unsightly and may require cosmetic treatment. Essentially, it means that a child has been exposed to more fluoride than is strictly necessary for the prevention of tooth decay. For these reasons, CDA has not only reduced the levels of supplementation set out in its table over the last decade, but has also suggested that supplementation be use to protect only individuals or groups living in unfluoridated areas and at special risk for dental caries. CDA also notes that a recent report to Health Canada's Medical Services Branch suggests that "there is a need to objectively reassess, in a scientific and comprehensive manner, using a multi-disciplinary tram, all aspects of the current need for, and future use of supplements in Canada". DCA encourages further evidence-based reviews and underlines the possibility that they could result in modification or withdrawal of the CDA table on fluoride supplementation.
IF FLUORIDE IS AVAILABLE FROM MANY SOURCES, AND THE PREVALENCE OF DENTAL FLUOROSIS AMONG CHILDREN IS INCREASING, WHY DOES CDA CONTINUE TO SUPPORT WATER FLUORIDATION?
CDA recognizes that water fluoridation is an economical and effective way of ensuring that a community receives the exposure to fluoride necessary to prevent tooth decay. Water fluoridation is an important public health measure because it protects everyone in a fluoridated community, especially those who don't take other measures or who may avoid or have limited access to dental care, This is estimated to include about 20% of the population which also has the highest rate of tooth decay. Consequently, it is not surprising that water fluoridation is one of the few public health measures that has resulted in true cost savings for society. The growing availability of fluorides from a variety of sources - including toothpastes, mouthrinses, supplements, manufactured foods and professional fluoride treatments - may mean that there will be members of the community who receive adequate exposure to fluoride to prevent decay without fluoridated water. This raises the kind of ethical question that results when a community introduces any legislation which affects all of us for the primary benefit of some of us. For these reasons, CDA has been emphasizing the importance of monitoring levels of fluoride introduced into water supplies to ensure that targets are consistently met and not exceeded. CDA has noted, as well, the reduced levels being recommended by the Canadian Federal-Provincial Sub-Committee on Drinking Water, which recommends that optimum levels should be in the range of 0.8 to 1.0 ppm. CDA encourages research to assess minimal optimal levels that can maintain effectiveness while taking into account the wider availability of fluoride and the prevalence of dental fluorosis.
DOES THE AVAILABILITY OF FLUORIDE FROM A VARIETY OF SOURCES MAKE IT DIFFICULT TO DETERMINE HOW MUCH ADDITIONAL EXPOSURRE A PATIONT REQUIRES?
Yes. The CDA emphasizes that the need for fluoride depends upon overall exposure, including place of residency, diet and oral health regimens. For example, the dentist attempts to roughly estimate such exposure (as well as likely risk for caries) prior to prescribing fluoride supplementation. This is not an easy task.
CAN YOU GET MORE FLUORIDE THAN YOU NEED TO PREVENT DECAY?
Yes, as the increasing prevalence of dental fluorosis in children has shown. Patients and the parents of young children are encouraged to assess their circumstances and to be aware of their own potential exposure to fluoride (in drinking water from their own wells, for example). Provincial health departments should help inform both patients and health professionals about the fluoridation status of naturally fluoridated drinking water in communities and areas. Parents should supervise their young children when they brush their teeth and teach them to use only a pea-sized amount of fluoridated toothpaste and to minimize swallowing. It is also possible to not get enough fluoride to prevent decay, so careful attention is required. Dentists and patients should review overall potential exposure to fluoride whenever treatment options include the possibility of additional exposure.
DOES FLUORIDE PRESENT MAJOR HEALTH RISKS?
Like many natural substances, fluoride can be harmful in excessive amounts. The difference between benefit and toxicity is dosage. Whether the typical exposure that most of us receive is harmful is under constant review. There are also many studies on this topic. In 1991, a review of scientific literature was undertaken by the United States Public Health Service's (USPHS) Committee to Coordinate Environmental Health. The report concluded that there is "a lack of evidence of associations between levels of fluoride in water and birth defects, or problems of the gastrointestinal, genito-urinary and respiratory systems".
Three other possible health problems were reviewed in detail: cancer, effects on bone and dental fluorosis. The scientific literature on cancer was divided into two fields - studies on animals and epidemiological studies on communities with varying levels of fluoride in the drinking water. Briefly, it was found that male rats subjected to heavy doses of fluoride were associated with higher incidences of cancer, female rates were not. A second study found no association for either gender of rat. The community studies found no relation between levels of fluoride in drinking water and cancer rate. The USPHS review concluded that taken together, these two types of studies do not show any correlation between cancer in humans and fluoride levels .
With respect to fluoride's effect on bone, the USPHS review noted that some studies suggested that "certain types of bone fracture may be higher in some communities with either naturally high or adjusted fluoride levels". It also noted that some studies did not detect such an increased incidence of bone fractures, and that such occurrence "is affected by a variety of factors, including nutritional deficiencies, impaired renal function and age at exposure". In short, there may be some increased bone fragility associated with higher rates of exposure, but there are many variables and we don't yet know for certain.
With respect to dental fluorosis, the USPHS review acknowledged that the prevalence among children is increasing. However, it noted that because dental fluorosis does not compromise oral health or tooth function, an increase in dental fluorosis does not represent a public health concern". It also added that "total fluoride exposure may be higher than necessary to prevent tooth decay" and that "in general, prudent public health practice dictates using no more than the amount required to achieve a desired effect". In short, dental fluorosis is essentially a cosmetic condition, but its prevalence id increasing and we should be attempting to limit exposure to the amount required for protection against caries.
WHAT'S THE BOTTOM LINE ON FLUORIDE IN DENTISTRY?
The bottom line is that fluoride prevents cavities. The dental profession and CDA are well aware of its tremendous value. CDA recognizes that the availability of fluoride from a variety of sources and the increasing prevalence of fluorosis have brought fluoride supplementation into question. We support the need for further review on this topic,, but we are also aware that supplementation has proven to be useful in protecting young patients both pre-eruptively and post-eruptively. Clinicians working with cavity-prone families or individuals, or in areas with high rates of cavities, rely on supplementation to help protect these patients. We support the cautious use of supplementation in such cases, in liquid or chewable format, provided the water supply is not fluoridated and overall exposure to fluoride from all sources is inadequate. CDA recognizes and supports the public health value of water fluoridation, as well as the desirability of determining optimal levels that can continue to provide protection from carries while reducing the potential for fluorosis. We encourage such research. We also encourage careful monitoring of municipal water supplies to ensure that recommended concentrations are not exceeded. CDA also recognizes and continues to support the tremendous contribution to cavity prevention of fluoridated toothpastes and mouthrinses. We encourage the use of pea-sized amounts of dentifrice and supervision of tooth brushing by young children to help them learn not to swallow . We support the use of other forms of topical fluoride, such as professional application, provided consideration is given to overall exposure to fluoride. Finally, CDA recognizes the need to continue to monitor the scientific literature with respect to levels of exposure to fluoride and general health. Fluoride continues to be a powerful weapon in the battle against caries. Like all powerful weapons, it should be controlled carefully, used as required and treated with respect. (For source material references, see appendix one of the Canadian Dental Association's "CDA Member Information Bulletin: Fluoride and Dentistry")

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