How Much Fluoride is Too Much

Academy of Cosmetic Dentistry reports that in 2007 Americans spent $2.75 billion dollars on cosmetic dental procedures. But some parents, in efforts to protect their children’s teeth from tooth decay, may cause their children to develop fluorosis. Fluorosis occurs when an excess amount of fluorine is incorporated into the tooth enamel during tooth formation. The result can range from barely discernable white patches on the tooth surface to deep yellow or brown pitting and staining.

Role of Fluoride

Fluoride is known as a trace element. This means that your body requires it, but only in a small, or “trace” amounts. If fluoride is present during the formation of tooth enamel, it becomes incorporated into the enamel, resulting in a hard, cavity-resistant surface. When bacteria located on the surface of the teeth release acids created during the breakdown of sugars, fluoride can help neutralize those acids to prevent the erosion of the tooth enamel. Fluoride can also bind with enamel that has already been compromised to remineralize those tissues and prevent dental caries, or cavities, from occurring.

Dangers of Excess Fluoride

When children ingest an excess amount of fluoride during the years of tooth formation (i.e., under the age of eight) hypomineralization of tooth enamel can occur. This is what health professionals refer to as fluorosis. Most of the time fluorosis presents as chalky-white spots on the surface of the tooth. This is considered minor fluorosis and often can only be detected by a dental professional. Occasionally, however, fluorosis can cause brown or yellow pitting on the tooth surface. While this is usually physically harmless, it can at times be severe enough to compromise the enamel to the extent that it can no longer protect the inner part of the tooth, or dentin, from decay. The psychological affects and impact of going through life with yellowed, pitted teeth can at times be far-reaching as well. Severe fluorosis can only be repaired through extensive and expensive cosmetic dentistry.


Sources of Fluoride

The majority of American children ingest safe and adequate amounts of fluoride through municipal water supplies. Most municipal water supplies have a fluoride concentration of 0.6 to 2 mg/L, but the National Research Council issued a report in 2006 that found that some municipal water supplies contain fluoride concentrations of as much as 4 mg/L due to fluoride’s natural presence in some local water sources. Fluoride is also present in fluoride supplements, fluoride toothpastes, over-the-counter fluoride products such as Gel-Kam and Phos-Fluor, and in topical fluoride applications performed in the dentist office. Some other, lesser known dietary sources of fluoride include instant teas, pesticides, and Teflon-coated cookware. Children can chronically ingest excess amounts of fluoride by, for example, drinking fluorinated water and taking an additional fluoride supplement. The appealing flavor of many fluoride toothpastes may cause children to use an excess amount and also swallow the toothpaste. And finally, because of their easy availability and the high public awareness of the benefits of fluoride, many parents may consider fluoride products innocuous, and adopt a “more is better” attitude toward their use.

Preventing Fluorosis

Over the counter fluoride rinses should not be used by children under six, and only under the recommendation of a dentist. Many well-meaning parents may not realize this and encourage their use for cavity protection for their child. But if their child is already receiving fluoride through his or her drinking water or a prescribed fluoride supplement, good brushing and flossing, a nutritious diet, and regular dental visits are the best steps to take for their children’s oral health.

Fluoride toothpastes should not be used by children under age two. For babies and young children, brushing carefully with a soft-bristled brush and water is enough to remove plaque and food particles from the teeth. If the parents desire, a fluoride-free “trainer toothpaste” can be used.

Prior to a child brushing with fluoride toothpaste, parents should teach the child not to swallow toothpaste and how to rinse after brushing. And the ribbon of toothpaste shown on commercials is not necessary; only a pea-sized amount is required, especially for young children.

Parents receiving prescription fluoride supplements for their children understand the dosing instructions. And if the child is receiving adequate fluoride (0.6 ppm) through his drinking water, oral fluoride supplements are unnecessary.

Is Fluoride Safe?

There are many groups opposed to the fluorination of public drinking water. These groups are often over-zealous in their statements and the scientific “proof” they offer to support their position is dubious. The safety of fluoride in the correct amounts and its role in preventing dental caries is well-documented. Fluoride supplementation is nothing to fear, but parents should be careful not to let their children’s use exceed recommended amounts.

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