April 1, 2012

Dental Fluoride: Savior or Poison?

Savior or poison?  The answer is both!  Living through 25+ years of treating patients with fluoride, I have heard it all.  A large majority of my patient do not give having fluoride a second thought.  It is simply something you need to have to maintain a healthy dentition.  However, there is a small minority of patients that refuse fluoride treatment and sometimes I will ask them why.  These are generally the answers I receive:

  • I do not think it is worth the money
  • I have not had any cavities for years
  • It is not good for you

For the “I do not think it is worth the money” crowd, I usually tell them the price of a one surface filling and point out to them all the demineralized areas in their mouth that are potential cavity problem areas.

The “I have not had any cavities for years” people I tend to agree with.  If you have been taking care of your teeth and have no signs of decay, then fluoride is not indicated.

Those who say “It is not good for you” it is better to not try and convince them otherwise.  Zealots are a difficult bunch to convert.  Fluoride is usually only a small part of what they reject in their lives and it is better not to confront them about the benefits of fluoride therapy.

Fluoride is both a treatment for dental caries and a poison.  It is all in the dose just like every other drug on the market today.  If you take too much, you can overdose.  If you take too little it will not have the desired effect.  This is the fundamental flaw of the fluoride nay sayers.  They don’t want any fluoride at all because it is ALL bad for you.  This disregards many of the facts involving fluoride:

  • Fluoride is the 17th most abundant element in the earth’s crust
  • It can form a compound with every other element except helium and neon, therefore is used in many different products including pesticides.
  • It is found in most well water
  • It has antibacterial properties
  • It has been used since the 1950’s in preventing cavities
  • It is responsible for ushering dentistry into the modern era.

Fluoride containing compounds are so numerous and different it is impossible to categorize their  toxicity, yet the critics lump them all together into one fluoride containing category and call it all poison.  Some fluoride containing compounds commonly used in every days lives include:


Every element and chemical on the earth has a toxic level.  There have been deaths report by ingesting too much water.  It is toxic by both inhalation and ingestion.  The usual dose of fluoridated water is in the range of 1 part per million (ppm or 1 mg per liter of water) while sea water is usually from 1.2-1.5 ppm and surface fresh water is about 0.01-0.3 ppm.  Deep water well can have substantially higher amounts and can be as high as 2800 ppm.

Dental Fluoride Treatments:

The days of swishing and splitting out a fluoride treatment at the dental office are long gone.  The risk of a patient swallowing some of the old fluoride treatment was high and this was a problem especially with children.  Critics of fluoride pointed this fact out and said it was responsible for higher than normal systemic fluoride levels in the body.  It was a powerful tool in their argument against fluoride treatments in the dental office.

However, with the advent of fluoride varnishes these same arguments do not apply.  The fluoride is now bound up in a varnish and is not absorbed in the body systemically.  It is safe for children as young as two years old and can be ingested without any problems that were seen with the old fashion liquid fluoride treatments of the past.

Most of the fluoride varnishes on the market today have 5% sodium fluoride and some type of natural or synthetic resin base carrier.  Some even have xylitol as a flavoring.

Fluoride varnishes were first approved as cavity liners in 1991, but recently the FDA/ADA has approved it for preventive cavity treatments in the dental office.

While there are many illegitimate critics of fluoride in drinking water and in dental products, there are others who are looking at the scientific literature to verify the need for fluoridation with a fresh and new approach.  They have finally understood that no one will take them seriously without science to back them up.  And I say good for them and I hope they keep up the good work. Just do not force your opinions on someone without scientifically proven facts to back it up.


1.  Oper Dent. 2012 Feb 7. [Epub ahead of print] Caries-preventive Activity of Fluoride-containing Resin-based Desensitizers. Sohn SYi KSon HChang J.

2.  J Contemp Dent Pract. 2011 Nov 1;12(6):408-13. Caries Prevention Effect of Intensive Application of Sodium Fluoride Varnish in Molars in Children between Age 6 and 7 Years. Gugwad SCShah PLodaya RBhat CTandon PChoudhari SPatil S.

3.  Int J Med Sci. 2012;9(2):129-36. Epub 2012 Jan 7. Effects of Two Fluoride Varnishes and One Fluoride/Chlorhexidine Varnish on Streptococcus mutans and Streptococcus sobrinus Biofilm Formation in Vitro. Pinar Erdem ASepet EKulekci GTrosola SCGuven Y. Department of Pedodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey.

4. Evid Based Dent. 2011 Dec;12(4):104-5. doi: 10.1038/sj.ebd.6400823. Fluoride varnish may improve white spot lesions. Stafford GL. Department of General Dental Sciences, Marquette University School of Dentistry, Milwaukee, Wisconsin, USA.

5.  Community Dent Oral Epidemiol. 2011 Dec 8. doi: 10.1111/j.1600-0528.2011.00656.x. [Epub ahead of print] Effect of 5% fluoride varnish application on caries among school children in rural Brazil: a randomized controlled trial. Arruda AOSenthamarai Kannan RInglehart MRRezende CTSohn W. Department of Orthodontics & Pediatric Dentistry, University of Michigan, Ann Arbor, MI, USA Department of Cariology, Restorative Sciences & Endodontics, University of Michigan, Ann Arbor, MI, USA Department of Periodontics & Oral Medicine, University of Michigan, Ann Arbor, MI, USA Division of Environmental Health, Department of Public Health, São Paulo, Brazil.

6.  J Dent Child (Chic). 2011 Sep-Dec;78(3):143-7. Topical iodine and fluoride varnish effectiveness in the primary dentition: a quasi-experimental study. Milgrom PMTut OKMancl LA. Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, University of Washington, Seattle, USA. dfrc@u.washington.edu

7. Braz Oral Res. 2011 Oct;25(5):433-8. Combination effect of fluoride dentifrices and varnish on deciduous enamel demineralization. Gatti ACamargo LBImparato JCMendes FMRaggio DP. Departamento de Odontopediatria, Faculdade de Odontologia, São Leopoldo Mandic, Campinas, SP, Brazil.

8. Int J Paediatr Dent. 2011 Oct 17. doi: 10.1111/j.1365-263X.2011.01188.x. [Epub ahead of print] Mother and youth access (MAYA) maternal chlorhexidine, counselling and paediatric fluoridevarnish randomized clinical trial to prevent early childhood caries. Ramos-Gomez FJGansky SAFeatherstone JDJue BGonzalez-Beristain RSanto WMartinez EWeintraub JA. Section of Pediatrics, Los Angeles School of Dentistry, University of California, Los Angeles Center to Address Disparities in Children’s Oral Health, UCSF School of Dentistry, San Francisco San Ysidro Community Health Center, San Ysidro, CA, USA.

9. J Dent Res. 2011 Nov;90(11):1306-11. Epub 2011 Sep 15. A cluster-randomized controlled trial: fluoride varnish in school children. Milsom KMBlinkhorn ASWalsh TWorthington HVKearney-Mitchell PWhitehead HTickle M. The University of Manchester, School of Dentistry, Coupland 3 Building, Oxford Road, Manchester M13 9PL, UK.

10.  N Y State Dent J. 2011 Jun-Jul;77(4):38-42. Caries management with fluoride varnish of children in U.S. Lam AChu CH. alam@citytech.cuny.edu