We have been led to believe since long that our toothpaste should contain salt, which is mostly rich in Fluoride. The burning question here is whether we should use fluoride free toothpaste or not? There is a somewhat complicated and detailed answer to this simple question. Against the widespread belief, most dentists suggest you use fluoride free toothpaste for some reasons. Especially, if you are buying toothpaste for your child, who is below two years of age, without a second thought buy non-fluoride toothpaste.

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Although most people are convinced that fluoride reduces tooth decay, they miss the big picture where fluoride is the cause for a typical tooth decay called DENTAL FLUOROSIS.

This majorly affects children below two to three years of age and present as brown stains and pitting on the teeth. In adults, too much Fluoride can cause Osteoporosis, Thyroid malfunctions, and Endocrine problems, even cancer.

This debate about fluoride free toothpaste has been going on for decades now. In the United States of America, 75 to 90 percent of toothpaste include fluoride.

You can identify these with the FDA warning at the back of the toothpaste, stating them to be kept out of children’s reach because of fluoride content.

What is fluoride?

Chemically, fluoride is the 9th element on the periodic table and the most electronegative element as well. It is classified under halogens.

Halogens are harmful to any living being when administered in small quantities over a long time. This is a significant reason why fluoride-containing toothpaste is contraindicated.

Fluoride in combination with Sodium forms NaF or sodium fluoride, which is salt. Fluoride in toothpaste is in the form of NaF salts.

Fluoride alone in elemental form can’t state the degree of its toxicity. But in combination with another element can form a compound which determines its degree of damage.

Fluoride is also incorporated in drinking water by community water supply agencies. The government introduced this in compliance with a widespread belief that fluoride causes a reduction in the incidence of tooth decay.

Hence, we can consciously take measures such as opting a fluoride free toothpaste. (1)

History of fluoride with our teeth and dentifrices

Our favorite dentifrices, that is, mouth rinse and toothpaste, have long gone hand in hand with fluoride. Since 1950, advertising and marketing world has led us to believe that toothpaste should contain fluoride salts to prevent tooth decay.

It all started with a scientist name McKay, who identified fluorosis and went on to research on its cause. Another scientist Mr. Dean followed his studies and concluded that mild amounts of fluoride could prevent tooth decay.

Companies were quick to formulate the new elixir and marketed the wrong notion worldwide, knowing little of its future implications.

How fluorides reduce tooth decay?

Fluoride is added to community water supplies in the concentration of 1 parts per million, which is a very dilute form. Toothpaste, mouthwash and supplemental pills that help prevent tooth decay have a higher level of fluoride.

Other common sources include beverages made with tap water and food that made with fluoridated water. After extensive research started by McKay and Dean, fluoride became a part of water supplies in 1 ppm concentration.

Fluoridation of community water was done in a way that it didn’t cause fluorosis of teeth. (2)

According to the  CDC (Center for Disease Control), fluoride prevents tooth decay on tooth surfaces but only after teeth erupt into our mouth which can be explained by the following mechanisms –

Preventing the process of demineralization

Fluoride helps to prevent gastric acids from weakening enamel (the outer surface of the tooth). Enamel is composed of minerals like calcium and phosphate.

Acid tends to break down these dental minerals, this, in turn, leads to tooth decay. Fluoride helps to inhibit the dissolving of tooth minerals by acid by replacing calcium and forming stronger crystals.

Remineralization of enamel

Acids attack and weaken enamel. Fluoride reverses this process by attracting calcium from the saliva. This further brings both calcium and phosphate ions together to make enamel less dissolvable when attacked by acids.

Reduction in bacterial activity

Dental plaque has a high bacterial activity. Fluoride interferes with the bacterial acid production, which leads to a decrease in demineralization.

In the United States of America, the Environmental Protection Agency (EPA) is the government body that regulates fluoride in drinking water.

Between the years 1976 and 1987, studies showed that adding fluoride to community water supplies in the concentration of  0.7-1.2 parts per million (ppm) was known to reduce tooth decay by 30% – 60% in milk teeth (primary) and 15% – 35% in adult teeth (permanent).

Fluoride based toothpaste infographic

Fluoride free toothpaste or not?

A single tube of fluoride toothpaste has sufficient amount of fluoride to affect adversely a small child. Billions of children brush their teeth with fluoridated toothpaste every day, thus putting themselves at risk of swallowing large amounts of fluoride in this process.

Average children approximately swallow about 33% of the toothpaste that is applied to their brush each time they brush.

Now considering the amount of fluoride which is added to the water supplies, you might want to know if your child requires this additional fluoride in toothpaste.

Fluoride free toothpaste has some antibacterial agents which keep your children safe while helping in the elimination of bacteria that is known to cause tooth decay.

On the other hand, the harmful effects of fluoride remain a topic of debate in scientific societies across the world. There is a significant rise in rates of dental fluorosis that provides evidence suggesting that fluoride overexposure has become increasingly common.

This leads to systemic problems as well as endocrine anomalies and thyroid issues. In many cases of fluoride hyper-exposure, osteoporosis has been reported in adults. (3)

So, we can easily state that there are potentially dangerous effects of fluoride-based toothpaste. Instead, it would be better to use fluoride free toothpaste.

Other sources of fluoride

Other than dentifrices, food, and water rich in fluoride act as an excellent source. Community and school water supplies are mildly nut sufficiently fluoridated to protect teeth decay.

Some fluoride-rich food sources include –

  • Seedless raisins
  • Seafood like crab and shrimp
  • Grape juice
  • Beverages like black tea and coffee prepared using tap water
  • Artificially sweetened soda

Toothpaste and its contents

Toothpaste is mostly consisted of –

  • Detergents – like sodium lauryl sulfate often lead to canker sores and allergies.
  • Abrasives – causes tooth sensitivity.
  • Binding agents – like carrageenans, xantham gums, and alginates.
  • Humectants – retain moisture in toothpaste.
  • Preservatives – prevent bacterial growth.
  • Coloring agents – for marketing.
  • Antiseptics – like tea tree oil, alcohol, and peppermint.
  • Fluoride salts
  • Flavorings
  • Antibiotics – triclosan

Dental fluorosis

Dental fluorosis is brown staining and mottling or pitting of enamel. Common cases present with no change in the structure of enamel and are painless.

Fluorosis starts as a white flaky appearance of enamel. Moderate cases show brown stains whereas severe cases show pitting on enamel.

How do you know if your child has Dental Fluorosis?

There are many possible causes of changes in the color of the teeth and you may want to see a dental professional to confirm fluorosis.

The American Academy of Pediatrics (AAP) advises that children should begin regular dental visits by the time they are one. As soon as you see flaky white spots on your child’s teeth, see your pediatrician.

How much Fluoride should your child have to protect the teeth without the risking Fluorosis?

Children, who drink a lot of fluoridated water and consume food rich in fluoride, do not need to use fluoridated dentifrices. They will get the fluoride they need for healthy teeth from food and water.

If you still use fluoridated toothpaste, ensure that your child does not swallow toothpaste or mouth rinse, which contains high amounts of fluoride.

Treatment of fluorosis

There are many ways to deal with fluorosis like –

  • Teeth bleaching to whiten the teeth and reverse the brown stains.
  • Bonding with resins to cover the enamel pitting.
  • Strip crowns for structurally abnormal teeth.

Why avoid Fluoride free toothpaste?

In the United States alone, almost 75% – 95% of toothpaste containing fluoride. Toothpaste with fluoride presents a health risk not only to a child but also to an adult. The main reasons for using fluoride free toothpaste include –

  • The warning on the back of toothpaste about fluoride content is insufficient. As children under six years of age cannot spit. It’s somewhat tempting for them to eat the bubble gum flavored toothpaste, taking the safe bar way higher than 20mg of fluoride ingestion per day.
  • The side effects not only cause fluorosis but also weaken bones and ligaments and affect muscle and nervous system as well.
  • In adults, it can cause osteoporosis and endocrine (thyroid) malfunctions, even cancer.

Prevention and Control

Go for fluoride free toothpaste. Even if you are not allergic to fluoride, the systemic risks are way too high than tooth decay. Fluoride in small quantity and in controlled units prevent tooth decay. But over-ingestion of fluoride via toothpaste can cause systemic toxicity.

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Be very careful while choosing a toothpaste. You can consult your dentist if it confuses you. Keep your children away from dental aid and medicaments and see to it that they do not swallow their toothpaste at all.

Following these guidelines as they will keep fluoride-related health issues aside for good.

Over to you on fluoride free toothpaste

An excess of anything is not good and the same applies to fluorides in toothpaste too. Fluoride in small concentrations can prevent tooth decay, but that much is covered by just drinking water.

In no way, we need extra fluoride for our teeth in the form of toothpaste other than drinking water. In fact, the extra fluoride in toothpaste will only cause systemic damage to our body and is even lethal to a small child.

Be prompt in action and see a dentist if you see flaking of teeth in your child, which is an early sign of fluorosis.

Go for fluoride free toothpaste. Even if you are not allergic to fluoride, the systemic risks are way too high than tooth decay. Fluoride in small quantity in controlled units prevents tooth decay, but the same when ingested massively can cause systemic toxicity.
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