Fluoride for dental health

Fluoride is a natural mineral that is found in water. The amount of naturally-occurring fluoride in the water varies from area to area. In Malta and Gozo, since most of our water is produced by reverse osmosis, there is little or no fluoride in our tap water.

Fluoride has been researched for over 50 years and water fluoridation has been proven to cut dental decay by 40 to 60%. Fluoride is present in many different natural sources, such as sea salt, tea and mineral water but is also artificially added to some brands of bottled water. A level of one part in a million has been shown to be most effective. Fluoride can greatly help dental health by strengthening the tooth enamel, making it more resistant to tooth decay. Many toothpastes now contain fluoride, and this is how most people get their fluoride.

If your drinking water does not have fluoride added, fluoride toothpaste is effective. However, some people are more prone to dental decay. If so, your dentist may suggest using fluoride supplements or topical fluoride applications, which can help to reduce dental decay. The amount of fluoride in toothpaste is usually enough to lower the level of decay. In areas where the water supply is fluoridated, fluoride toothpaste provides additional protection. However, in these areas, children under 7 years old should use one of the toothpastes containing lower levels of fluoride.

It is sometimes necessary for children who need added protection to take extra fluoride in the form of supplements (specially formulated gels, drops, tablets or mouthwashes) or topical applications. It is extremely important that these are only taken on the advice and instruction of your dentist.

‘Dental fluorosis’ can occur when too much fluoride is taken. This can happen for example when the water supply is already fluoridated and supplements are taken, or when children ‘eat’ toothpaste. Campaigners against fluoridation claim that an overdose of fluoride can sometimes cause ‘brittle bone’ disease and digestive disorders, but these suggestions have not been scientifically proven.

Enamel fluorosis is a result of too much fluoride, absorbed while the enamel of the teeth is forming. Severe fluorosis may lead to pitting of the enamel and discolouration. However, severe fluorosis is rare in the Malta and Gozo. In its mildest form, fluorosis appears as very fine pearly white lines or flecking on the surface of the teeth. This mild fluorosis is often undetectable except by a dental expert.

Many reports have been published about the pros and cons of fluoride. After many years the scientific conclusion is that fluoride is of great benefit to dental health and helps to reduce decay, while causing no harmful side effects to general health.

Fluoride comes from a number of different sources including toothpaste, specific fluoride applications and perhaps the drinking water in your area. These can all help to prevent tooth decay.

You can get low-fluoride toothpastes, and the general rule is to use a small smear of toothpaste up to 5 years; from 5 to 7 use slightly less than a pea size and a normal pea size from 7 upwards. Children should be supervised up to the age of 7, and you should make sure that they spit out the toothpaste and don’t swallow any if possible.

Supplements can be taken as follows:

  • Pregnancy (8th and 9th months only): 1x 1mg tab once daily
  • 6 – 12 months old: 0.25mg in drops once daily (not in milk)
  • 2 – 4 years old: 2x 0.25mg tabs daily
  • 4 – 6 years old: 3x 0.25mg tabs daily
  • 6 – 12 yrs old: 1x 1mg tab daily

Older children and Adults should allow 1–2 1mg tabs to dissolve slowly in their mouth for added topical benefit.

If you are unsure about using fluoride toothpaste or supplements ask your dentist.

Joseph Xuereb
Joseph Xuereb
Principal Dental Surgeon & Owner of Savina Dental Clinics, Dr Joseph Xuereb BChD (Hons), MFGDP(UK), MGDS RCS(Eng), FFGDP RCS(UK), FICD is a general dental practitioner with a special interest in Implant and Restorative Dentistry. Dr Joseph & the teams' full biographical information can be found here.