Fluoride is a double threat to cavities because it protects teeth by preventing cavities and reverses early signs of tooth decay, strengthening the tooth structure.
You may be startled to learn that tooth decay is the number-one most common chronic childhood disease according to the Centers for Disease Control and Prevention. Tooth decay is four times more common than early childhood obesity, five times more common than asthma, seven times more common than hay fever, and twenty times more common than diabetes.
The American Academy of Pediatric Dentistry reports that about 60% of U.S. children will have had one or more cavities by the age of 5. Poor oral health can have significant short- and long-term implications for young children. Cavities can be painful and impact a child’s ability to chew, swallow, smile, speak, and sleep. If left untreated, they can result in infection and tooth loss and cause a child to miss school or have trouble concentrating in class. Each year, over 51 million school hours are lost due to dental health issues, and low-income children suffer twice as many cavities as their peers.
Fortunately, tooth decay is preventable. However, many parents are unaware of the best ways to help their children fight this formidable foe. To figure out why cavities have reached epidemic proportions and what parents and caregivers can do about it, we consulted one of our favorite experts, Dr. Lauren Companioni, pediatric dentist at South Tampa Kids Dental Krewe. With a pirate themed dental office, complete with ship and crew, Dr. Lauren makes going to the dentist a positive experience for kids; so positive in fact, we actually overheard young patients not wanting to leave!
In previous interviews with Dr. Lauren, we learned that early dental visits, healthy dietary choices, fluoride, and routine dental practices at home drastically reduce a child's risk for tooth decay. Today, we asked Dr. Lauren to share her expertise with us on the use of fluoride. We asked her about sources of fluoride, its cavity-fighting abilities, and safety considerations.
What is Fluoride?
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Parents and patients might be surprised to learn that fluoride is naturally present in all water sources. If little pirates were to voyage by ship, they would find this natural mineral in the ocean as well as lakes, rivers, and streams. Pirates with inquiring scientific minds will be interested to learn that the fluoride ion comes from the 17th most abundant element in the Earth's crust called fluorine. Fluoride ions are released into the water and become part of all water sources as water passes over rock formations, dissolving minerals and fluoride compounds. The amount of fluoride in water varies according to the body of water's depth and mineral concentration.
The American Academy of Pediatric Dentistry reports that about 60% of U.S. children will have had one or more cavities by the age of 5.
What Causes Tooth Decay and How Does Fluoride Fight It?
As little pirates sail the seas, they may be tempted to indulge in tasty treats and sweets from the ship's kitchen and treasure chest. Sadly, cavity-causing bacteria in their mouths delight at this, devouring sugar and turning it into acid plaque. The acid plaque attacks and softens the enamel in their young teeth, which are already more porous and vulnerable to cavities in the first seven years of life. Soon, the pirates' nemesis, tooth decay, moves in and throws a housewarming party, bringing gifts of erosion, damage to the inner pulp of the tooth, and infection. Do little pirates have time for this? No! After all, they have parks, picnics, and play dates to attend to. So what tools can they use to combat these rotten villains? One excellent option, Dr. Lauren suggests, is fluoride.
Fluoride is a double threat to cavities because it protects teeth in two important ways. It not only helps prevent cavities, but it can also reverse early signs of tooth decay. Fluoride helps strengthen tooth structure, providing protection against acid plaque attacks. It also helps repair and remineralize weakened teeth that are starting to show signs of acid damage.
Dr. Lauren explains there are both systemic and topical forms of fluoride available to little pirates. Both have their own “superhero powers” and play an important role in protecting little teeth. Topical fluorides have the power to strengthen teeth already present in the mouth and make them more resistant to decay. Topical fluorides are applied to the surface of teeth and include toothpaste, mouth rinses, and dentist-applied treatments. Systemic fluorides are ingested and incorporated into the entire tooth structure to make them healthy and strong. They provide long-lasting protection and include fluoridated water, dietary supplements, and certain foods and drinks.
Dr. Lauren explains that pirate families can prevent cavities and promote long-term dental health by establishing routine oral-hygiene habits, like brushing teeth. She says that the earlier you get your baby used to some form of tooth brushing the better. Even before his or her teeth come in, you can clean your baby's gums with a damp washcloth or soft toothbrush and water. Once your baby's teeth begin to surface, she recommends brushing twice a day with a tiny smear of toothpaste and increasing the fluoride toothpaste to a pea-sized amount at ages two through six. Dr. Lauren stresses that children under the age of eight years old often lack the dexterity to brush their teeth thoroughly so it is important for parents to help them brush their teeth. The American Dental Association (ADA) recommends parents use a fluoride toothpaste bearing the ADA Seal of Acceptance to ensure proper concentration. The ADA also endorses the use of fluoride mouth rinses for children six years old and above. (Mouth rinses are not recommended for children under six due to the likelihood they may swallow the rinse.)
2. Professionally Applied Fluoride
In addition to toothpaste and mouth rinses used at home, topical fluoride can also be applied professionally at the dentist’s office. These fluorides are more concentrated than self-applied fluorides and hence are not needed as frequently. The ADA recommends that children receive a fluoride treatment at the dentist’s office once every six months.
Once your baby’s teeth begin to surface, Dr. Lauren recommends brushing twice a day with a tiny smear of toothpaste and increasing the fluoride toothpaste to a pea-sized amount at ages two through six.
Systemic Fluoride
1. Drinking Water: Community Water Fluoridation
Although fluoride is naturally occurring in all bodies of water, the concentration is usually below the 0.7-to-1.2-parts-per-million recommendation from the U.S. Public Health Service and ADA for effective cavity prevention. As such, cities often add fluoride to bring the water up to the desired level. Water fluoridation has been touted as the most cost-effective and equitable way to provide fluoride to communities, and it highly benefits low-income families who are not able to take advantage of other dental services.
Research shows water fluoridation reduces childhood tooth decay by 20-40%. Water fluoridation costs approximately $0.50 a year per person in large communities and $3.00 a year per person in small communities. For most cities, each dollar invested annually in water fluoridation translates into $38 in savings each year in dental treatment costs due to fewer incidences of cavities. The Centers for Disease Control and Prevention praises water fluoridation as one of the top ten great public health achievements of the 20th century.
2. Dietary Supplements
For children living in areas where water is not fluoridated, dietary fluoride supplements (drops, tablets, or lozenges) are available by prescription to prevent tooth decay.
Safety Considerations
Dr. Lauren explained that fluoride is both safe and effective when used appropriately and is a powerful tool in the fight against cavities. She noted that the American Academy of Pediatrics, the American Dental Association, and the Centers for Disease Control and Prevention all agree that fluoride is a safe and effective tool to combat tooth decay. Dr. Lauren endorses use of fluoride toothpaste, fluoridated water, and topical fluoride treatments at the dentist's office to help little pirate patients fight cavities and enjoy happy, healthy smiles for life. She reassures parents about the safety of fluoride, explaining it all comes down to the question of amount and frequency. When families follow the ADA guidelines, brushing little teeth daily, using a slight smear of toothpaste for 1-year-olds, and a pea-sized amount for ages two and up, they are well within established safety limits for fluoride.
Sometimes, little pirates tend to swallow their toothpaste, especially if it tastes good, so parents need to teach them to spit it out. Children under the age of six often have weaker control over their swallowing reflex, so parental supervision, praise, and imaginative incentives can go a long way in helping remind them to spit and not swallow the paste. Mouth rinses are not recommended for children under the age of six. Even children over the age of six can benefit from a friendly reminder not to swallow the often tasty-flavored rinses.
Swallowing a pea-sized drop of toothpaste every once in a while won’t cause kids any problems and is nothing for parents to worry about. If, however, children ingest an excessive amount of fluoride daily over a long period of time when their permanent teeth are forming, those teeth could develop fluorosis.
Fluorosis is a cosmetic condition involving the discoloration of the tooth enamel. Most cases are mild, with barely noticeable white streaks, but more severe cases cause dark stains. Although fluorosis can be treated cosmetically and is not painful or detrimental to the health or function of teeth, care should be taken to use fluoride appropriately and avoid the stains. At the age of eight when a child’s adult teeth have come in, there is no longer a risk of fluorosis.
To maximize the benefit, xylitol should be used 4-5 times a day. Vigilant adherence to brushing, flossing, and keeping children's teeth clean is also vital.
Xylitol as Cavity Preventative
On occasion, Dr. Lauren sees families at her practice that have serious reservations about fluoride and request alternative sources of treatment. Although Dr. Lauren is an advocate of fluoride, she respects varying opinions and works hard with her patients and their parents to find treatment options with which everyone is comfortable. In instances like these, Dr. Lauren recommends special vigilance to strong dietary practices, like avoiding sugary and starchy foods and beverages that promote tooth decay. She also recommends the use of xylitol as a cavity preventative and alternative course of treatment to fluoride.
Xylitol is a naturally occurring sweetener found in low amounts in the fibers of many fruits and vegetables. Unlike sugar, xylitol does not cause tooth decay, as it cannot be broken down into acids by oral bacteria. Xylitol helps restore a healthy alkaline/acid balance in the mouth that is hostile to bacteria and plaque. Xylitol is available in the form of gum and candies as well as toothpastes and mouthwashes to help reduce cavities.
The American Dental Association promotes the use of xylitol in professionally applied applications to teeth as part of “comprehensive cavity prevention programs.” Ideally, the ADA recommends xylitol used in conjunction with fluoride to utilize all known assets in the fight against tooth decay. When families are opposed to fluoride, however, xylitol is an alternative to try. Dr. Lauren recommends that her little pirate patients use xylitol after every meal, after eating snacks, and before bedtime. To maximize the benefit, xylitol should be used 4-5 times a day. Vigilant adherence to brushing, flossing, and keeping children's teeth clean is also vital.
A Family Endeavor
Parents of little pirates should also take care of their own dental health. Statistics show that some bacteria that promote tooth decay can also be transmitted from parents to their children. Likewise, children emulate parents' habits, so why not model healthy oral-health routines and make it a family priority. When the pirate ship sets sail to combat the nasty villain tooth decay, a united family front is the best defense. Don't forget to incorporate fluoride and xylitol into every member’s arsenal of tools. Yo ho, let’s go and defeat those cavities!
EverydayFamily extends our thanks and appreciation to Dr. Lauren Companioni for taking the time to share her expertise on preventative agents in the fight against tooth decay. We hope all our readers found some useful information today that will help keep your family’s teeth healthy and strong. For more information on how dentists, parents, and kids can work together to foster good, preventative, oral hygiene and care, please check out our first interview and second interview Dr. Lauren.
Monster-Free Mouths Movement
Parents and kids interested in learning more about taking care of teeth in a fun, creative way can click here to join the “Monster-Free Mouths Movement.” The American Academy of Pediatric Dentistry has launched a great campaign to help kids fight tooth decay. They can read more about “the mouth monsters” which include Tartar the Terrible, Tooth D.K., and Ginger Bite-Us. The site includes a downloadable “Mouth Monster Defense Kit” which includes: A Mouth Monster Most Wanted Poster, Mini Mouth Monster Mirror Posters, a Daily Tracker, Monthly Award Certificate, Dental Check-Up Award, and Parent's Tip Sheet.
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