Fluoride or not? This is what other professionals say

It is no longer just dental professionals who are talking about it, consumers have also joined in the debate: to brush with fluoride or not to brush with fluoride? This is a question to which they usually do not have an answer so they are right to ask it in the dentist’s or dental hygienist’s chair. The opinions are divided, also within dentistry. In this article, several experts from the dental industry talk about the use of fluoride. One advises to brush with it, the other prefers an alternative. You can read their arguments below. We also share some research for more background. 

Different kinds of fluoride 

In its pure form, fluoride is a gas: fluorine. Therefore, it is always bonded to another substance before use. This can be a salt such as sodium (sodium fluoride) or a metal such as tin (tin fluoride). The most common type of fluoride is sodium fluoride. Most fluoridated toothpastes contain this type of fluoride. Besides its use in dentistry, fluoride is also used in industry. It is useful for etching glass and as an ingredient in pesticides, among other things. In addition to the types mentioned above, there is also calcium fluoride. This is the safest kind of fluoride. It is a compound between calcium salt and fluoride. The remarkable thing about this compound is that it is hardly soluble in water. This makes it difficult to process and much less toxic than other types of fluoride. 

Function of fluoride  

Brushing with fluoride hardens the enamel of the teeth. This has been researched and proven many times. It builds up in the enamel and protects it against the Streptococcus mutans bacteria, which we know cause caries. Cor van Loveren, retired professor of preventive dentistry at the Amsterdam Academic Centre for Dentistry, explains. “It is very clear that fluoride is a huge protection against cavities. Before fluoride was used in the Netherlands, children had an average of eighteen cavities by the age of five; now there are about three.” Van Loveren further explains in the article that the mineral calcium is an important part of the tooth. “Calcium can get dissolved by acids, which are formed in the mouth from sugars. This causes cavities. In the presence of fluoride, calcium dissolves much less quickly,” Van Loveren said. 

Is fluoride unhealthy?

So fluoride can help prevent cavities, but is it dangerous? That depends, as with many substances, on the dose. ” If you ingest far too much fluoride at once, it can start to bind to the calcium in the blood. For example, if a toddler eats all of his parents’ toothpaste at once, this can lead to a temporary lack of calcium, which can be dangerous. Temporary hospital admission is then necessary to check the amount of calcium in the blood and, if necessary, to supplement it by infusion.”

The Europe Food safety Authority sets the maximum daily safe amount of fluoride intake for adults at 7 milligrams per day. According to an American research, adults ingest approximately 0.1 milligrams of fluoride per day through toothpaste. American adult toothpastes contain similar amounts of fluoride as European toothpastes.

bluem closeup of purple gemstones

Opposition

However, there are also studies that are sceptical about the effectiveness of fluoride use. A study at Saarland University in Germany shows that the fluorine bonding to the enamel by brushing with fluoridated toothpaste is limited to a thickness of only six nanometres. The researchers doubt whether such extremely thin layers of fluorapatite are capable of preventing cavities.  

What experts are saying

Ronald Muts, a Dutch dentist with over 30 years of experience in biological dentistry, prefers to focus on maintaining good oral hygiene, without chemicals. “In my opinion, that is the best method to prevent the occurrence of cavities, and not the use of fluoride,” he explains in the Dutch podcast Oersterk. “No doctor uses as many non-organic materials and substances as a dentist.  You end up asking yourself whether all these applications are healthy for your body or not. Fluoride is an example of this in my opinion. Fluoride is mixed with your saliva and it is often swallowed by children. When it comes into contact with stomach acid, fluoride then becomes hydrochloric acid, or an aggressive substance that can lead to vomiting.”

Muts advises to focus especially on nutrition, as it plays a very important role for the condition of your mouth and teeth. “It is important to limit the number of times you consume carbohydrates and sugars. The bacteria that cause cavities feed on sugars. If there are limited moments in the day when you eat, cavities are less likely to form. Vitamins and minerals also contribute to good oral health. For example, vitamin D helps prevent cavities, as do calcium and magnesium. Taking a special dental supplement can be a solution,” says Muts.  

Dental hygienist and nutritionist Tessa Hagen also shares this opinion. “After graduating I never thought I would be recommending toothpaste without fluoride, but with the products from blue®️m I have discovered that it is possible for many patients to remain caries-free even without fluoride. Fluoride is needed when demineralisation has occurred. blue®️m uses a combination of ingredients that work together to reduce plaque and bacteria, which in turn reduces mineral extraction from the tooth surface. Every patient is an individual, but in many cases fluoride-free brushing is possible.”

Oral hygienist Lieneke Steverink-Jorna has some reservations about this. She says that fluoride-free brushing is only beneficial for people who are not or less sensitive to cavities. “Some people consciously choose to use toothpaste without fluoride. That’s fine, especially if you never get cavities. Unfortunately, many people are not so lucky. Of course, it is then very important to have your diet and your brushing technique checked by the dental hygienist. Fluoride is a huge help in preventing the development of caries. If all your efforts have come to nothing, fluoride is a safe thing to embrace,” says Steverink-Jorna.

Australian dentist Dr Steven Lin wrote an article, published in 2015, on the pros and cons of fluoride use. Since most of Australia’s water supply was fluoridated in the ‘60s and ‘70s, tooth decay still occurs at near epidemic proportions in Australia. Why? Because we are busy arguing about the wrong things.

Even with the application of water fluoridation in Australia for over half a century, tooth decay is still considered by the Australian Dental Association as one of the country’s most prevalent diseases. The problem is that fluoride fails to address the core reason of why tooth decay occurs: our diet.

Dental decay has only existed in its contemporary form for about 200 years. Before this, archeological records show that humans lived for thousands of years without the significant presence of any dental disease. In the animal kingdom tooth decay is equally rare. The unsettling reality is that tooth decay is a disease of human civilisation and while fluoride has applications in treatment, it’s by no means the silver bullet.

At the heart of the problem are the bacterial changes in our mouth that occur due to the consumption of simple carbohydrates. This results in the proliferation of certain microbes whose metabolites cause destruction of the tooth surface.

Fluoride is known to have certain antibacterial actions in the mouth that seem to inhibit some bacteria. However with at least 500-700 species in the mouth, it’s unclear how it impacts the entire ecosystem. Fluoride is not a cure for tooth decay.

Conclusion

One fluoride is not the same as the next. And every tooth and body differs. We should not be afraid of fluoride in toothpastes. However, there are differences in the types of fluoride. Calcium fluoride is the safest option. The European Food Safety Authority wrote about it in The EFSA Journal (2008): “Overall, calcium fluoride, being much less soluble and less bioavailable than other soluble forms of fluoride, can be considered less toxic.” 

If you choose not to use fluoride, make sure you have extra good oral hygiene and a healthy diet. It is also important to use oral care products with sufficient active ingredients, such as active oxygen, lactoferrin and xylitol. Cavity-causing bacteria cannot survive in an oxygen-rich environment. Brushing or rinsing with active oxygen is therefore effective against cavities. Another effect of fluoride is the repair of superficial cavities. Xylitol has a remineralising effect on incipient cavities. It stimulates saliva flow and creates a protective layer around your teeth. This makes it harder for new plaque to form and keeps your mouth clean.