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To Fluoride or Not to Fluoride

To Fluoride or Not to Fluoride

Tooth decay (dental caries, cavities) is the most common chronic disease of children and adolescents aged 6 to 19 years1. The American Dental Association (ADA) believes fluoridating public water to be single most effective public health measure to prevent tooth decay and to protect all ages against cavities2.

New Jersey ranks 49th out of 50 states in its percentage of population that receive fluoridated water3. Due to lack of fluoride in our water supplies, many pediatricians will prescribe fluoride supplements and most dentists will apply topical fluoride— gel, foam or varnish—after a professional cleaning.

Fluoridating the public water supply is just as controversial and debatable nowadays as receiving vaccinations. Whether you’re pro or anti-fluoride, let’s discuss how tooth decay occurs and the role of fluoride and fluoride alternatives.

Tooth decay is an infectious disease caused by the interaction of caries-causing bacteria with carbohydrates on the tooth surface over time. These bacteria metabolize carbohydrates for energy and produce an acidic, sticky film called plaque on your teeth. The acids in the plaque lower the pH and cause dissolution of tooth minerals called hydroxyapatite, which is composed of calcium, phosphate and hydroxyl ions, in a process called demineralization.

In the early stages of demineralization, the tooth can remineralize. Saliva in your mouth is a natural buffer and can elevate the pH over time, allowing hydroxyapatite to form again from free calcium, phosphate and hydroxyl ions.

When you have a fluoride reservoir from water, toothpastes, mouth rinses or other topical agents, the free calcium and phosphate ions can bind to fluoride ions instead and form fluorapatite. Fluorapatite is more resistant to acid demineralization than hydroxyapatite, resulting in tooth surface that is more resistant to tooth decay.

Fluoride is toxic in large quantities and can have adverse effects, such as fluorosis—discoloration of teeth.  Ultimately, you should make an informed decision regarding fluoridation for your children.

Should you decide against all types of fluoride, here are some alternatives:

  1. Drink plenty of water. Water helps elevate the pH, allowing hydroxyapatite to form again.
  2. See your dentist for a professional cleaning. Removal of plaque and tartar will reduce the bacterial load.
  3. Get sealants. Sealants are plastic materials painted to coat the chewing surfaces of posterior teeth. They act as barriers to prevent cavities.
  4. Brush and floss. Mechanical debridement of plaque is crucial in reducing the amount of bacteria.
  5. Diet low in carbohydrates. Bacteria love starch and sugar. Limit their food supply and limit bacterial growth.
  6. Use xylitol. Xylitol is a type of sugar substitute that the bacteria cannot metabolize, thereby inhibiting their growth and reproduction. It also increases salivation, which elevates the pH. There are limited studies on the effectiveness of xylitol, however. Ingesting too much of xylitol can lead to bloating, flatulence and diarrhea.
  7. Use MI paste. MI paste contains RecaldentTM, which release calcium and phosphate ions. RecaldentTM is derived from milk casein, so you should not use this product if you suspect allergy to milk protein or benzoate preservatives.

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