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Why should there be fluoride in your toothpaste - perspective of a dentist !
- SUI GENERIS
- Dec 13, 2024
- 7 min read
Updated: 4 days ago
*Authored by the founder of Sui Generis who holds a degree in dentistry
Fluoride in community water supplies , milk , foods , toothpastes ,
in order to prevent dental decay , remains a long standing controversial and debated topic.
Although, public health policy makers, preventive health experts, dental experts have a long established bias of advocacy for the fluoride.
It is overwhelmingly common for dentists , dental academicians and researchers, dental public health authorities to promote fluoride unquestionably without a second thought.
They emphasize so much on accepting added fluorides in foods, water and toothpastes , to such an extent where they directly ridicule those who criticise fluorides as " Unscientific ".
What is fluoride ?
Fluorine is the world's 13th most abundant element and constitutes 0.08% of the Earth crust.
It has the highest electronegativity of all elements.
Fluoride is widely distributed in the environment,
occurring in the air, soils, rocks, and water.
Naturally found as Calcium fluoride , it is found as Sodium fluoride and sodium monofluorophosphate commonly in toothpastes in concentrations upto 1000 ppm in adults.
For kids , this concentration may be 250 to 300 ppm or parts per million.
Why dentists insist on adding fluorides to foods, water and toothpastes ?
Enamel or visible white part of your teeth is made up of hydroxyapatite crystals of calcium, magnesium and phosphates.
When fluoride reacts with hydroxyapatite, it forms fluoroapatite which is more resistant to demineralisation by acid producing bacteria in oral cavity.
Therefore, fluoride appears to make teeth resistant to dental decay or dental caries.
However, most clinical dentists hardly have the idea of biochemical action of Fluoride, but academics studying fluoride may be exceptions.
Fluoride can inhibit glycolysis enzymes in bacteria , can interfere with polysaccharide metabolism in bacteria and can disturb the ability of bacteria to maintain pH homeostasis. [1]
How did fluoride come into picture in dental caries prevention ?
From 1931, Dr. Trendley Dean, Head of the Dental Hygiene Unit at the National Institute of Health,USA,
began investigating the epidemiology of fluorosis.
After a decade's study, Dean and his team found that water containing fluoride at a concentration of 1.0 part per million (ppm) appeared to offer ,
some caries protection while minimising the extent of dental fluorosis.
The United States' lead in instituting artificial water fluoridation led to its acceptance by the World Health Organization as an effective oral health intervention.
At least 30 nations instituted artificial water fluoridation policies.
However, a number of countries including Sweden, The Netherlands, Germany, and Switzerland stopped fluoridating their water supplies due to concerns about safety and effectiveness. [2]
Fluoride is effective only topically or locally when directly applied to teeth.
Still, its anti caries effects are dependent on Calcium and Magnesium.
The deficiency of Magnesium and Calcium may consequently lead to tooth hypomineralization.
Hypo mineralization means less minerals than that should be.
Tooth hypomineralization can increase risk of caries.
How dental decay or caries occurs !
Although the causes of dental caries can be multiple like poor oral hygiene,
eating too much sugary and sticky sweet foods,
tooth hypomineralization, xerostomia or dry mouth ,
malaligned teeth/crowding of teeth leading to food accumulation,
excess consumption of processed foods with added sugars ,
not rinsing mouth after eating.
But the basic principle of caries development is simple -
Food accumulates and retains in oral cavity even after eating > Caries causing bacteria become active > Bacteria release acids to digest sugars in food > Acids lead to loss of minerals/demineralization > This continued loss of minerals slowly leads to infection of inorganic part of teeth , mostly enamel and then Dentin which eventually leads to infection of Pulp. Caries may involve roots also which are harder to manage.
Why fluoride is dangerous
The blind dominant narrative of endorsement of Fluoride in dental and public health fraternity,
as a magical tool to prevent caries, is not ready to investigate its effects on the biochemistry and physiology of the body.
Several recent studies question the effectiveness of fluoride to prevent dental caries,
and its safety is also being critically examined.
Fluoride may adversely affect cognitive development in Children. [3]
It can influence thyroid gland also. [4]
In a 2005 study, it was found that 47% of children living in a New Delhi neighbourhood with average water fluoride level of 4.37 ppm have evidence of clinical hypothyroidism attributable to fluoride. [5]
The most obvious and widespread impact of fluoride is dental fluorosis.
In some cases—where fluoride levels are very high or where there is prolonged ingestion at 2 ppm or higher, cases of skeletal fluorosis have been reported.
Skeletal fluorosis is a chronic metabolic bone disease caused by ingestion or inhalation of large amounts of fluoride.
In regions with water fluoride concentrations over 2 ppm,
or among workers constantly exposed to fluoride in aluminium or fertilizer industries,
skeletal fluorosis is common (>20% prevalence) and manifested as
joint pain in both upper and lower limbs, numbing and tingling of the extremities, back pains, and knock-knees.
Vertebral osteosclerosis may result in spinal cord compression. [6]
Fluoride therapy decreases cortical bone mineral density and increases skeletal fragility. [7]
Fluoride can disrupt the enzymes in the body.
Fluoride can interfere by attaching itself to metal ions located at an enzyme's active site or by forming competing hydrogen bonds at the active site which is not exclusively just on the teeth.
A recent study of the effects of inorganic fluoride compounds on human cellular functions revealed that fluoride can interact with a wide range of enzyme-mediated cellular processes and genes modulated by fluoride including those related to the stress response, metabolic enzymes, the cell cycle, cell-cell communications, and signal transduction. [8]
Chronic fluoride ingestion is commonly associated with hyperkalemia ( increase in potassium ) and consequent ventricular fibrillation. Ventricular fibrillation means abnormal contraction in muscles of ventricles of our heart. [9]
Although not overwhelming but around 50 publications in medical literature are documented where fluoride has been linked to cancer.
In a follow up study spanning around 30 years in male cryolite workers exposed to fluoride dust in Copenhagen, Denmark - it was found that fluoride can be a possible cause of bladder cancer and can possibly be cause of primary lung cancer as reported by Phillipe Grandjean and Jorgan H. Olsen [10].
Verdict for our readers
Dental caries is a pandemic which is present all over the world since some time,
especially since when the people started consuming ultra processed sweet foods , candies , drinks with added sugars.
There is no part of the world, no community where dental caries is not present
but its ultimate reason is the food lodgement
which gives bacteria chance to digest sugars ,
consequently leading to acid release
and eventually caries development after excessive loss of minerals from enamel.Fluoride has no direct concern with pathogenesis of dental caries.
If a person brushes twice in 24 hours ,i.e., one in morning and one before bedtime ,
brushes by correct brushing technique [modified bass technique] ,
rinses mouth after eating or drinking anything other than water ,
adds floss to their daily routine ,
eats less sugary foods like candies, donuts , traditional sweets , chocolates , ice creams etc.,
eats healthy fats and oils which protect from caries by covering pits and fissures in teeth - then, the chances of dental caries development become almost nil.
Dental caries is a lifestyle disorder which results from lack of consciousness of oral health and psychological dependence on sugary foods.
Out of carbs, proteins and fats - only simple carbohydrates i.e., monosaccharides,
oligosaccharides , which taste sweet ,hence called sugars ,
have the potential to cause caries.
One should stop eating refined sugar and sweets made from refined sugar completely.
One should adopt whole sweets like jaggery, maple syrup ,honey.
But, whole sweets or unprocessed sweets can also cause caries if one does not rinse mouth after eating immediately.
Brushing twice a day + flossing + rinsing mouth after any meal or snack + minimal sugar intake + correct brushing technique + eating whole foods + healthy fats and oils which protect from caries by covering pits and fissures in teeth + preventive dental examinations at regular intervals = negligible chances of dental caries = NO NEED TO ADD ARTIFICIAL FLUORIDE IN TOOTHPASTE/WATER |
Fluoride deficiency has never been documented in humans.
There is no current recommended dietary intake for fluoride as may be in case of iodine, sodium, potassium, calcium etc.
Hence, fluoride has no role in the normal functioning of the body.
In an extensive review of fluoride and human health published in 2011, the European Commission's Scientific Committee on Health and Environmental Risks concluded that fluoride is not essential for human growth and development.
We draw your attention and strongly advise you to read this review article on water fluoridation by Stephan Peckham. This blog article is strongly inspired by review article by Mr. Stephan Peckham.[ 11 ]
Nevertheless, Fluoride is naturally present in water, soil , foods and
hence, any attempt to add artificial fluoride will aggravate the susceptibility to fluorosis
and will have adverse effects eventually.
References
[1] Hamilton IR. Biochemical effects of fluoride on oral bacteria. J Dent Res. 1990 Feb;69 Spec No:660-7; discussion 682-3. doi: 10.1177/00220345900690S128. PMID: 2179327.
[2] Pizzo G, Piscopo MR, Pizzo I, Giuliana G. Community water fluoridation and caries prevention: a critical review. Clin Oral Investig. 2007 Sep;11(3):189-93. doi: 10.1007/s00784-007-0111-6. Epub 2007 Feb 27. PMID: 17333303.
[3] Choi AL, Sun G, Zhang Y, Grandjean P. Developmental fluoride neurotoxicity: a systematic review and meta-analysis. Environ Health Perspect. 2012 Oct;120(10):1362-8. doi: 10.1289/ehp.1104912. Epub 2012 Jul 20. PMID: 22820538; PMCID: PMC3491930.
[4] National Research Council, et al. "Fluoride in drinking water: a scientific review of EPA's standards." (2007).
[5] Susheela AK, Bhatnagar M, Vig K. Excess fluoride ingestion and thyroid hormone derangements in children living in Delhi, India. Fluoride. 2005;38(2):98-108.
[6] Fisher RL, Medcalf TW, Henderson MC. Endemic fluorosis with spinal cord compression. A case report and review. Arch Intern Med. 1989 Mar;149(3):697-700. PMID: 2919942.
[7] Riggs BL, Hodgson SF, O'Fallon WM, Chao EY, Wahner HW, Muhs JM, Cedel SL, Melton LJ 3rd. Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis. N Engl J Med. 1990 Mar 22;322(12):802-9. doi: 10.1056/NEJM199003223221203. PMID: 2407957.
[8] Barbier O, Arreola-Mendoza L, Del Razo LM. Molecular mechanisms of fluoride toxicity. Chem Biol Interact. 2010 Nov 5;188(2):319-33. doi: 10.1016/j.cbi.2010.07.011. Epub 2010 Aug 3. PMID: 20650267.
[9] McIvor ME, Cummings CE, Mower MM, Wenk RE, Lustgarten JA, Baltazar RF, Salomon J. Sudden cardiac death from acute fluoride intoxication: the role of potassium. Ann Emerg Med. 1987 Jul;16(7):777-81. doi: 10.1016/s0196-0644(87)80573-5. PMID: 3592332.
[10] Philippe Grandjean, Jørgen H. Olsen, Extended Follow-up of Cancer Incidence in Fluoride-Exposed Workers, JNCI: Journal of the National Cancer Institute, Volume 96, Issue 10, 19 May 2004, Pages 802–803
[11] Peckham S, Awofeso N. Water fluoridation: a critical review of the physiological effects of ingested fluoride as a public health intervention. ScientificWorldJournal. 2014 Feb 26;2014:293019. doi: 10.1155/2014/293019. PMID: 24719570; PMCID: PMC3956646.