Who’s afraid of fluoride?

MANILA, Philippines - Yes,  research has shown that fluoride is safe and effective in preventing and controlling dental decay when used in appropriate amounts.  Ingestion of excessive fluoride can cause “fluorosis” of developing permanent teeth.  Usually, fluorosis is mild with unnoticeable white specks or streaks on these teeth.  Uncommon more severe cases show pitting and brownish discoloration, which can be improved through scores of dental aesthetic techniques.  Adult supervision of children will make sure that fluoride use follows recommendations appropriate for every child’s age. 

How does fluoride prevent tooth decay?

Fluoride has been found to be most effective when used topically (fluoride bathes the erupted teeth in the mouth) than systemically (fluoride becomes part of the tooth structure when it is swallowed and absorbed in the body). Routinely using a small amount of fluoride on the teeth prevents dental caries by inhibiting the loss of minerals in tooth enamel and strengthening teeth that are starting to develop cavities.  Fluoride also causes the decay-causing bacteria to limit their acid production that damages the teeth.  Toothpaste is the cheapest, effective, and most accessible fluoride vehicle for caries prevention.  Fluoride even works better with a low sugary diet and proper tooth brushing. 

What are the age-appropriate fluoride toothpaste recommendations of the Philippine Pediatric Dental Society, Inc (PPDSI)? 

Six months to three years old — 1000 ppm fluoride concentration (smear); three to six years — 1000 ppm (pea-size); six years and above — 1350-1500 ppm (10-20 mm)

Recent research shows that fluoride is most effective when topically applied on the teeth, at least twice a day (after breakfast and before bedtime), and is allowed to stay in the mouth for at least an hour without eating, drinking or rinsing. An adult (parent or caretaker) is responsible for dispensing the correct amount of toothpaste and brushing the teeth correctly.

How much fluoride should a toothpaste contain?

Studies have shown that toothpastes should contain at least 1000 ppm (parts per million) of fluoride for it to be effective in caries prevention and/or reduction.  However, most baby toothpastes in the Philippines contain less.  Parents should make sure that the toothpaste they use for their children contains no less than 1000 ppm.  Children more than six years old may use higher concentrations of up to 1500 ppm.

When should my baby start to use fluoride toothpaste?

Babies’ teeth should be brushed with fluoride toothpaste as soon as they erupt into the oral cavity (usually between six and 12 months of age) for early and immediate caries protection.

Can my baby use toothpaste with fluoride even if he/she is still unable to spit?

Yes.  The recommendations given by the PPDSI for infants and toddlers less than three years assume that all the toothpaste used will be swallowed.  Ingesting the recommended smear (a large grain of rice) of 1000 ppm fluoride concentration of toothpaste twice daily is way below the maximum allowable amount for that age group. 

Aside from toothpastes, what are the other sources of fluoride?

Fluoride is also available for use in oral health care in mouth rinses, professionally applied gels or varnishes, and fluoride drops or tablets and sometimes in drinking water.  Children less than six years old should be monitored such that ingestion of fluoride does not go beyond the age recommended systemic amount.   Your pediatric dentist may recommend any of these additional fluoride modalities based on the child’s caries risk assessment and age.  Since nine out of 10 Filipino children aged five years (NMEDS 2011) have dental caries, a strong preventive intervention is needed as soon as the first tooth erupts.

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Dr. Carina Mabanta-de los Reyes, DMD, MS DDM, UP College of Dentistry, 1982 and MS & cert in pedia dent, University of Illinois, Chicago, 1986, is diplomate and director of the Philippine Board of Pediatric Dentistry, and consultant at St. Luke’s Medical Center Quezon City with private practice at The Medical City, MATI Rm. 1211, Ortigas, Pasig.