From the Guidelines
Fluoride is generally safe when used as directed in dental products and water fluoridation programs. The optimal level of fluoride in drinking water provides dental health benefits while minimizing risks. Fluoride strengthens tooth enamel by promoting remineralization and making teeth more resistant to acid attacks from bacteria. However, excessive fluoride intake can cause dental fluorosis (white spots on teeth) or, in extreme cases, skeletal fluorosis.
Key Points to Consider
- Children under 6 should use only a pea-sized amount of fluoride toothpaste and be supervised to prevent swallowing.
- Most people receive appropriate fluoride amounts through fluoridated water, toothpaste, and professional dental treatments.
- The safety of fluoride has been extensively studied, and the consensus among health organizations is that fluoride at recommended levels provides significant dental health benefits with minimal risks, as noted by the Centers for Disease Control and Prevention 1.
Recommendations for Use
- All persons should receive frequent exposure to small amounts of fluoride, which minimizes dental caries by inhibiting demineralization of tooth enamel and facilitating tooth remineralization 1.
- Drinking water with an optimal fluoride concentration and brushing teeth twice daily with fluoride toothpaste are recommended for all persons 1.
- Additional fluoride measures might be needed for persons at high risk for dental caries, and measured use of fluoride modalities is particularly appropriate during the time of anterior tooth enamel development (i.e., age <6 years) 1.
From the Research
Safety of Fluoride
The safety of fluoride as a compound is a topic of discussion among researchers.
- Fluoride is considered an essential trace element that can have a prophylactic action against dental caries at doses lower than 1.5 mg/day 2.
- However, at high doses, fluoride may induce skeletal fluorosis, leading to pseudorachitism in children 2.
- The ingestion of toxic amounts of fluoride is rare, but the prevalence of dental fluorosis has increased in North America, suggesting that fluoride levels need to be closely monitored 3.
- Fluoride can accumulate in the body and cause damaging effects on body tissues, particularly the nervous system, with prolonged exposure 4.
- Acute toxicity can occur after ingesting one or more doses of fluoride over a short time period, leading to poisoning, mainly due to unsupervised ingestion of products for dental and oral hygiene and over-fluoridated water 5.
Factors Affecting Fluoride Safety
Several factors can affect the safety of fluoride, including:
- Dose and duration of exposure: high doses and prolonged exposure can increase the risk of adverse effects 2, 4.
- Source of fluoride: fluoride can be ingested from various sources, including foods, beverages, and dental products 3, 6.
- Individual variation: there is substantial variation in fluoride ingestion among individuals, with some people receiving up to several times as much exposure as the mean 6.
- Age and susceptibility: children are more susceptible to the toxic effects of fluoride 4, 5.
Recommendations for Safe Use
To ensure the safe use of fluoride:
- Fluoride supplements should be considered a targeted, preventive procedure only for those at elevated caries risk, and careful consideration should be given to other fluoride sources 3.
- The European Academy of Paediatric Dentistry (EAPD) recommends a preventive topical use of fluoride supplements because of their cariostatic effect 5.
- Appropriate consideration of the variation and complexity of fluoride ingestion is warranted in efforts to ensure a margin of safety favoring dental caries prevention while limiting objectionable fluorosis 6.