The importance of managing patients’ fluoride use

The NHS recommends that patients brush their teeth thoroughly with a fluoride toothpaste to effectively prevent tooth decay.[i] However, with many options available on the market containing varying levels of fluoride, it’s essential that clinicians are able to recommend the right solution for each patient, and understand the benefits and risks associated with it.

Fluoride is a naturally occurring mineral found in water in varying amounts, depending on where you are in the UK.^[ii] It is widely accepted that fluoride plays a vital role in preventing tooth decay, and has been a standout ingredient in toothpastes since the 1970s.^[iii] Because it is so widely used, it’s important to have a good understanding of the benefits it offers, as well as any potential risks, and how to use it to help your patients protect their oral health more effectively.

What are the benefits afforded by fluoride?

Fluoride prevents demineralisation by travelling into the enamel sub-surface, where it absorbs into the crystal structure, and provides protection. It promotes remineralisation as it accelerates the growth of fluorapatite crystals on partially demineralised teeth. It absorbs into the surface and attracts calcium, in turn attracting more fluoride, resulting in a fluorapatite-like surface. This makes the tooth surface less vulnerable to acid. Additionally, it hinders plaque formation. At a low pH, fluoride ions are able to travel through the cariogenic bacterial cell wall. Once inside, it acidifies the bacterial environment and inhibits the bacteria^[iv]

What are the risks of over-prescribing fluoride?

Whilst fluoride offers patients countless dental health benefits, it’s important to consider the potential effects of over-use.

Dental fluorosis

During childhood, whilst the teeth are still developing, exposure to high concentrations of fluoride can lead to mild dental fluorosis. These are small white streaks or specks on the enamel. Whilst this doesn’t affect patients’ health, the discolouration can be noticeable. To mitigate the risk, children should not use high concentrations of fluoride, and should be supervised when brushing their teeth to ensure they do not swallow their toothpaste.^[v]

Skeletal fluorosis

Excessive exposure can impact bone health too, leading to a bone disease called skeletal fluorosis. Over time, this can cause pain and damage to bones and joints, and the risk of fractures may increase.^iv

What are the legal limitations surrounding fluoride?

In the UK, there is a legal limit for the maximum concentration of fluoride that over-the-counter toothpastes can contain to protect patients’ safety. This is 1,500 ppm fluoride,^[vi] and is why many popular toothpastes contain just under this – usually 1,450 ppm. Some patients and clinicians may assume that this is the recommended concentration for clinical benefits, however, it should instead be viewed as an absolute maximum daily dosage. Although, dentists have the ability to prescribe higher dose fluoride toothpastes to those who are susceptible to caries.^v

However, a high concentration doesn’t necessarily mean a toothpaste offers an effective result. The fluoride contained in toothpaste is usually soluble, meaning that its effects do not last very long, washing away very quickly. As such, it’s important for clinicians to consider options that provide their patients with long-lasting results.

Low concentration and slow-release fluoride

Clinicians may instead consider recommending a toothpaste option which contains a lower concentration of fluoride, which is released over a longer period.

BioMin® F, the innovative fluoride-containing toothpaste from BioMin®, incorporates fluoride in the structure of a bioactive glass, alongside phosphate and calcium ions. By capturing the fluoride within the toothpaste’s structure, it is able to adhere to the tooth surface and dissolve slowly – gradually releasing a continuous supply of fluoride over 12 hours. BioMin® F works with the saliva to produce fluorapatite which is deposited on the surface of the teeth and in the dentinal tubules, which strengthens and protects the tooth enamel. Additionally, BioMin® F acts as a pH buffer as it’s gradually released. This means that, when a patient consumes acidic food or drink, the levels of acid in the mouth are kept to a minimum.

By carefully considering the recommendations clinicians make to patients, taking into account all of the potential risks and shortfalls of particular fluoride toothpastes, they can offer their patients an effective, long-lasting solution.

For more information about BioMin®, and the innovative range of toothpastes, please visit www.biomin.co.uk or call 0203 281 7282.