The most common health condition of all is untreated dental caries.[i] This is brought on by a variety of factors, from diet to poor oral hygiene routines, and inadequate exposure to fluoride.
Fluoride itself is a naturally occurring mineral found in some water sources, meaning it can be consumed by the everyday person. The volume in which it appears depends on which area of the world, and the UK, that an individual lives.[ii] However, patients who do not get enough fluoride may need alternative solutions to prevent against dental decay.
It is the responsibility of the dental team to ensure that patients take in ample fluoride, and they should be able to make recommendations for each unique case dependent on an individual’s needs.
How much is enough?
Clinicians should always ask themselves if a given patient gets adequate fluoride, or is their intake in excess or entirely insufficient? Being at either end of the spectrum can be problematic.
An over-ingestion of fluoride over a lengthy time period can contribute to fluorosis which, in its mildest form, can appear as white or translucent mottling or banding of teeth – more severe cases can lead to enamel damage or pitting.[iii] The effects of fluorosis are deemed to be entirely aesthetic, and particularly affect the developing dentition of children.iii This is not to say that adult patients are immune from the effects; a 2018 study found that fluorosis was more common in adults with a lifetime exposure to water fluoridation than those without exposure, but the aesthetic impact diminished with age.iii
Insufficient fluoride intake, however, can be far more damaging – but it’s important to look at it first through the benefits of adequate fluoride consumption. This includes the prevention of caries though a number of different processes.[iv]
Fluoride inhibits tooth demineralisation, promotes remineralisation, and also affects bacterial metabolism and acid production, which are all obviously positive.[v] The crystalised structure of the enamel surface absorbs fluoride ions, protecting it against demineralisation.v Then, as and when demineralisation occurs, fluoride continues to absorb into the partially affected crystals, attracting supersaturated calcium and phosphate ions to promote remineralisation.v Fluoride also directly combats cariogenic bacterial species by interfering with enzymatic activity, resulting in cell lysis.v
If a patient’s fluoride intake is insufficient, this protection quickly falls apart; enamel is more susceptible to damage, which is then not actively repaired, and oral bacteria is left untouched to develop carious lesions.
Predominant sources of fluoride
In the UK, drinking water can artificially and naturally feature fluoride, with the first UK fluoridation schemes being established in the 1950s and 60s.[vi] However, fluoridated water is currently only supplied to 10% of the population in England; a majority is subsidised through regional schemes, but 8% of this is through naturally occurring fluoride.vi Over 50 million people in England alone remain without this source of fluoride, and thus may require alternative solutions.
Water fluoridation is an area of debate, and the UK Parliament recognises it as such.vi Protesters voice concerns over state intervention, the robustness of scientific evidence, possible negative health consequences, and feelings about the purity of water.vi
Most modern toothpastes contain fluoride, and so patients can benefit from the mineral whilst simultaneously displacing plaque and oral bacteria. Clinicians should advise that most patients choose toothpastes containing 1350-1500ppm of fluoride, and there are specially designed solutions that are suited to children under 3-years-old that have a lower volume of fluoride, but it should still be around a 1000ppm minimum.[vii]
Take matters in your own hands
Still, dental caries remains a widespread issue in the UK – 31% of adults have tooth decay.[viii] In many cases, clinical intervention to support fluoride uptake is necessary. This is possible through the application of fluoride treatments, which is generally provided in a highly concentrated rinse, foam, gel, or varnish. This will provide a greater quantity of fluoride than that found in water or toothpaste, and will require patients to not eat or drink for a set amount of time after care. The result is improved fluoride access, at a level that can be controlled to avoid excessive or insufficient intake.
The Clinpro Clear Fluoride Treatment from Solventum, formerly 3M Health Care, is a water-based, rosin-free formula that is simple to apply, and an ideal choice for clinicians and patients alike. Available in 3 flavours – flavourless, watermelon and mint – to improve the patient experience, it has a minimum contact time of just 15 minutes whilst ensuring effective fluoride uptake.
It’s paramount that all patients have access to fluoride, whilst remaining aware of the risks of overexposure. In order to prevent caries development, clinicians should discuss how patients typically get their main sources of fluoride, and suggest clinical treatments where appropriate.
To learn more about Solventum, please visit https://www.solventum.com/en-gb/home/oral-care/
©Solventum 2024. Solventum, the S logo and Clinpro are trademarks of Solventum and its affiliates. 3M is a trademark of 3M company.
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About Solventum
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[i] World Health Organization, (2024). Oral health. (Online) Available at: https://www.who.int/news-room/fact-sheets/detail/oral-health [Accessed January 2025]
[ii] NHS Inform, (2024). Fluoride. (Online) Available at: https://www.nhsinform.scot/tests-and-treatments/dental-treatments/fluoride/ [Accessed January 2024]
[iii] Macey, R., Tickle, M., MacKay, L., McGrady, M., & Pretty, I. A. (2018). A comparison of dental fluorosis in adult populations with and without lifetime exposure to water fluoridation. Community Dentistry and Oral Epidemiology, 46(6), 608-614.
[iv] World Health Organization, (2019). Inadequate or excess fluoride: A major public health concern. (Online) Available at: https://iris.who.int/bitstream/handle/10665/329484/WHO-CED-PHE-EPE-19.4.5-eng.pdf?ua=1 [Accessed January 2025]
[v] Veneri, F., Vinceti, S. R., & Filippini, T. (2024). Fluoride and caries prevention: a scoping review of public health policies. Annali di Igiene, Medicina Preventiva e di Comunità, 36(3).
[vi] Lowery, G., Bunn, S., (2021). Water fluoridation and dental health. UK Parliament. (Online) Available at: https://post.parliament.uk/water-fluoridation-and-dental-health/ [Accessed January 2025]
[vii] Oral Health Foundation, (N.D.). Fluoride. (Online) Available at: https://www.dentalhealth.org/fluoride [Accessed January 2025]
[viii] Oral Health Foundation, (N.D.). Oral health statistics in the UK. (Online) Available at: https://www.dentalhealth.org/oral-health-statistics [Accessed January 2025]
