Thanks to new materials and techniques, dentists are more successful than ever before at reversing the disease process and preserving, repairing, and replacing teeth. This report will introduce you to the latest developments — from smart fillings that can help prevent cavities to new methods for placing dental implants. It sifts through the hype surrounding certain dental products and procedures. Can chewing xylitol gum protect against tooth decay? Are silver fillings and fluoridation safe? Which toothbrush really works best? You’ll find the answers to these questions within this report.
You'll also find a wealth of information on techniques to repair or replace damaged teeth — including root canal therapy, bridges, orthodontic treatment, dentures, and implants — as well as advice on managing dental emergencies. In addition, it provides information on cosmetic procedures, such as bleaching, bonding, veneers, and tooth reshaping.
Prepared by the editors of Harvard Health Publications in conjunction with Hans-Peter Weber, D.M.D., Chair of the Department of Restorative Dentistry, Harvard School of Dental Medicine. 49 pages. (2009)
All about fluoride
Fluoride is a powerful ally in your fight against tooth decay. In 1945, Grand Rapids, Mich. became the first American city to add fluoride to its drinking water. The results were dramatic. Studies that measured the health of children’s teeth after 13 to 15 years showed a drop of 50% to 70% in the level of tooth decay. In the next five decades, more than 10,000 American communities followed suit. In 2006, the Centers for Disease Control and Prevention (CDC) reported that nearly 70% of the U.S. population — approximately 184 million people — was receiving optimally fluoridated water, a jump of more than 11% over 1992 levels. The widespread fluoridation of drinking water is often cited as one of the 10 great public health accomplishments of the 20th century.
How does it work?
Fluoride is a common mineral found in all of the earth’s water sources and many foods. Fluoride in the saliva enhances the body’s ability to rebuild the mineral crystals that make up tooth enamel when acid-producing bacteria cause them to decay. The new enamel created during this remineralization process is actually harder and more decay-resistant than the original tooth surface. In addition, fluoride seems to inhibit bacteria’s ability to produce the sticky substance that enables plaque to adhere to the tooth surface. It also makes it more difficult for bacteria to turn sugar into acid.
Fluoride has the greatest power to fight decay when it’s present on an ongoing basis after the teeth have erupted through the gum. This means that people of all ages — not just young children — can reduce their risk for decay by regularly exposing their teeth to fluoride.
How do you get it?
One of the simplest methods is from drinking water. In 1962, the U.S. Public Health Service determined the optimum standard of fluoride in drinking water to be 0.7 to 1.2 parts per million (ppm) — the equivalent of 0.7 to 1.2 milligrams per liter of water. This level has proved successful in fighting decay without posing a risk of overexposure. Another means is to use toothpaste that contains fluoride. For most people, these two sources of fluoride are sufficient to keep decay in check.
If your community doesn’t have fluoridated water or if your family uses bottled water, your dentist may suggest getting fluoride from other sources. Most brands of bottled water do not contain the recommended amounts of fluoride, and some brands contain no fluoride at all. Fluoride is also removed from the water in some home water treatment systems. If you have a water filtering system, check the manual or contact the manufacturer to find out how the filter affects fluoride levels in your water.
People who are at high risk for decay or who don’t drink fluoridated water can get additional fluoride via mouth rinses, oral supplements, or treatments such as fluoride gels and varnishes applied by a dental professional. Talk to your dentist about whether you and your family are getting the fluoride you need.
Is it safe?
Despite fluoridated water’s solid track record in improving oral health, rumors abound linking fluoride to a broad range of ills, from heart disease to allergies to genetic abnormalities. Numerous studies conducted in the past 60 years refute claims that the current level of fluoride in drinking water causes these diseases.
A host of national and international health organizations have issued statements about the safety and effectiveness of fluoridation. Organizations that support fluoridating water include the CDC, the American Medical Association, the World Health Organization, the National Institute of Dental and Craniofacial Research, the American Dental Association, and the U.S. Public Health Service.
Research on fluoride continues, and a 2006 research paper garnered some attention because it suggested a possible link between fluoride in water and a rare form of bone cancer known as osteosarcoma in young men. However, the author of the paper reported that the study had limitations and that further research was needed to confirm or refute these findings. Earlier studies on fluoridation and osteosarcoma also do not support such a link. In a review of all available evidence, including data from this study, the National Research Council concluded that evidence concerning fluoride and osteosarcoma was “tentative and mixed,” and they did not recommend that the CDC make any changes to the allowable levels of fluoride in drinking water.
While the bulk of scientific evidence has found that fluoridation is safe, fluoride can be lethal if you ingest excessive amounts — 2.5 to 5 grams for an average adult. However, you would have to consume 5,000 to 10,000 glasses of fluoridated water in one sitting to reach this level. The true poisoning danger is for children who get into improperly stored fluoride tablets or who ingest a large amount of a fluoridated toothpaste or mouth rinse.
A minor drawback to using fluoride is the risk of fluorosis, a condition that discolors tooth enamel. Staining ranges from nearly imperceptible chalklike markings to heavier mottling and brown blemishes. Fluorosis appears in permanent teeth when a child ingests too much fluoride while these teeth are forming in the gum. The risk of fluorosis disappears once the permanent teeth are fully developed — around age 8. Although it’s a cosmetic concern, fluorosis doesn’t affect the functioning of the teeth.