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Ariel J. Raigrodski, DMD, MS, FACP
Norman P. Goodwin, DDS
Heidi R. Johnson, DDS
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Lynnwood, Washington
Lynnwood, WA

Fluoride


Tooth Decay Management—Protecting Your Teeth Throughout Life

Fluoride is a natural mineral that has been proven to strengthen teeth and prevent the incidence of tooth decay. The American Dental Association recommends fluoride treatment for children as soon as teeth emerge. This simple preventive measure of applying a fluoride varnish to a child's first teeth can strengthen teeth at risk for decay and create a tooth surface that is more resistant to decay.

Applying a fluoride varnish protects a child's primary (first) teeth from decay (also known as the infectious disease Dental Caries). Fluoride is applied twice a year from ages one to six or seven when the child gets their permanent teeth. Fluoride varnish works by repairing gaps in the tooth enamel, protecting teeth from plaque-forming bacteria that like to colonize in small pits and gaps.

In a study comparing risk for developing teeth decay between school children and older adults, risk was determined to be twice as high for the elderly than for children due to lower buffering capacity (due to low amount of saliva) as well as higher plaque levels and bacteria. A large proportion of elderly adults is considered to be at high risk for tooth decay.

Common primary risk factors include the presence of bacteria that produce the acid responsible for demineralization causing tooth decay. Sugar consumption is a known primary risk factor. The consumption of fermentable carbohydrates in foods, snacks and drinks both total amount and frequency of consumption – influences the ability of bacteria to produce acid. Soda pop consumption can result in rampant tooth decay and tooth erosion. Even if soda pop contains no fermentable carbohydrates (i.e., “diet” soda pop) it is still highly acidic, leading to erosion that subsequently places the enamel at increased risk for further demineralization by acid from cariogenic bacteria. Consumption of energy drinks containing high levels of sugar and caffeine, in addition to the consumption of soda pop, has increased, and their consumption has expanded to include younger and older age groups. Another source that increases subsequent susceptibility to demineralization by acidogenic bacteria is gastric acid, which is prevalent in bulimic patients, during pregnancy, and as a result of gastro-esophageal reflux disease (GERD).

Xerostomia (dry mouth) or hyposalivation (reduced amount of saliva) is a primary factor in tooth decay risk. An absent or reduced salivary flow results in loss of buffering capacity and loss of salivary calcium, phosphate, fluoride and other protective elements. The impact of reduced of saliva can readily be seen in patients following use of xerostomia inducing medications, in patients with autoimmune disease (Sjögren’s syndrome) and in head and neck radiation patients. There are currently more than 42 drug categories comprising more than 400 drugs that have reduced amount of saliva as a side effect, including cardiovascular drugs, antihistamines, antidepressants, diuretics and sedatives. As a result, dry mouth and/or reduced amount of saliva is a major contributing risk factor, particularly in the older adult.

In addition, Periodontal disease and therapy, as well as gingival recession, place patients at increased risk for dental decay due to exposure of root dentin surfaces.

Optimizing the daily level of fluoride exposure in the general population is recognized as helpful, safe and cost effective way of managing tooth decay. While water fluoridation has an effect on fluoride content of enamel when provided during tooth development, most of the effect of fluoride has been found to be topical rather than due to fluoride incorporation during tooth development. Evidence-based results in recent years indicate the effectiveness of self-applied and professionally applied fluorides as well as water fluoridation in reducing caries in adults. For low risk patients, regular twice-daily use of fluoride dentifrice may suffice to help prevent caries. For moderate and higher-risk patients, intervention and a tailored program are required; the program should include the use of in-office topical fluoride as well as home care.

In the case of elderly patients who are at high risk for caries, it has been recommended that intervention should focus on antibacterial therapy, high-fluoride therapy, patient education and shorter recall intervals.

Fluoride is easily applied to teeth. It dries almost immediately upon contact with clean dry teeth and will not be removed by saliva. The procedure is quick, painless, and often included in dental insurance coverage, but you will want to check with your provider to be certain.

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Ariel Raigrodski, DMD, MS, FACP
Norman Goodwin, DDS
Heidi Johnson, DDS

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19020 33rd Ave W Suite 200
Lynnwood, WA 98036
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