Self-Applied
Fluoride Toothpaste. Fluoride-containing toothpaste is the most commonly used form of self-applied fluoride worldwide.3 Fluoride in toothpaste is taken up directly by the dental plaque and demineralized enamel and also increases the concentration of fluoride in saliva.2, 3 Brushing with fluoride toothpaste increases the fluoride concentration in saliva 100- to 1,000-fold; this concentration returns to baseline levels within 1 to 2 hours.3 Fluoride toothpaste makes up more than 95% of toothpaste sales in the U.S.2The American Dental Association recommends use of a fluoride toothpaste displaying the ADA Seal of Acceptance. Fluoride toothpastes available over the counter in the U.S. generally contain a fluoride concentration of 1,000 to 1,500 ppm.2, 5, 6 Prescription-strength fluoride toothpastes contain 5,000 ppm fluoride as sodium fluoride.2, 6 In the U.S., the active ingredient in fluoride-containing toothpastes can be sodium fluoride, sodium monofluorophosphate, or stannous fluoride.5, 6
For most people (children, adolescents, and adults) brushing twice a day with a fluoride toothpaste'when you get up in the morning and before going to bed'is recommended.2 Children's brushing should be supervised to ensure that they use the appropriate amount of toothpaste. For children younger than 3 years, parents and caregivers should begin brushing children's teeth as soon as they begin to come into the mouth by using fluoride toothpaste in an amount described as no more than a smear or alternatively as the size of a grain of rice.3 For children 3 to 6 years of age, parents and caregivers should dispense no more than a pea-sized amount of fluoride toothpaste.3
Fluoride Mouthrinse or Gels. Fluoride mouthrinse is a concentrated solution intended for daily or weekly use and designed to be rinsed and spit out.2 The most common fluoride compound used in mouthrinse is sodium fluoride.2 The fluoride from mouthrinse is retained in dental plaque and saliva and helps prevent tooth decay.2, 3 Over-the-counter solutions of 0.05% sodium fluoride (230 ppm fluoride) for daily rinsing are available for use by persons older than 6 years of age;2, 5, 6 use in persons younger than 6 years of age is not recommended because of the risk of fluorosis if the rinse is swallowed repeatedly.3, 6 Higher strength mouthrinses (e.g., 0.2% neutral sodium fluoride to be used once a week) for those at high risk of tooth decay must be prescribed by a dentist or physician.2 Solutions of 0.2% sodium fluoride (920 ppm fluoride) are also used in supervised, school-based weekly rinsing programs.2, 3, 5
There are also self-applied gel formulations of sodium fluoride (1.1% [5,000 ppm] sodium fluoride) or stannous fluoride (0.15% [1,000 ppm] fluoride) available by prescription for home use.2, 5
Professionally Applied
Fluoride Mouthrinse, Gels, or Foams. Professionally applied fluorides are in the form of a gel, foam or rinse, and are applied by a dental professional during dental visits.2 These fluorides are more concentrated than the self-applied fluorides (e.g., 1.23% fluoride ion [12,300 ppm]), and therefore are not needed as frequently.
Because an early study7 reported that fluoride uptake by dental enamel increased in an acidic environment, fluoride gel is often formulated to be highly acidic (pH of approximately 3.0).3 Products available in the U.S. include gels of acidulated phosphate fluoride (1.23% [12,300 ppm] fluoride), as 2% neutral sodium fluoride products (containing 9,000 ppm fluoride), and as gels or foams of sodium fluoride (0.9% [9,040 ppm] fluoride).2, 5 In a dental office, fluoride gel is generally applied for 1 to 4 minutes.2, 5 Home use follows instructions provided in the package insert or as instructed by a dentist or physician.2 These higher strength products, if used in the home, must be prescribed by a dentist or physician.
Because these applications are relatively infrequent, generally at 3- to 12-month intervals, fluoride gel poses little risk for dental fluorosis, even among patients younger than 6 years of age.2, 3 Routine use of professionally applied fluoride gel or foam likely provides benefit only to persons at high risk for tooth decay, especially those who do not consume fluoridated water and brush daily with fluoride toothpaste.2
Fluoride-Containing Prophylaxis Paste. Fluoride-containing paste is routinely used during dental prophylaxis. The abrasive paste, which contains 4,000 to 20,000 ppm fluoride, might restore the concentration of fluoride in the surface layer of enamel removed by polishing, but it is not an adequate substitute for fluoride gel or varnish in treating persons at high risk for dental caries.3 Fluoride prophylaxis paste alone is not considered by the U.S. Food and Drug Administration (FDA) or ADA an effective method to prevent dental caries.3, 8
Fluoride Varnish. Varnishes are available as sodium fluoride (2.26% [22,600 ppm] fluoride) or difluorsilane (0.1% [1,000 ppm] fluoride) preparations.2, 5, 6 A typical application requires 0.2 to 0.5 mL, resulting in a total fluoride ion application of approximately 5 to 11 mg.5
High-concentration fluoride varnish is painted by dental or other health care professionals directly onto the teeth and sets when it comes into contact with saliva.2, 5, 6 Fluoride varnish is not intended to adhere permanently; this method holds a high concentration of fluoride in a small amount of material in close contact with the teeth for several hours.2 Varnishes must be reapplied at regular intervals with at least 2 applications per year needed for sustained benefit.2 Although it is not currently cleared for marketing by the FDA as an anticaries agent, fluoride varnish has been widely used for this purpose in Canada and Europe since the s.2, 3 Studies conducted in Canada and Europe have reported that fluoride varnish is as effective in preventing tooth decay as professionally applied fluoride gel.2 The U.S. Preventive Services Task Force recommends the clinical application of fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption.9 The recommendation is given a 'B' grade, indicating that there is high certainty that the net benefit of the intervention is moderate or there is moderate certainty that the net benefit is moderate to substantial.10
According to the Centers for Disease Control and Prevention (CDC), there is no published evidence to indicate that professionally applied fluoride varnish is a risk factor for dental fluorosis, even among children younger than 6 years of age.2 Proper application technique reduces the possibility that a patient will swallow varnish during its application and limits the total amount of fluoride swallowed as the varnish wears off the teeth over a period of hours.11
Silver Diamine Fluoride. Silver diamine fluoride (SDF) is a colorless liquid that at pH 10 is 24.4% to 28.8% (weight/volume) silver and 5.0% to 5.9% fluoride.12 The FDA has classified SDF as a Class II medical device and it is cleared for use in the treatment of tooth sensitivity, which is the same type of clearance as fluoride varnish, and must be professionally applied. Although some products are commercially available in other countries, currently, Advantage Arrest' (Elevate Oral Care, L.L.C.) and Riva Star' (SDI, Inc.) are the only commercially available SDF products for dental use in the U.S.13 There have been reports of the use of SDF in caries control and management, although it is not specifically labeled for use for this indication (i.e., 'off-label use'). Likely a result of its fluoride content, when applied to a carious lesion, SDF has been shown to lower caries risk of the adjacent tooth surface.14 SDF has also shown efficacy in management of root caries in the elderly.15-17 It likely has additional applicability as an interim approach for managing problematic caries in individuals currently unable to tolerate more involved dental treatment.18
Single application of SDF has been reported to be insufficient for sustained benefit.19 Its potential downsides include a reportedly unpleasant metallic taste, potential to irritate gingival and mucosal surfaces, and the characteristic black staining of the tooth surfaces to which it is applied.13
Systemic fluorides such as community water fluoridation and dietary fluoride supplements are effective in reducing tooth decay. These fluorides provide topical as well as systemic protection because fluoride is present in the saliva.
Water Fluoridation
Fluoride is present naturally in all water sources.1 Community water fluoridation is the process of adjusting the fluoride content of fluoride-deficient water to the recommended level for optimal dental health, which is currently recommended at 0.7 parts fluoride per million parts water.20, 21 Water fluoridation is an effective and inexpensive means of obtaining the fluoride necessary to prevent tooth decay.3 Studies show that water fluoridation continues to be effective in reducing tooth decay by 20% to 40% in children and adults, even in the era of widespread availability of fluoride from other sources, such as fluoride toothpaste.22 While water fluoridation is an extremely effective and inexpensive means of obtaining the fluoride necessary for optimal tooth decay prevention, not everyone lives in a community with a centralized, public or private water source that can be fluoridated.22 For those individuals, fluoride is available in other forms.
There are several ways to determine the concentration of fluoride in the water supply.3, 22 If water comes from a public or community water supply, contact the local water supplier to determine the fluoride level. Local, county or state health departments can also be a resource for this information. The U.S. Environmental Protection Agency's (EPA) website for water quality reports (called Consumer Confidence Reports) provides information, as does the U.S. Centers for Disease Control and Prevention's (CDC) fluoridation website, "My Water's Fluoride." The CDC website lists fluoridation status by water system for those states that have provided information.
If the water source is a private well, it will need to be tested and the results obtained from a certified laboratory.22 The local or state health department will have water sample testing information. Although the EPA does not have the authority to regulate private drinking water wells, the agency recommends that private well water be tested every year. And although the EPA does not specifically recommend testing private wells for fluoride levels, health professionals will need this information before consideration of prescription of dietary fluoride supplements or to counsel patients about alternative water sources to reduce the risk of fluorosis if the fluoride levels are above 2 ppm.
The majority of bottled waters on the market contain less than 0.3 ppm fluoride, which is less than the optimal level of fluoride.3, 11 The FDA announced in April that it is proposing to revise the quality standard for bottled water to state that bottled water to which fluoride is added by the manufacturer may not contain fluoride that exceeds 0.7 milligrams per liter (0.7 ppm).23, 24 If finalized, the proposed rule would amend the allowable levels of fluoride in domestically packaged and imported bottled water to which fluoride is added.
Some types of home water treatment systems (e.g., reverse osmosis and distillation systems) can reduce the fluoride levels in water supplies, potentially decreasing the decay-preventive effects of optimally fluoridated water; however, carbon/charcoal filtration systems do not remove fluoride.11
Dietary Fluoride Supplements
Fluoride supplements can be prescribed for children ages 6 months to 16 years who are at high risk for tooth decay and whose primary drinking water has a low fluoride concentration.2, 25 Tablets and lozenges are manufactured with 1.0, 0.5, or 0.25 mg fluoride.2, 3 Most supplements contain sodium fluoride as the active ingredient.2 To maximize the topical effect of fluoride, tablets and lozenges are intended to be chewed or sucked for 1'2 minutes before being swallowed;2, 3, 5 for infants, supplements are available as a liquid and used with a dropper.3 Dosing is based on the natural fluoride concentration of the child's drinking water and the age of the child (see Table).5, 25
All dietary fluoride supplements must be prescribed by a dentist or physician.2 For children aged younger than 6 years, health care providers should weigh the risk for tooth decay without fluoride supplements, the decay prevention offered by supplements, and the potential for dental fluorosis.2 Consideration of the child's other sources of fluoride, especially drinking water, is essential in determining this balance.3, 5 Parents and caregivers should be informed of both the benefit of protection against tooth decay and the potential risk of dental fluorosis.2 The U.S. Preventive Services Task Force recommends the clinical use of oral fluoride supplementation starting at age 6 months through 5 years for children whose water supply is deficient in fluoride.9 The recommendation is given a 'B' grade, indicating that there is high certainty that the net benefit of the intervention is moderate or there is moderate certainty that the net benefit is moderate to substantial.10
Table. Fluoride Supplement (Tablets and Drops) Dosage Schedule (Approved by the American Dental Association Council on Scientific Affairs)25 Age Fluoride Ion Level in Drinking Water (ppm)* <0.3 0.3-0.6 >0.6 Birth-6 months None None None 6 months-3 years 0.25 mg/day** None None 3-6 years 0.50 mg/day 0.25 mg/day None 6-16 years 1.0 mg/day 0.50 mg/day None *1.0 part per million (ppm) = 1 milligram per liter (mg/L)Important Considerations When Using Dosage Schedule:25
YongYing contains other products and information you need, so please check it out.
It is important to note that fluoridated water may be consumed from sources other than the home water supply, such as the workplace, school and/or day care, bottled water, filtered water and from processed beverages and foods prepared with fluoridated water. For this reason, dietary fluoride supplements should be prescribed by carefully following the recommended dosage schedule. Dietary fluoride supplements are not recommended for children residing in a community with adequate levels of fluoride in the water supply.
The ADA's dietary fluoride supplement recommendations remain unchanged in light of the new guidelines for community water fluoridation in the U.S. released in April by the U.S. Public Health Service.21 The recommendation for fluoride levels in drinking water was reconsidered in when it was determined that 0.7 milligrams of fluoride per liter of water (0.7 ppm) was optimal. The new recommendation, which was supported by the ADA, does not change the ADA Council on Scientific Affairs' systematic review, clinical recommendation and chairside guidefor the use of dietary fluoride supplements that were released in .
It seems like a simple task: choosing the best toothpaste for you.
But, it can be overwhelming with the number of choices available, the varying purposes, and the range of prices. The tendency is to pick out the nearest or cheapest choice (or both!), pay for it, and leave the store.
It's critical to first consider any dental needs you have that could determine what you need in toothpaste. Do you have highly sensitive teeth, for example? Do you have gum disease? Dentures? Each person's situation is unique, so discuss this with your dentist at your next routine dental exam. This is all part of your daily oral health routine to keep your teeth healthy throughout your life.
Choosing the right toothpaste for your needs shouldn't be stressful or confusing. In this article, we will outline exactly how to choose the best toothpaste for you.
After getting some advice from your dentist, there are a couple of important questions to consider the next time you buy toothpaste:
This is the main question to ask. If you are clear on what you want your toothpaste to do, you can narrow down the hundreds of choices to a manageable number. Do you want whitening power? Anti-plaque or anti-cavity? Do you need a toothpaste for sensitive teeth?
Once you have your goals in mind, you can eliminate even more choices by asking yourself the following questions.
Any toothpaste you choose should be approved by the American Dental Association (ADA). The ADA requires ingredients that do one of the following: whiten teeth, reduce gingivitis, prevent bad breath, defend against erosion, or help with tooth sensitivity. The active ingredients will be listed on the box along with what each ingredient does.
Some products do not meet the ADA's requirements, as not every dental product submitted qualifies for the ADA Seal. Clinical and/or laboratory studies that prove a product's safety according to the appropriate category requirements must be met to qualify.
Even then, the ADA Seal is only awarded for five years at a time. And if any of the ingredients change during that time, the manufacturer must submit its data again. Additional testing may be required if any of those changes could affect the product's safety or efficacy.
Any toothpaste you use will be ingested to some degree or absorbed into your body through your mouth. If you need to avoid certain ingredients for whatever reason, you need to know whether it's in any product you eat or drink. Or, as you saw earlier in this article, you may need a particular ingredient to satisfy your reasons for choosing one toothpaste over another. Read all labels and ingredients carefully so you can make educated decisions.
Here are some of the most common ingredients included in toothpaste along with their function:
As you can see, some of these ingredients have both positive and negative effects. It's up to you, with your dentist's help, to know what you are putting in your body and how it may affect your overall health.
Most dentists routinely recommend oral health products that contain fluoride. It prevents tooth decay and removes plaque on your teeth. Toothpaste containing fluoride will usually highlight that fact on the box and product.
Obviously, you can't test it in the store before you buy it. But, you can research reviews of any toothpaste to read what others have said about it and get a pretty good idea.
It's important you like the taste of your toothpaste. If you don't like it, you are less likely to use it as often as you should. This is especially true for children.
The same is true of the texture. Make sure any toothpaste you choose is smooth, not gritty. A toothpaste should not be abrasive to the enamel on your teeth.
Your dentist knows your oral health history and is the best resource for suggestions. If you have sensitive teeth, gum disease, dentures, or some other condition, it's important to use products that address them rather than make them worse or cause additional problems. Ask your dentist about the best options for you.
Yes, this is a possibility and is another important reason for making a careful selection when you purchase toothpaste.
After brushing your teeth, if you find white stringy material in your mouth, you may be having a reaction to your toothpaste. In this case, the toothpaste is too harsh for your mouth or your saliva is reacting to an ingredient in the toothpaste. The cells lining your cheeks are sloughing off, creating the white, stringy material. This reaction can last for up to an hour after brushing, even if you rinsed. Discontinue use immediately and find a less harsh toothpaste.
Doing this properly can be a bit more complicated than it first appears. But, as we've outlined above, there are some specific guidelines to keep in mind to make it less stressful.
It's always important that it is ADA-approved, doesn't contain harmful ingredients, tastes and feels good in your mouth, has fluoride added, and targets your personal oral health needs. Now, you can make your choice with assurance.
Your dental team here at Wilmington Dental Associates is happy to answer any questions you have about the best toothpaste for you. Schedule an appointment for your next routine dental exam and discuss it with our hygienists and the dentist. Then, you'll have the best information available to you.
Contact us today!
For more Fluoride Manufacturersinformation, please contact us. We will provide professional answers.