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 Why should I have fluoride treatments?

Can Fluoride Help Adults?
Fluoride isn't just for children.

"The use of fluoride can prove beneficial for both children and adults," says Sandra Burkett, D.D.S., instructor of clinical dentistry at the Columbia University College of Dental Medicine.

Twenty years ago, dentists thought that fluoride worked mainly by strengthening developing teeth before they entered the mouth. As a result, young children were the main focus of fluoridation efforts. Now, research has shown that fluoride applied to the teeth, using toothpastes, mouth rinses and fluoride treatments, is just as important for all teeth in fighting decay.

"The regular use of fluoride helps to protect the permanent teeth from decay and sensitivity, allowing patients to keep their permanent teeth much longer," Dr. Burkett says.


Although everyone should use fluoride every day, some adults are at higher risk of decay and might need more intensive supplementation. To find out if you might be one of them, consider these questions:

  1. Are you taking any medications that cause your mouth to become dry? Do you have a disease that causes dry mouth? Many adults take medications that can cause dry mouth, called xerostomia. Many common medications have this side effect, including allergy medications, antihistamines, anti-anxiety drugs and high blood pressure medicines.

    Some diseases, most notably Sjögren's syndrome and diabetes, also can cause dry mouth.

    "Decreased saliva flow can increase your risk for dental decay," Dr. Burkett says. That's because saliva helps neutralize the acids in your mouth and washes away food particles that are fuel for decay-causing bacteria. Saliva also contains many minerals, including fluoride, that help keep your teeth decay-free.

    If you are having dry mouth, try using a fluoride mouthwash to lubricate your mouth and protect your teeth. Saliva substitutes are also available at the pharmacy, and many people use them to replace the saliva they have lost.

    Dr. Burkett also recommends sucking on sugar-free hard candy or chewing sugar-free gum to increase salivary flow. In particular, she recommends that you look for products that contain xylitol. "Xylitol is a naturally occurring and beneficial sugar," she says. "Also, brush regularly with fluoride toothpaste and visit your dentist as recommended to prevent the formation of cavities."
  2. Have your gums receded so more of your teeth show, or has your dentist told you that you have periodontal (gum) disease? By the time you're an adult, you may already have some form of periodontal disease, which can cause your gums to recede and expose more of your teeth. This gives bacteria more room to roam and makes you particularly susceptible to cavities in the roots of your teeth. For example, more than half of adults over age 75 have had root decay. If your dentist has treated you for periodontal disease, your gums may have been reshaped and your tooth roots exposed. This also can lead to decay.

    To protect your teeth's roots, your dentist can paint a fluoride varnish or gel on them. You can use a fluoride mouthwash or a prescription fluoride gel to get more fluoride.
  3. Have you needed a filling in the last year? If you have had recent tooth decay, you're at risk for more. Having had a cavity in the near past means that you have the bacteria and other conditions necessary to form additional cavities. "The use of fluoride should be an important part of your daily oral health care regimen if you have prior cavities," Dr. Burkett says.
  4. Do you have crowned teeth and/or bridges? Crowned teeth are not safe from cavities. As long as some natural tooth remains, these teeth are at risk. "The edges of fillings or crowns can provide a hiding place for decay-causing bacteria," Dr. Burkett says. "Fluoride can protect the tooth from decay and in certain cases stop the decay process and allow the tooth to get stronger."
  5. Are you wearing dental braces? "Braces make it difficult for you to reach all areas of the teeth, and provide niches where food can become lodged. The plaque that forms as a result can lead to cavities," Dr. Burkett says. "Your dentist can recommend a fluoride rinse or gel that, when applied daily, protects the teeth against cavities."
  6. Are you receiving, or have you received, radiation therapy to the head and neck? Adults receiving radiation therapy to the head and neck are at very high risk of tooth decay because the radiation damages their salivary glands, causing dry mouth. Saliva fights tooth decay, so people suffering from dry mouth are at higher risk for decay.

    "If dry mouth results from radiation therapy, then it is important that you use generous amounts of fluoride to prevent decay and visit your dentist every two to three months, or as recommended," Dr. Burkett says.

What To Do
Regardless of risk, all adults should use fluoride toothpaste. Fluoride mouth rinses also are available over the counter and can be used once or twice a day. Toothpaste delivers about 1,000 parts per million of fluoride and mouth rinses about 250 parts per million.

If you think you are at high risk of decay, ask about receiving fluoride treatments in the dental office. During a treatment, your dentist or dental hygienist will dry off your teeth and either paint them with a gel or put a gel or foam into mouth guards that will be placed in your mouth for one to four minutes. You also can get a varnish or gel on the roots of your teeth. You'll be asked not to eat, drink or smoke for 30 minutes after the treatment.

Dental-office fluoride treatments provide fluoride at high levels of 9,000 parts per million to 20,000 parts per million, depending on the type.

You also can give yourself a fluoride treatment at home every day. The fluoride in these treatments, which are usually prescription gels, ranges from 1,000 parts per million to 5,000 parts per million. Your dentist can prescribe these treatments based on your particular needs and risks for dental decay.

Talk to your dentist to determine your risk of dental decay. The use of fluoride products in combination with good oral hygiene habits, control of snacking and dietary carbohydrates, and use of an antimicrobial toothpaste and mouthwash should help reduce the chance of new decay.

"Dentistry is changing, and as a result adults are no longer plagued with dental diseases and can keep their teeth for much longer than was possible over a decade ago," Dr. Burkett says. "The use of fluoride and good oral hygiene practices can ensure that your teeth remain healthy as you age."
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11/06/2006

Medical Reference provided in collaboration with the Cleveland Clinic

Fluoride is a mineral that occurs naturally in many foods and water. Every day, minerals are added to and lost from a tooth's enamel layer through two processes, demineralization and remineralization. Minerals are lost (demineralization) from a tooth's enamel layer when acids - formed from plaque bacteria and sugars in the mouth - attack the enamel. Minerals such as fluoride, calcium and phosphate are redeposited (remineralization) to the enamel layer from the foods and waters consumed. Too much demineralization without enough remineralization to repair the enamel layer leads to tooth decay.

Fluoride helps prevent tooth decay by making the tooth more resistant to acid attacks from plaque bacteria and sugars in the mouth. It also reverses early decay. In children under six years of age, fluoride becomes incorporated into the development of permanent teeth, making it difficult for acids to demineralize the teeth. Fluoride also helps speed remineralization as well as disrupts acid production in already erupted teeth of both children and adults.

In What Forms Is Fluoride Available?
As mentioned, fluoride is found in foods and in water. It can also be directly applied to the teeth through fluoridated toothpastes and mouth rinses. Mouth rinses containing fluoride in lower strengths are available over-the-counter; stronger concentrations require a doctor's prescription.

A dentist in his or her office can also apply fluoride to the teeth as a gel, foam, or varnish. These treatments contain a much higher level of fluoride than the amount found in toothpastes and mouth rinses. Varnishes are painted on the teeth; foams are put into a mouth guard, which is applied to the teeth for 1 to 4 minutes; gels can be painted on or applied via a mouth guard.

Fluoride supplements are also available as liquids and tablets and must be prescribed by your dentist, pediatrician or family doctor.

Is There an Age at which Fluoride Intake Is Most Critical?
It is certainly important for infants and children between the ages of 6 months and 16 years to be exposed to fluoride. These are the timeframes during which the primary and permanent teeth come in. However, adults benefit from fluoride too. New research indicates that topical fluoride - from toothpastes, mouth rinses, and fluoride treatments - are as important in fighting tooth decay as in strengthening developing teeth.

In addition, people with certain conditions may be at increased risk of tooth decay and would therefore benefit from additional fluoride treatment. They include people with:

  • Dry mouth conditions: Dry mouth caused by diseases such as Sjögren's syndrome, certain medications (such as allergy medications, antihistamines, anti-anxiety drugs, and antihypertensives) and head and neck radiation treatment makes an individual more prone to tooth decay. The lack of saliva makes it harder for food particles to be washed away and acids to be neutralized.
  • Gum disease: Also called gingivitis, gum disease can expose more of your tooth and tooth roots to bacteria increasing the chance of tooth decay.
  • History of frequent cavities: If you have one cavity every year or every other year, you might benefit from additional fluoride.
  • Presence of crowns and/or bridges or braces: These treatments can put teeth at risk for decay at the point where the crown meets the underlying tooth structure or around the brackets of orthodontic appliances.

Ask your dentist if you could benefit from additional fluoride.