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Professional Courtesy Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine

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Fluoride Fallout
– by Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine

Once again we are reminded that you can have too much of a good thing. Recent headlines proclaimed the Department of Health and Human Services' recommendation to set the level for optimally fluoridated water at 0.7 parts per million (ppm). This led to confusion for some and more ammunition for those that have adamantly opposed the addition of fluoride to our drinking water at any level.

One Townie reacted to the news with this comment¹:
"We can't win for losing! First it's toxic mercury fillings, now it's toxic fluoride! ABC News did a story on it tonight that made it seem terrible. Well, so be it. Eliminate fluoride and mercury fillings and we'll all have more work than we can handle." –Jawbreaker, Posted 1/07/2011, Post 2 of 4

Here are a few widely circulated facts about community water fluoridation:
  • Centers for Disease Control and Prevention proclaimed it was one of 10 great public health achievements of the 20th century.
  • Every dollar invested in water fluoridation saves an estimated $38 in dental treatment costs.
  • More than two-thirds of the U.S. population is served by optimally fluoridated drinking water.
Just to be clear, the announcement simply reduced the optimal number from a range of 0.7-1.2ppm, to a flat 0.7ppm across the board. In the past, a range was used as people believed that water consumption varied based on average temperatures throughout the year. Lower concentrations in Arizona and higher numbers in Alaska, for example. The source of the recommendation was based on studies of rising rates of fluorosis, the unattractive marks that appear on teeth as a result of the ingestion of higher-than-optimal amounts of fluoride during tooth development.

Recently other Townies have expressed some confusion about how to explain the difference between topical and systemic fluoride to patients and parents.

There is no cause for alarm, but there will certainly be patients who only hear part of the story and fear that their child could be getting "too much" fluoride with an in-office treatment. Wrong. Patients need to understand the difference between systemic and topical fluoride. Systemic fluoride is the result of ingesting fluoride- fortified water, food and drink containing fluoride or fluoride supplements. Children's teeth are susceptible to fluorosis during enamel formation, from birth to age six. On the other hand, topical fluoride is not swallowed and the effects are local in nature. The multiple benefits of topical treatments are well known: remineralization of early caries, reduction in root sensitivity and decrease in caries rates.

I have not prescribed fluoride supplements for my young patients as I live in a community with fluoride in the water. Many patients in our area use reverse osmosis in their homes or drink bottled water, both which do not contain fluoride; I avoid the supplements because I believe patients get an adequate halo effect from the foods in their diet. Additionally, we provide in-office fluoride to all of our patients. The gold standard for in-office treatment is fluoride varnish.

Benefits of fluoride varnish:
  • high concentration of fluoride applied directly to the teeth where it will enjoy a long contact time
  • patient does not have any waiting periods to return to normal eating and drinking
  • the taste is improved from rinses and foams
  • very effective for sensitive areas of recession in adults
  • great protection against root caries
Finally, a few suggestions for the application of fluoride varnish in your office:

1. It should be applied by the dentist after completion of the exam, since it only takes a few seconds and you can save the time of the hygienist re-gloving and getting back into treatment position. 2. Apply it to the facial surfaces of all molars and premolars after they have been slightly dried with the air syringe. Avoiding the front teeth will be more comfortable for the patient and they won't leave the office feeling self-conscious about smiling.

If you like to charge for your services, there is an ADA code for application of fluoride varnish – D1206. Consult your CDT book for details on the appropriate use of this code.

Have a question that needs to be answered or a debate that needs to be settled? Send me an e-mail: tom@dentaltown.com

1. http://www.dentaltown.com/MessageBoard/thread.aspx?a=11&s=2&f=229&t=160564&g=1&st=fluoride
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