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As far as I understand, fluoride helps in hardening the enamel of our teeth by replacing the calcium element in hydroxyapatite to convert it in the stronger fluorapatite, like explained here. Wether that's worth other potential risks of using fluor is debatable, but let's keep that aside. I'm curious if it is still beneficial to keep using fluorised toothpaste if you already did so for like 10 years. I suppose all hydroxyapatite is long converted into fluorapatite already after so much brushing. Why would it still be recommendable to keep using it?

Bart
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2 Answers2

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Fluoride can be absorbed into the teeth and form fluoroapatite only in children up to 6-8 years of age (WebMD).

Later, fluoride from toothpaste may still be helpful, because it stimulates the incorporation of calcium and phosphorus into the enamel that has been demineralized (PubMed Central, 2006). So, fluoride stimulates remineralization and thus slows down the development of caries; it doesn't mean that it cures caries.

Recent advancements in fluoride: A systematic review (PubMed Central, 2015)

A summary of RCTs on fluoride concentration in toothpastes showed a positive dose response: Pastes with 1000–1500 ppm F showed 23% caries reduction compared to fluoride-free placebo; this value increased to 36% for pastes with around 2500 ppm F. For pastes having below 1000 ppm F, no significant difference was found with placebo, probably due to the small number of studies.

^^ The above means, there was less caries after fluoridated paste use, and not that the established caries was cured.

Jan
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  • Interesting, I didn't know enamel could regenerate. I though once you lost some of it, it'd be lost forever. – Bart Feb 09 '18 at 17:17
  • Only very small lesions may be healed. Obvious caries is still considered permanent. – Jan Feb 09 '18 at 17:59
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    Every meal and contact with acids demineralises teeth, not only caries. Lesions in this sense would include the invisible day to day occurences. So that's a constant process. It seems a common misconception that remineralisation might refill cavities, regardless of size. That's also a prob with your excerpt: incidence of caries is reduced, not existing reversed? Can you clarify that? – LаngLаngС Feb 09 '18 at 19:39
  • @LangLangC Sometimes pain in your teeth comes and goes, that is much too subjective of an observation to say cavities can be healed, but it might do so to some height? Or is that nonsense? – Bart Feb 09 '18 at 23:12
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    @Bart Misunderstanding? I meant remin is going on, always, in enamel and dentin. Extraordinarily important, but that is also microscopic and below. And also important for sensitive teeth. But people often mistake remin for filling large macro-structural holes (often from caries), which is (currently?) impossible with tools at our disposal. – LаngLаngС Feb 09 '18 at 23:17
  • The review I quoted above mentions "caries reduction," which, for me, reads as existing caries being healed. – Jan Feb 10 '18 at 08:59
  • According to some other reviews, the association of fluoridated toothpaste and caries reduction can be interpreted as preventative, not curative effect. And, yes, association is not already cause-effect relationship. – Jan Feb 10 '18 at 09:56
  • Lesions that are demineralized can be reversed while cavitated (an area that is missing) lesions will never reverse, and have to be fixed. – enap_mwf Feb 18 '18 at 01:47
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The main protective effect of fluoride is outside the tooth, not inside.

Small amounts of fluoride in solution around the tooth inhibit demineralization more effectively than incorporated fluoride and have a much greater caries-protective potential than a large proportion of fluorapatite in enamel mineral. Schweiz Monatsschr Zahnmed 122: 1030–1036 (2012)

For example, even an incredible amount of fluoride has limited protective effect. In a classic study, Ogaard compared the resistance of fluoroapatite (shark enamel) and hydroxyapatite (human enamel) against a high caries challenge in a human in vivo model. Two samples of shark enamel and human enamel were each placed in removable appliances in six children and carried for 1 month and a plaque retentive device was placed over each enamel sample. The results showed that the mean total mineral loss (delta Z) was 1680 vol% micron in human enamel and 965 vol% micron in shark enamel. The corresponding mean values for lesion depth were 90 micron and 36 micron, respectively. It was concluded that even shark enamel containing 30,000 ppm F has a limited resistance against caries attacks.

In a later review, the same author concludes that

The fluoride concentration in the apatitic structure of enamel does not have as significant an effect on reducing caries as a continuous presence of fluoride in the plaque liquid.

Hence, to receive the protective effect of the fluoride, we require to keep it near the tooth surface all time.

JohnP
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sue
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  • hence, sharks doesn't have cavities not because the fluoride on her/his teeth, instead because they don't eat or drink sugar. – sue Mar 14 '18 at 12:23
  • Well, isn't the fact that sea water would dilute any acid concentrations a larger factor to consider here than "sugar intake of sharks"? Or was that studied somewhere as well? – LаngLаngС Mar 14 '18 at 12:52
  • @sergiouribe, you can include studies about the relationship between dental fluorosis and caries; fluorosis is associated with either decreased or increased risk of caries. – Jan Mar 14 '18 at 14:22
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    So, if i understand correctly, it's more beneficial to have the environment around your teeth fluorised, rather than only your enamel? In an exagerated comparison; you'd be better off having a fluor releasing pill in your mouth all day, than replacing your enamel with literal shark enamel? – Bart Mar 14 '18 at 18:50
  • @Bart that's correct, you (and also any shark) should better use a fluoridated toothpaste rather than change your human teeth for shark teeth. – sue Mar 14 '18 at 19:43
  • @jan I will be happy to, but I think is better to mantain the focus in the question posted here. Anyway, you can read here the most important facts: https://www.nidcr.nih.gov/health-info/fluoride/the-story-of-fluoridation – sue Mar 14 '18 at 19:45
  • @sergiouribe, teeth with fluorosis have more fluoroapatite (here). In this study, fluorosis was associated with less caries, and in this one with more caries. It appears that mild fluorosis tends to be protective against caries, while severe fluorosis may be even more harmful than no fluorosis. – Jan Mar 15 '18 at 07:58
  • @jan people who live in a community water fluoridated (CWF) area develop mild form of fluorosis, not of health concern instead aesthetic, People who lives in a CWF area who discontinue the fluoridation experiment an increase of caries incidence in all ages groups http://jech.bmj.com/content/early/2016/05/13/jech-2015-206502.long If you read spanish, here is a textbook about fluoride and dentistry, and chapters 3, 4 & 5 details the effect of fluoride in the human in general and teeth and caries in particula: https://www.slideshare.net/gisellauribe/fluoroterapia-en-odontologia – sue Mar 18 '18 at 21:42
  • I don't read Spanish. You can include the main points in your answer. There are only 2 things to mention: the effect of the incorporated fluoride (fluorapatite) and the surface-acting fluoride from toothpaste on caries prevention. It's a big and seemingly controversial topic, but I think we should stick to toothpaste effects, because the question was only about this. – Jan Mar 19 '18 at 07:42
  • it's no controversial at all, All the evidence (in-vitro, clinical and epidemiological) since 1979 agree.

    The information presented to the public (i.e: the egg and fluoride ad) is the source of confussion.

    Any person with teeth should toothbrush twice a day with fluoridated (>1.000 ppm) toothpaste. Nowadays tough the main source of caries risk is not the lack of fluoride sorrounding the teeth, instead the added sugars in food. Hence, avoid sugar.

     – sue Mar 20 '18 at 14:02
  • also, in the Fejerskov textbook "Dental Caries", 1st ed pag 52-53: https://dl2.pushbulletusercontent.com/grAiHJRIX2rTpoXb157oxZ26HDmgIw0X/IMG_20180320_111246.jpg – sue Mar 20 '18 at 14:19