Fluoride in Dentistry

Recently, I received another text from Whats app and Telegram forwarded from friends and family members regarding the danger of fluoride. The message is about digesting your toothpaste that contains fluoride and it will lead to brain damages or lowering the IQ of Malaysian people thus deemed as part of the bigger agenda of some western countries.

Being a health practitioner myself specifically a dentist for that matter, I feel like I need to say something about this. This is my opinion, based on my training and will go along with many other dental practitioner.

I think the concern about digesting our toothpaste during brushing comes from the fact that excessive toothpaste ingestion that may lead to fluoride toxicity that symptoms including stomach pain or cramp, nausea, vomiting and in extreme cases, it may causes death of which statistically, is very rare. However, I would repeat, that is the case of EXCESSIVE toothpaste digestion. We need to look at other facts too.

Fluoride is added into our toothpaste and our water supply due to its known properties to protect our teeth from decay[i]. By binding to the tooth surface, it reinforce the tooth structure after the acid on our mouth modifies them. Fluoride is also known to certain extend, can interrupt the bacteria’s system and disrupt them from functioning properly. So, fluoride has been working so hard in our mouth to protect our pearls. By adding them into our toothpaste, it is the cheapest means of fulfilling our duty to look after our precious teeth. Globally, after fluoride has been added into toothpaste and our water supply, caries rate has been reduced significantly[ii][iii].

For us, the dental practitioner, our concern would be for the children if they swallowed their toothpaste while brushing. A study has shown that during tooth brushing, a 10 kilograms children will need to swallow about 33 milligrams of toothpaste to cause fluoride toxicity while a study shown that a kid might swallow about 0.1 milligrams of toothpaste while brushing. This amount will be made even smaller if the children AND their parents have been following the recommended amount of toothpaste used which is just a smear layer for a kid below 2 years old and only a pea-size for those aged 2-6 years old. Normally, a kid would spit out the excess toothpaste and they then will usually rinse it out with plain water. Provided that the kids are supervised by their parent, digesting excessive toothpaste can be avoided.

The only concern about the negative effect of fluoride would be fluorosis of which the teeth presented with white line or streaks and it cause to certain extend, considerable issues in term of cosmetic and some countries has reported teeth with weak structure. But the latter effect only occurs in area where fluoride would be available in high concentration such as an area with naturally existed fluoride in their water supply that is as high as a 1.1ppm. In Malaysia[iv], the average fluoride concentration would be around 0.4-0.7 ppm (the number looks small but it meant a big difference in millions in term of providing protection to our teeth) and there are suggestions to reduce it a bit due to the ease of availability to commercialized toothpaste (that contains fluoride) and also convenience access to dental service. If there are any concerns about fluorosis is that the tooth affected might need to be repaired to cover the defect.

Back to my point regarding tooth caries, or we called it ‘gigi berlubang’, it is one of our major concern in dentistry not only in Malaysia but also worldwide[v]. The cost of treating this disease has become exhaustively up to billions in certain country. Not to mention the burdens that have been faced by those inflicted by the disease. Preventing the disease before it can start causing problems would be the best option for patient too as there won’t be a need of going through the anxiety of walking into a dentist’s chair. And not to mention the drilling and all.

A person can be concerned about his or her own health and undeniably there are studies that reported the bad effects of fluoride to our organs[vi]. Indeed, there are studies that shows excessive fluoride can cause organ’s damage like kidney. But it happens only if you have excessive amount of fluoride in your body where they can accumulate when we have other medical problem. But for a healthy person, fluoride naturally exists in our blood in about 2.6 grams of it and this amount is however, well-regulated by our body.

Thus, considering the benefit that fluoride can provide for our oral health, I would say the concern about negative effect of fluoride in toothpaste should be treated with caution. If any doubts arise, professional health practitioner should be consulted to find out more information in order to make a sound and informed decision.
Dr Hairuladha Abd Razak
Dental Officer, Forensic Department HKL