New Mexico Dental Journal Winter 2015-2016

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How Do We Prevent Decay?
By Shelly L. Fritz, DDS and Bill Niendorff, DDS
Fluoride
The Chemistry: Sodium
f luoride or other f luoride salts
change the tooth cr ystal f rom
hydroxyapatite to f luorapatite to
make a much harder tooth struc-
ture that is more resistant to the
oral acids. Bi-products of calcium
fluoride, sodium oxide and sodium
hydroxide can raise the pH of the
saliva, neutralizing oral acids thus
maintaining the equilibrium of
minerals in enamel. Fluoride ions
do not remineralize non-cavitated
enamel lesions, but frequent use
of high concentration preparations
(e.g. 5,000 ppm) has been shown
to effectively prevent some carious
decalcification. Topical f luoride
varnishes increase the contact time
of tooth enamel with the fluoride
ion which facilitates greater penetra-
tion and absorption.
Fluoride is also widely available in
varying forms and concentrations
in many home care products and
materials including rinses.
There are also some newer preven-
tives that are intended to modify the
oral biofilm, thus reducing the risk
of caries by targeting oral bacteria
and salivary content. Among these
are the following products which are
discussed.
To ensure the dentifrice or gels
you prescribe has the amount
of f luoride it claims to have,
use products with the ADA
Accepted Seal on the tube.
Example products include, Aim,
Aloe Sense, Aquafresh, Arm
and Hammer, Cool Wave and
numerous renditions of Colgate
and Crest brand toothpastes/
gel have been researched and
approved by the
ADA labs. Have
y ou r p a t i ent s
look for this seal
as shown here.
Here is a brief summary of selected caries preventive materials—some old, some new—and their use.
Your questions, comments and suggestions are appreciated. Please email .
7 nmdental.org
History: In the 1930s, scientists
discovered that children who drank
water with naturally high levels
of f luoride had less tooth decay.
Back then, the high decay rate was
endemic! In 1945, Grand Rapids,
Michigan became the first city to
modify the fluoride concentration
in their community water system to
what was then the optimum amount
at 1.2mg/L (1.2 ppm) to provide the
residents with the benefits of fluo-
ride. Since that time, fluoride levels
have been adjusted in community
water systems around the world.
Water supplies have been managed
so that 75 percent of the U.S. popu-
lation now has access to fluoridated
community water.
Currently, half of the children in
the U.S. have never had a cavity
in their permanent teeth. Over
the past 70 years, fluoridated water
was the primary factor in saving
$40,000,000,000 (yes, billion!) in
oral health care costs. Because fluo-
ride is also in most tooth pastes/gels,
this past year, the CDC lowered the
optimum fluoride level in commu-
nity water systems to 0.7 mg/L (0.7
ppm). This action reduces the risk of
fluorosis due to combined sources of
fluoride containing products.
Some of the 100 organizations who
recognize the public health benefits
of community water f luoridation
for preventing dental decay include:
American Dental Association, UN
World Health Organization, U.S.
Public Health Service, American
Medical Association, American
Academy of Pediatrics, International
Association for Dental Research,
National Parents and Teachers
Association, and American Cancer
Society. The Centers for Disease
Control and Prevention, World
Health Organization, and Amer-
ican Public Health Association have
proclaimed that community water
f luoridation is one of ten of the
greatest public health achievements
of the 20th century.
ToothDecayPrevention