LOGO : Site title

Miriam recently expressed concern about her baby's teeth:

"She has white speckles on her teeth and when I read into it further, it seems that fluoride in the water (and used in formula) can cause some symptoms of decay. Is fluorination the norm here and has anyone visited the dentist with their babies yet to have tips to pass on and have you any advice on how to make teeth washing an easier ritual?"

We asked Henry Choi, a Toronto-area dentist to comment:

F luoride has been a target of many concerned and overconcerned groups. Small amounts occur naturally in the water as do other minerals, but the public water supply is monitored (according to http://www.city.toronto.on.ca/water/faq.htm, Toronto’s water supply is tested every four hours), and fluoride is supplemented to optimise cavity prevention. Some local municipalities are petitioning to remove this supplement, as they fear possible health risks as you age, but such theoretical risks have not been scientifically demonstrated.

As far as cavity prevention goes, the small concentration of fluoride, and we are talking 0.5 to 1.0 ppm, I think, is directly incorporated into the building of the tooth during growth. The resulting teeth, baby or adult dentition, is much less prone to cavities, therefore, you have a lifetime of sounder teeth.

The drawback to fluoride is if there is too large a concentration, and in some areas where the water supplies are not monitored, there may well be a high level in the water supply; this can lead to fluorosis where fluoride basically oversaturates the growing tooth and weakens the structure, which may also have a negative effect on bone, but such an occurrence would require massive doses. I have heard that some children's dentists are seeing more cavities in spite of better informed parents. This may be in part due to bottled and/or a deionized water supply. I tell parents to cook or drink using some tap water, but I do get a lukewarm response from some mothers when I mention this.

Some dentists have gone on the no-fluoride bandwagon and over diagnose fluoride mottling, which is usually white chalky to brown chalky and structurally weaker teeth, but I've noticed many white spots and lines in children who in all likelihood have not had large fluoride exposure – we are talking large. My unscientific guess is that this may be due to health/metabolism/illnes during the tooth development, i.e., fever/illness, which may have disrupted a nice even formation, although it's possible that they may have been exposed to a higher concentration of fluoride as well.

Incidentally, Quebec does not have fluoride in the water supply and traditionally have had significantly higher cavity rate than the regions that have fluoride.

I find the spots and lines are usually as solid as non spotted/patched areas, so they usually do not need any treatment, therefore I discourage removing these areas and replacing them with composite bond resins. But if the patient/parent chooses to do so, the result is excellent and usually does not require freezing/anaesthesia. I am of the anti-treatment/minimal treatment school, so if some fluoride early in life can reduce removal of the tooth structure to treat cavities, or worse, removal of the tooth, naturally I am all for it; after all paediatric dentistry is considered the most stressful profession.

Teeth are fully formed by age 12, so further fluoride in the water supply will not be incorporated into the tooth. Thus, the benefit after this age is minimal/none, but also the health risk seems to be little/none, so there is no reason to avoid tap water, but I think people are generally more conscious of possible health risks.