As an additive to numerous community water sources, fluoride has worked its magic to prevent caries and improve oral health for more than 75 years. In fact, the US Centers for Disease Control and Prevention (CDC) lists water fluoridation as one of the 10 great public health achievements in the 20th Century.1
Although municipal water fluoridation has always been and continues to be a controversial topic, abundant evidence supports water fluoridation, in the appropriate proportions, as safe, affordable, and effective in strengthening teeth and reducing the rate of caries in kids.2-4
Even those living without fluoridated drinking water have benefitted from fluoride due to its presence in over-the-counter dentifrices and professionally applied fluoride varnish.
But while most of today’s children are growing up with plenty of fluoride around, early childhood caries is very real. This is especially true in at-risk populations. In fact, caries is said to be the most common of chronic childhood diseases. For these reasons, strategies such as school-based fluoride varnish programs have become common.
Many physicians, recognizing the value of preventive treatment for young children, are collaborating with dentists to inoculate kids against the ravages of caries with a coat of fluoride varnish. In some cases, pediatricians are applying the varnish in office.5
Fluoride isn’t just for kids anymore. Older adults can benefit just as much from its use. For instance, gingival recession is a common side effect of aging, giving meaning to the term, “long in the tooth.” Unfortunately, as root surfaces are exposed, older adults can fall victim to hypersensitivity and root caries. This condition is exacerbated by the plethora of medications many seniors take, some of which can reduce salivary flow.
Xerostomia can lead to widespread decay. In pre-boomer patients, this scenario may be all too common, as they grew up without the protection afforded by fluoridation. For such reasons, preventive care is key. Indeed, some experts recommend an application of fluoride varnish for such patients at every appointment.6
In addition to gingival recession, dentinal tubules can become exposed via acidic erosion, abfraction, and even tooth whitening. According to the hydrodynamic theory, dentinal hypersensitivity results from changes in dentinal tubule fluids, which trigger pulpal nerves to send pain signals.7–9
Formulations such as sodium fluoride and stannous fluoride varnish can be applied to occlude tubules. This can reportedly provide immediate relief from dentinal hypersensitivity. High-concentration varnish can be applied in the dental office, although some fluoride gels can be used at home in conjunction with custom trays.7,10
Keep It Dry
Isolation is an important aspect of fluoride varnish, as it is best applied to dry teeth.
For such processes, systems such as Isolite, Isodry or Isovac can be a clinician’s best friend. Keeping moisture under control through continuous suction, and providing comprehensive isolation and soft-tissue retraction, while also shielding the patient’s throat, these systems enhance not only safety but the chance that desired outcomes are achieved.
Perhaps, with the combination of water fluoridation, at-home use of fluoridated dental products and the proper clinical applications of fluoride varnish, clinicians and their patients will have the best shot at winning the battle against the devastation that caries can inflict.
- Centers for Disease Control and Prevention. Community Water Fluoridation: A Vital 21st Century Public Health Intervention. Available at: https://www.cdc.gov/grand-rounds/pp/2013/20131217-water-fluoridation.html. Accessed February 11, 2019.
- Centers for Disease Control and Prevention. Achievements in Public Health, 1900-1999: Fluoridation of Drinking Water to Prevent Dental Caries. Available at: https://web.archive.org/web/20160312042651/http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4841a1.htm. Accessed February 11, 2019.
- U.S. Department of Health and Human Services Federal Panel on Community Water Fluoridation. U.S. public health service recommendation for fluoride concentration in drinking water for the prevention of dental caries. Public Health Rep. 2015;130:318–331.
- National Center for Health Statistics. Decayed, Missing, and Filled Teeth Among Youths 12–17 years, United States. Available at: https://www.cdc.gov/nchs/data/series/sr_11/sr11_144acc.pdf. Accessed February 11, 2019.
- Farmer C. Tiny teeth teamwork. Mentor. 2017;8(3):16–18.
- Farmer C. Smile for the ages. Mentor. 2016;7(7):14–19.
- Withers S, Zawistowski D. Targeting the pain. Mentor. 2017;8(11):29–32.
- Brannstrom M. The elicitation of pain in human dentine and pulp by chemical stimuli. Arch Oral Biol. 1962;7:59–62.
- Li Y. Dentin hypersensitivity: diagnosis and strategic approaches. Available at: https://idh.cdeworld.com/courses/21172-Dentin_Hypersensitivity:Diagnosis_and_Strategic_Approaches. Accessed February 11, 2019.
- Mantzourani M, Sharma D. Dentine sensitivity: past, present and future. J Dent. 2013;41(Suppl 4):S3–S17.