Fluoride
Introduction
Fluoride is a naturally occurring mineral that is found in foods and drinks such as fish and tea. It is also present in varying concentrations in natural water.
Fluoride has been added to some drinking water supplies in the UK to bring the concentration up to a level that protects against dental decay (see below). This has been done for almost 60 years.
Fluoride can also be synthesised (manufactured) using chemical processes. Synthetic fluoride is used in toothpaste, from which most people get their fluoride.
The use of fluoride in the UK
In the UK, the Department of Health and British Dental Association recommend that fluoride should be added to tap water. This is because of its proven oral health benefits, particularly in promoting the development of healthy teeth in children and significantly reducing the incidence of tooth decay.
However, it is up to individual local health authorities to decide, in consultation with local health groups and the local community, whether or not fluoride should be included in local water supplies.
A level of 1mg of fluoride per litre of water (1mg/l or 1 part per million) has been shown to be most beneficial in the development of strong teeth and for providing protection against dental decay. This will usually be the maximum amount of fluoride that is added to water supplies.
Your local water supplier should be able to tell you how much fluoride is in your drinking water.
Fluoride treatments
All adults and children should use a toothpaste containing fluoride.
In areas where water supplies contain too little fluoride, children at high risk of dental decay can also be given mouthwashes, drops and tablets. Ask your dentist for advice before using these treatments.
Your dentist or a member of their team can apply topical fluorides during dental visits. These gels are more concentrated than the self-applied fluorides, so they are not needed as frequently. Some adults can benefit from these applications. Fluoride gels can help to reduce dental decay.
If you are prone to dental decay, your dentist may advise the use of fluoride supplements in addition to fluoride toothpaste for extra protection. However, it is very important that fluoride supplements are only taken on the advice and instruction of your dentist.
Fluoridated water in the UK
Around 10% of the UK population (about 6 million people) currently benefit from a water supply in which the fluoride content has been adjusted to, or is naturally present at, the optimum level for dental health. The West Midlands is the most extensively fluoridated region.
The Drinking Water Inspectorate checks that water supplies do not contain more than 1.5mg/l of fluoride.
For more information, see the British Fluoridation Society's report: The Extent of Water Fluoridation (PDF).
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Advantages
Over the past 50 years, extensive research has been conducted into the health benefits of fluoride. The main benefit of fluoride is that it strengthens tooth enamel (the outer surface of the tooth), which provides protection against tooth decay.
Protecting against tooth decay
Although it is beneficial for everyone, fluoride is particularly important for children when their teeth are developing.
The 2000 University of York report A Systematic Review of Water Fluoridation (PDF) concluded that water fluoridation increased the proportion of children without tooth decay by 15% and that children in fluoridated areas had an average of 2.25 fewer teeth affected by decay than children in non-fluoridated areas.
Fluoride protects teeth by strengthening the enamel of children's teeth, making their teeth more resistant to the acid attacks that can cause tooth decay. It reduces the ability of plaque bacteria to produce acid and enhances the repair (remineralisation) of enamel.
If children have fluoride when their teeth are developing, the grooves in their teeth are usually shallower, making plaque easier to remove.
Dental care for children
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Children should be supervised when brushing their teeth until they are about seven.
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Children up to the age of three should use a smear of toothpaste with a fluoride level of at least 1,000 ppm (parts per million).
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After the age of three, they should use a pea-sized amount of toothpaste containing 1,350-1,500 ppm of fluoride.
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Risks
In recent years, there have been some concerns that fluoride may be linked to a variety of health-related problems, such as bone cancer.
The Medical Research Council has looked at all the available research and confirmed that there is no increased risk of any adverse health effects, including bone cancer, from artificially fluoridated water. For more information, see the Medical Research Council's 2002 report Water Fluoridation and Health.
Dental fluorosis
Dental fluorosis is a condition that can occur if teeth are exposed to too much fluoride when they are developing.
The condition may develop if fluoride supplements are taken by children under seven years of age who live in areas where the water supply is fluoridated.
In its mildest form, dental fluorosis appears as very fine pearly white lines or flecking on the surface of the teeth. Mild fluorosis can often only be detected by a dental expert.
Severe fluorosis may lead to pitting of the enamel and discolouration. However, severe dental fluorosis is rare in the UK.
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