Fluoride is a natural element that helps strengthen tooth enamel and exposed root surfaces to make both more resistant to acid exposure. Continual and proper use of fluoride provides significant benefits to prevent tooth decay by aiding in remineralization and preventing demineralization.
Using a fluoride toothpaste or rinse, drinking fluoridated water, and regular treatment at the dentist play important roles in preventing tooth decay. This is especially important for people at high-risk for decay.
You and your dentist need to know if you or your children are at a higher risk for tooth decay. If so, you may benefit from both professionally-applied fluoride and/or prescription-strength fluoride products for use at home. There are many risk factors, but some of the most common include:1
- Poor oral hygiene
- A history of cavities
- Poor nutrition
- Drug or alcohol abuse
- Chemo or radiation therapy
- Dry Mouth (xerostomia)
Common types of professionally-applied topical fluoride include:
- Varnish — a thick liquid which is applied on and between teeth like paint. It is sticky and adheres to your teeth for up to several hours while releasing fluoride.
- Gels and foams — placed into trays that are positioned over the teeth for a few minutes. Foam is generally not considered as effective as varnish or gels.2
The ADA established a panel to review evidence-based research and gather consensus opinions to provide guidance to high-risk groups on professionally applied and prescription-based fluoride application. The current guidelines for patients at high risk for tooth decay are:
- Younger than six years: Varnish at least every three to six months. Children in this age group should only get topically-applied varnish as gels may be more easily swallowed. At home, the ADA panel advises not to give children under six prescription toothpaste, gel or rinse for the same reason.
- Ages six - 18 years: Varnish or gel at least every three to six months. Children over the age of six may use prescription-strength toothpaste, gel or rinse at home, or have topical fluoride applied by the dentist. Your child may not need both to maximize the effects of fluoride on their teeth.
- Older than 18 years, or Adults with decay on their tooth roots : Varnish or gel every three to six months. The ADA guidance for these groups is based primarily on expert opinion as evidence-based research is insufficient to strongly support a recommendation that professionally-applied fluoride is necessary as opposed to the proper use of prescription at-home fluoride products.3
What to expect
Your dental professional will:
- "Paint" concentrated fluoride varnish directly onto your teeth. The varnish sets when it comes into contact with saliva. The varnish will temporarily hold a small amount of the concentrated fluoride in close contact with your teeth for up to several hours.
Fluoride varnish must remain on your teeth for four to six hours to have maximum effect. Your teeth may feel "fuzzy" for a while after receiving fluoride varnish. After six hours, brushing and flossing your teeth will remove the fluoride varnish. Some 'do's and don'ts' following varnish treatment include:
- Do not brush or floss your teeth. If possible, wait until the following morning.
- Avoid any fluoride in non-prescription products such as toothpastes, gels, and rinses.
- Avoid hot beverages.
- Try to avoid hard, sticky, or crunchy foods.
- Do not eat or drink food or beverages containing alcohol (including mouthwash).
- It is okay to eat soft foods.
- It is okay to have cold drinks but avoid beverages containing acid, such as juice and soda.
Fluoride gel or foam
Your dental professional will:
- Dispense a fluoride-containing gel or foam into disposable trays.
- Place the trays over your teeth.
- Request that you "chew" gently on the trays to force the fluoride gel or foam between your teeth and into the pits and fissures of your teeth.
- Leave the trays in place for one to four minutes.
- Provide suction to remove saliva during the procedure so you do not swallow any of the gel or foam.
- Remove the trays from your mouth.
- Thoroughly suction your mouth to remove excess gel or foam.
After the treatment, you should not eat or drink anything (including water) for at least thirty minutes. If you take prescription fluoride supplements, check with your dentist. They may ask you to stop using them for several days following topical fluoride treatment.
Risks and concerns
An overdose of dental fluoride is extremely rare when applied to the surfaces of your teeth by a dental professional. However, fluoride ingested in large enough doses (for example, large quantities of fluoride toothpaste, rinses, or supplements) can result in serious adverse reactions.
- If swallowed, a standard dose of topical fluoride applied by your dentist or from at-home products can cause nausea and vomiting, especially in children.
- Some formulations of topical fluoride have a disagreeable but temporary, metallic taste.
- Long-term exposure to higher than recommended fluoride levels can result in fluorosis, especially in children. Fluorosis does not occur with regular topical fluoride treatments from a dentist.
There are no equivalent evidence-based treatment alternatives to professionally-applied, topical fluoride . Still, there are other ways to prevent tooth decay , including proper nutrition, good oral hygiene, fissurotomy, and ongoing exposure to other sources of fluoride. Alternatively, dentists may recommend prescription-strength toothpastes, gels, foams, or rinses for use at home. You can also speak with your physician about changing medications that cause dry mouth (xerostomia), which can lead to tooth decay.
If your dentist recommends fluoride and you refuse or delay treatment, your teeth will not benefit from the positive effect fluoride has on tooth enamel . Tooth decay may result, which will need to be treated with more invasive procedures that may require the removal of some healthy tooth structure. Preserving tooth structure is a goal of dentistry, and fluoride treatment is an effective tool in helping prevent that possibility.
Questions to ask
- At what age should my children begin getting topical fluoride ?
- Am I (or my children) at a higher risk for tooth decay ? If so, how does that affect your fluoride treatment recommendations (at home and in the office)?
- Based on the risk factors, how frequently should I (or my children) be receiving fluoride treatments?