What fluoridation agents are available?

There are many different agents and products on the market for fluoridation of teeth. First of all, a fluoride toothpaste should be used when brushing your teeth every day. In almost every commercially available toothpaste, unless specially labelled, there is a prescribed amount of fluoride with 1000 to 1500 ppm (= parts per million).There are also more fluoridated toothpastes or gels that should be used once a week, e.g. elmex gelée (available in pharmacies).

In addition to toothpastes, there are fluoride-containing mouth rinses for daily use. It is also recommended to use fluoridated table salt for cooking. There are also fluoride tablets that can be used for fluoridation.

What is a fluoridation splint?

A fluoridation splint is a custom plastic splint that serves as a kind of carrier for fluoride-containing gel. It is made to fit the upper or lower jaw in the laboratory and should be worn once a week for about 5 – 10 minutes. Swallowing the gel should be avoided.

During the fabrication process, impressions of the jaws are first taken at the dentist and sent to a laboratory. There, plaster models of the jaws are made and a precisely fitting splint is made on them using a plastic material. The splint is used for an additional fluoridation of the teeth and thus reduces the risk of caries.

Compared to brushing the fluoride gel onto the teeth, the splint enables a more even distribution over the entire dental arch. Furthermore, the exposure time of the fluoride gel is increased. As the fluoride gels used contain a dose of approx. 12500 ppm fluoride, application in smaller children is contraindicated. Frequent swallowing of the gel can lead to an overdose of fluoride.

Fluoridation in special cases

The German academy for child and youth medicine recommends that the baby should get combined fluoride and Vitamin D tablets for the first months. After the first milk tooth has erupted, systemic fluoridation is continued: up to the 36th month of life, the body is supplied with 0.25 mg/day of fluoride in the form of tablets or drops. Until the 12th month of life it is combined with vitamin D. After the 36th month of life, systemic fluoridation can be dispensed with if it is ensured that the teeth are brushed (at least) twice a day without the toothpaste being substantially swallowed.

Additionally, table salt containing fluoride can be used. If the conditions are not met, it is recommended to continue fluoridation after consulting the dentist. In contrast to these recommendations, the DGZMK (the German Society for Dental, Oral and Orthodontic Medicine) considers the use of a fluoride-containing toothpaste to be more sensible from the breakthrough of the first milk tooth onwards.

The statement is based on the results of studies that show that local fluoride supplementation is more effective and also includes the following points: Fluoridation is not necessary during the first 6 months of life. With the appearance of the first milk teeth, care should be provided once a day with a pea-sized amount of fluoride toothpaste. Care should be taken not to swallow large quantities.

From the 24th month onwards, teeth are brushed twice a day. This is to develop good brushing habits on the one hand and to strengthen the caries prophylaxis on the other hand. Parents should supervise the infants while brushing their teeth and brush them again if necessary.

Of course, parents often have their own thoughts on how to properly care for their child’s teeth. Especially as children often swallow dental care products, which are cosmetics in the true sense of the word and are not subject to any food law controls. The pediatricians also recommend not to use additional table salt in the baby food.

Therefore, local fluoridation cannot take place in this way. Due to this much different information, it is recommended that the first visit to the dentist is at the age of one year. Then the dentist can perform the so-called fluoride anamnesis and ask which measures are taken by the parents.

Nutritional information is asked for, because the parents often do not know which foods contain fluoride (e.g. black tea). Then the dentist can decide together with the parents what measures are to be taken. Many parents underestimate the important role of the milk teeth and think, “it is only the milk teeth, the permanent ones will follow anyway” – this is a wrong way of thinking!

The milk teeth have an important placeholder function. If a tooth is lost prematurely due to caries, the remaining teeth can migrate into the gap and restrict the space for the permanent tooth to follow. This can result in a crooked permanent tooth and require extensive orthodontic treatment.

Furthermore, inflamed milk tooth roots can endanger the health of the permanent teeth. The intact milk teeth are a prerequisite for proper nutrition, language learning and emotional development.It should also be remembered that the first permanent tooth breaks through at the age of 6 years. The so-called 6-year molar is very often filled or decayed at a young age because brushing and fluoridation have been neglected.

Sometimes it is too late for prophylaxis – many parents wonder if there is anything else that can be done. The milk teeth are treated with plastic or metal fillings – just like the “adult teeth”.

Fluoridation is not required in the first 6 months of life.
With the appearance of the first milk teeth, the care should be done once a day with a pea-sized amount of fluoride-containing toothpaste.
Care should be taken not to swallow large quantities.
From the 24th month onwards, the teeth are brushed twice a day. This is to develop good brushing habits on the one hand and to strengthen the caries prophylaxis on the other hand.
Parents should supervise the infants while brushing their teeth, and if necessary, brush their teeth again.
From school age on, teeth are brushed with a toothpaste with a fluorine content of 1-1.5 mg.
Fluoridated table salt should also be used.
The fluoride tablets can be given to children if no fluoride pasta or salt containing fluoride can be used.

Fluoridation of teeth is also very important during pregnancy. Especially for women who frequently vomit during pregnancy, fluorides are an essential part of dental care.

Since some expectant mothers even find it difficult to brush their teeth because of the gagging effect, a mouth rinse containing fluoride is recommended. This solution can be used several times a day to harden the enamel. Especially after vomiting this is a good alternative.

Proper tooth brushing shortly after would damage the enamel, because the tooth surface is softened by stomach acid and then wears out faster when brushing. There is no need to worry about damage to the adolescent. Fluoride is not dangerous for the child if taken in normal amounts.

Bleaching is a method of teeth whitening. It involves the use of strong chemicals that attack the tooth enamel. The hardness of the enamel decreases during this treatment, but can increase again due to fluoridation.

The application of a fluoride gel is also very helpful during the treatment. Hypersensitivity reactions can be reduced and the treatment can be made more pleasant. Furthermore, the tooth surface roughened by the bleaching process becomes smoother again.

Fluoride helps with the remineralization of the tooth enamel. This means that minerals are re-integrated into the teeth and the tooth becomes more resistant. On the other hand, some studies say that the application of fluoride after bleaching slows down the reoccurrence of discoloration. Some manufacturers also recommend a daily two-minute application of fluoride gel for about a week after bleaching to regenerate the damaged enamel.