An expert has answers for you about how to protect your child’s teeth if your water lacks fluoride.
For generations, fluoridated drinking water has helped safeguard the teeth of most American children.
Yet recently, skepticism over this public-health measure has gained new traction, and some locales—including the states of Utah and Florida—have stopped adding fluoride to public water supplies.
Dentists point to a significant body of evidence supporting the safety of water containing appropriate levels of fluoride, and fluoride’s effectiveness as an oral health booster, particularly for children. Fluoride makes teeth stronger and prevents cavities by replenishing minerals in teeth that are depleted by acid from food and beverages and by microbes that live in the mouth. Without these necessary minerals, the enamel—the tooth’s outer layer—is vulnerable to decay.
“It’s concerning, especially now that we have two states that have banned fluoride in water,” says Cheen Loo, chair of the pediatric dentistry department at Tufts University School of Dental Medicine.
“The American Academy of Pediatrics, the American Dental Association, and the American Academy of Pediatric Dentistry are strongly recommending that we have fluoridated water supplies, because it’s a very effective, and cost-effective, way of reducing cavities,” she says. “I think there’s still a lot of work to do to dispel the concerns that people have.”
Here, Loo digs into how parents can continue to provide the advantages of fluoride for their kids if it’s lacking in their water supply, and how to make sense of news about fluoride:
Fluoride sources other than water
This includes fluoridated toothpaste, fluoride rinses, and topical varnishes applied every six months at a dentist office. These are sources that dentists have long recommended for those who rely on private well water or on public systems that lack fluoridation. (Even before Utah and Florida’s recent actions, about one-third of Americans did not have access to fluoridated water supplies.)
Some patients at the Tufts pediatric clinic live in towns that are not fluoridated, and “we tend to see more decay in patients who come from those areas,” Loo says. For those children, Loo recommends fluoride toothpaste, and sometimes a supplemental fluoride rinse or a stronger, prescription-strength toothpaste.
Fluoride toothpaste is safe and effective for all ages
Loo says many parents see fluoride-free toothpaste as a safer option, but it is not as good as fluoride toothpaste at protecting young teeth. “If you use the right amount, it’s not going to cause any problems,” she says.
If parents are worried that using too much fluoride on baby teeth could lead to fluorosis—white spots—on permanent teeth, or about toxicity, Loo says dentists can show parents during an office visit the specific amount to use for children of different ages.
Proper brushing technique
Unfortunately, “children are not always good at taking care of their teeth on their own, and may not be cooperative” Loo says. “Younger children, especially, don’t always have the dexterity to brush very well. It’s really up to the parents to help them.”
Most children, especially toddlers, tend to brush the front teeth but don’t get all the way in the back, Loo says. “So I always tell parents it has to be supervised brushing. You can have them hold the toothbrush, play and brush a little bit, but the parent has to finish the job and make sure they get all the surfaces and all the teeth.”
At the Tufts pediatric clinic, dentists use disclosing dyes, which temporarily stain areas where plaque—a sticky bacterial film—has built up. “We see with toddlers, and even grade-school children, that when they brush, there are always some areas that they are missing,” Loo says.
Flossing
Flossing properly can also be beyond the skills of young children, and Loo recommends parents also help with this.
How to tell if your child should start flossing on their own? “If they’re skilled at tying their own shoelaces, they’ll be able to handle flossing,” Loo says. Or children can use the flossers that come with a little handle, although they don’t hug the teeth as well as floss wrapped around the fingers.
But let’s be honest, even most adults don’t floss correctly. For kids, “we ask parents to do as much as they can,” Loo says.
Fluoride rinses are safe for older children
Pediatric dentists recommend that over-the-counter fluoride rinses not be used by children under 6, because younger children are more likely to swallow rather than swish and spit it all out. “We don’t want that to happen,” Loo says.
But older children can safely use fluoride rinses, even prescription-strength ones. Dentists sometimes prescribe rinses for children with braces, who may have a hard time brushing and flossing around the wires and brackets.
Ingestible fluoride supplements, such as drops or chewable tablets, should be used with care.
Ingested fluoride strengthens developing teeth systemically, whereas topical fluoride is applied directly to the tooth surface to provide localized protection against cavities.
In October, the Food and Drug Administration recommended that ingestible fluoride products not be given to children under 3 or those not at high risk for tooth decay. (The FDA had at one point considered banning these products).
Loo says dentists have historically recommended these ingestible supplements for children living in homes without fluoridated water. But, she says, pediatric dentists have moved away from a lot of these prescriptions, and are more likely to recommend a topical fluoride varnish, which is applied professionally and lasts for several months.
Source: Tufts
