Let’s Talk Fluoride & Sealants

Most of us have heard of these two things when going to the dentist. It is rather familiar territory, but let’s talk about why we provide them or discuss their home use (fluoridated toothpaste). These two discussion points are considered part of a cavity-reducing regimen. Sealants are only provided in a dental setting and fluoride is both in your toothpaste and as an in-office professional strength application. Fluoride is discussed as a systemic versus topical use. Most of us experience topical use in our toothpaste or mouthwash.

I introduce the topical fluoride toothpaste discussion early on during our toddler exams, following the AAPD guidelines on the use of conservative, age-appropriate measures of fluoridated toothpaste once they have teeth.

I begin with identifying how close to 20 baby teeth your baby has at our toddler exam. I indicate night-time use to alleviate our parents concern of ingesting too much fluoride, but as they grow to having more than half their baby teeth, start switching to fluoridated toothpaste in the morning and evening. A demonstration of the portion is provided, because let’s face it, who really knows how little it is until they see it. Often parents admit that they were expressing more on the toothbrush and now they feel better the correct amount. You can use a washcloth to gather some of the excess saliva, but ideally this conservative amount of fluoride in the slur of toothpaste bubbles and saliva is used for uptake. Fluoride is an ion that is replacing another ion in the enamel matrix (hydroxyapatite) of the teeth to create a more fortified matrix of fluorapatite. This fluoridated version is a more resilient matrix to reduce cavity risks due to various acid attacks from food choices and frequent eating.

Parents have asked about fluoride mouthwash. I recommend it’s use once children are good at spitting. It can be tricky gargling a mouthful of solution and not accidentally swallowing it. If this is not the case, try filling the capful with a little mouthwash and dipping the toothbrush and flosser into it to brush and floss on. I don’t tend to lean too heavily on this additional step of mouthwash, but if you can do it, sure! I prefer parents and kids are spot-on with brushing and flossing 2x day for 2 mins! Once this is achieved, you can add on additional steps. Toothpaste and mouthwash are topical applications of fluoride. There are varying concentrations of fluoridated products for cavity management. If your child needs these, your dentist will guide you as to its specific use and the duration of use. The more concentrated the formula, the more out of reach it should remain. If your child takes on too much fluoride, usually a belly ache or nausea sets in. Give them milk or any calcium product to uptake the excess fluoride! If it is a considerable sum, call POISON CONTROL to guide you. I have seen some kids experience nausea and upset tummies after in-office fluoride varnish (a very concentrated formula used in many offices). Maybe step back to the foam fluoride option, if this should occur.

Systemic fluoride is likely prescribed in the form of fluoride vitamins if not in your city water.  I don’t tend to prescribe these since the topical options are plentiful and my area has good city water fluoridation. City water fluoridation was provided as a public health measure to reduce cavities and has been hugely beneficial in the prevention of decay.. Well water communities may need to test their water source to determine how much naturally existing fluoride there is to determine the age-appropriate concentration of fluoride prescription supplements.

Sealants are referred to as pit-and-fissure sealants, because the material is applied to the nooks and crevices of the molars. Since they are mostly applied to the permanent molars, the conversation starts at around 6 years age for the 1st molars and 12 years age for the 2nd molars. Sealants are applied to clean teeth (I prefer them applied after your child’s cleaning, before the professional fluoride is applied). Sealant material is a mostly BPA-free plastic polymer material, similar to white composite filling material, that flows into the grooves and crevices. It helps to make teeth, smooth and glass-like to prevent food breakdown in hidden nooks and crannies in your child’s permanent teeth. Sealants are NOT used to prevent in-between teeth cavities, so we try to take cavity-checking bitewing x-rays beforehand to know that alternate treatment is not needed. Some teeth may have the beginning of cavities starting on the chewing or pit surfaces. We clean these areas using our handy handpiece and then prepare the teeth with etch (“tooth shampoo”), bond (“elmer’s glue for the teeth”) and then the sealant. Sealants are mainly applied to permanent molars in school-aged children, lessening the risk of cavities by almost 3 times! There are sealant options that release fluoride, such as glass ionomer options. These are used either as a standard or for kids who have these early cavities. I admit that traditional sealants are technique-sensitive and require good isolation. For the most part, kids can easily tolerate this non-invasive procedure. Perhaps there are vulnerabilities to the teeth causing excess sensitivity to the etching step or your child has a strong gag-reflex. I offer laughing gas (nitrous oxide) for these scenarios.

To understand why we use these cavity-reducing measures, let’s understand cavity development. Cavities can develop on baby teeth as soon as they are coming in. The process of a cavity requires the following: (1) a tooth, (2) bacteria-laden plaque (streptococcus mutans), (3) a carbohydrate source (any sugar) and (4) time. When too much sugar is taken in, the saliva becomes more acidic and the food that remains from not brushing, breaks down proximal to the teeth, eventually causing the cavitation. We all eat during the day, but they younger ones tend to graze more and ingest more milk throughout the day. Try to minimize bottle or sippy cup use with anything other than water if not at meal-time. Dilute juice so that not so much sugar is ingested. My youngsters and adolescents tend to take on more candy ingestion and trendy drink options such as sports drinks, sodas or sweetened coffees. Perhaps your teens are up later studying and using drinks with sugar for remaining more alert. All these increase cavity risks in the older age groups. Push for more water consumption. No night-time eating or drinking, other than water. All these changes help to reduce cavities. Flossing is the way to remove the bacteria and food residue from between teeth that touch—it just takes 2 to floss! Remember that I always encourage kids to brush and floss their teeth to learn, BUT for parents to follow thru after them. I encourage this even for kids up to 10 years old!