The most important function of toothpaste in my opinion is to deliver fluoride the most important ingredient in toothpaste to the teeth, most other ingredients cater for personal preference and marketing gimmicks and very few ingredients have some benefits, mostly in the presence of fluoride.
There is in abundance of > 5000 systematic reviews( best form of evidence) to support the benefits of fluoride in the mouth and how fluoride protects teeth.
My argument is that people who claim to make 'Flouride' a monster, have their agendas for it, most possibly some form of financial reward. And just because a few dentists who know all about teeth, brushing and other adjuncts to cleaning teeth, use a fluoride-free option for their children's teeth, please evaluate your risk factors, diet, and brushing before you choose a fluoride-free option for your own.
Also if you look at evidence from research you will be able to see that a few dentists are strongly associated with the most commonly advised alternatives, and if it was truly as good as fluoride, it would have been better embraced by the profession!
In my humble opinion, a fluoride-free option for toothpaste/lifestyle is not advisable to the general population. Evidence guides us to that- AND ALL GOVERNMENT GUIDELINES IN THE WORLD AGREE. Japan is the only country moving towards a fluoride-free alternative!
MECHANISM OF ACTION OF FLUORIDE
For us to appreciate fluoride as a protector of teeth, we need to understand a few basics, fluoride usually reaches the teeth mostly as toothpaste ( 1000 ppm for children and 1450 ppm in adult toothpaste) and with water fluoridation ( usually 0.7 to 1 ppm ). For children or very vulnerable adults, fluoride varnish (22,600 ppm) a high-concentration fluoride is applied in surgery by a dentist every 6 months.
Flouride can loosely bind to the surface of the tooth as a calcium fluoride-like (CaF2) layer, this layer covers the entire outer surface of the enamel and acts as a sacrificial layer to acid attack, However, when this layer is exposed to saliva for an extended period, a fluorapatite layer can form on top of the CaF2. The fluorapatite formation will restrict the dissolution of it more which in turn stabilizes it even further.
These 2 layers of Calcium fluoride-like and fluorapatite help protect the teeth in multiple ways this process is more complicated but I shall try and make it as simple as possible for your understanding as follows
Strengthens enamel - Fluoride is the only mineral in this world that can make your teeth stronger. It does this by converting the tooth mineral hydroxyapatite into fluorapatite by replacing the hydroxyl ion with fluorine. Flouroapetite makes the enamel stronger. The most quantifiable effect can be seen in the decrease of the critical pH ( the pH level below which the enamel demineralises from 5.5 to 4.5 which means a stronger acid is needed to dissolve it If you have fluorapatite, you can consume more acidic foods or beverages without enamel demineralization.
Repairs decayed teeth -If you eat too many sweets your teeth will start to demineralize, which is officially the first tooth decay stage. When this happens, the enamel will start to lose minerals. Fortunately, if you use a fluoride toothpaste you can reverse the process and repair the enamel via remineralization. Decayed tooth structure more readily takes up fluoride and strengthens it and also the calcium fluoride-like layer serves as a mineral reservoir of calcium and phosphate which helps with the remineralisation process.
Protects against acid dissolution - Flouride can loosely bind to the surface of the tooth as a calcium fluoride-like (CaF2) layer, this layer covers the entire outer surface of the enamel and can serve as a sacrificial layer that protects the tooth beneath it. You can think of it as an extra barrier layer that acids and cavities have to dissolve through before it reaches the actual tooth and serves as the first line of defence against cavities.
Mineral reservoir for remineralization The calcium fluoride-like layer is composed of all the minerals that the tooth needs to remineralize. Therefore when this layer dissolves, it will release all of the calcium, fluoride, and phosphates. These minerals can then be used to simply remineralize any demineralized tooth structure. In addition to that it can also be used to buffer the oral environment to deacidify it. That will prevent further dissolution of the enamel.
Antibacterial properties Fluoride has antibacterial properties that interfere with the bacteria's sugar metabolism. It interferes with the bacteria's ability to take in sugar from the mouth and its ability to digest it thus the ultimate result is the bacteria starving to death.
Decreases sensitivity The Stannous fluoride (SnF2) in toothpaste not only prevents cavities but also possesses desensitizing properties. The high concentration fluoride varnish with 5% sodium fluoride also can reduce tooth sensitivity. The mechanism of action is by replugging all of the unclogged dentinal tubules ( usually from dietary acids) and forming a chemical bond to the exposed dentin, that effectively reduces dentinal hypersensitivity.
DOES FLOURIDE ALTERNATIVES WORK?
There will definitely be some benefits to teh alternatives, but nothing has a track record like Flouride and the Fluorosis( a mild cosmetic issue as white spots on teeth ) from fluoridated toothpaste applies to only children less than 3 years of age (the second year being most crucial).
IT CAN ONLY HAPPEN IF the child of, 3 years of age has upto 13 episodes of brushing a smear amount of toothpaste and if a child of 3-6 years has 8 episodes of brushing with a pea size amount of toothpaste in a day and swallows all of the toothpaste !! whoever does that!
The picture above on the left shows the correct amount of toothpaste for children. A smear size amount for 0-3 years and a pea size amount for 3-6 years of 1000 ppm fluoridated toothpaste is advised, so do not be fooled by the toothpaste marketing of a full length of toothpaste as on the picture on the right side!
SO ALL ADJUCNCTS FOR REMINERALISATION OF ENAMEL SHOULD BE USED ALONGSIDE YOUR FLUORIDE TOOTHPASTE, AND IF A HIGH RISK OF FLOUROSIS ( PARENTS AND SIBLINGS HAVE IT) THEN INSTEAD OF POSSIBLY UPTO THE AGE OF 3 YEARS AFTER WHICH IT IS IRRELEVANT.
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