Fluoride and oral health

Toothpaste

Brushing your teeth with fluoridated toothpaste helps prevent tooth decay.

Water

Drinking water that contains an optimal level of fluoride helps prevent tooth decay.

Varnishes

Fluoride varnish prevents tooth decay in people who are at risk for the disease. Fluoride varnish should be painted on your teeth by someone who has been trained to do so.

Mouth rinses

Fluoride mouth rinses or mouthwashes prevent tooth decay in people who are at risk for the disease. Talk to your oral health professional before using them. Never give fluoridated mouth rinses or mouthwashes to children under 6 years of age. These rinses contain very high levels of fluoride, and young children are more likely to swallow them.

Gels and foams

Gels and foams are applied to the teeth to prevent tooth decay in people who are at risk for the disease. However, research shows that they do not work as well as fluoride varnish.

Supplements

Fluoride supplements are drops or tablets. Only take them if an oral health professional advises you to.

Effects of too much fluoride

Fluoride is good for your teeth, but having too much fluoride can cause 2 potential side effects on health:

• dental fluorosis
• skeletal fluorosis

Dental fluorosis

Dental fluorosis is a condition that changes the way your tooth enamel (the outer layer of your teeth) looks: small white lines or flecks appear on your adult teeth (permanent teeth). This can happen only if, when you were a young child, you ingested too much fluoride when your permanent teeth were developing under the gums. You cannot get dental fluorosis after your adult teeth have grown in.

Dental fluorosis is classified according to the level of severity, from normal to severe (normal, questionable, very mild, mild, moderate, severe). In its mild form it is only a cosmetic outcome and does not affect your oral health or your overall health.

The Canadian Health Measures Survey found that:

• 59.8% of children had teeth that were classified as normal
• 23.5% had teeth that were identified as questionable
• 16% of children had very mild or mild dental fluorosis
  • 12.0% had one or more teeth with fluorosis classified as very mild
  • 4.4% were classified as mild

Few children had moderate or severe dental fluorosis (less than 0.3%). The number of children affected was too low to allow reporting.

Skeletal fluorosis

Skeletal fluorosis involves hardening of the bones and joints. It can happen when there is a very high amount of fluoride in your bones. It is caused by ingesting very high levels of fluoride every day for a long time.

Skeletal fluorosis is extremely rare in Canada because we adjust our water to contain very low levels of fluoride and limit fluoride in our products.

Getting the right amount of fluoride

Since the 1940s, researchers have been testing the safety and benefits of fluoride. Apart from dental fluorosis and skeletal fluorosis, there are no other health risks that have been proven to be related to fluoride.

When pregnant and breastfeeding people drink water fluoridated at optimal level, it is safe for the fetus or infant.

For infant formula: Municipal tap water and commercially bottled water (except carbonated or mineral waters) are safe for preparing powdered or concentrated infant formulas.

It is safe to add fluoridated tap water to:

• powdered infant formula
• concentrated liquid formula

Before adding water to infant formula, read the label to see if the formula already contains fluoride. If you live in an area with naturally occurring high levels of fluoride (higher than the guideline of 1.5 mg/L, the maximum acceptable concentration), we suggest you mix the formula with drinking water with a lower fluoride concentration level.

If you are still concerned about fluoride intake for feeding during infancy, there are some simple and effective ways to reduce excessive fluoride intake:

• breastfeed your child
  • breast milk contains very low levels of fluoride (5 to 10 micrograms of fluoride per litre of milk)
• mix powdered or concentrated liquid formula with water that is fluoride-free or contains low levels of fluoride
  • examples are water labelled as purified, deionized, demineralized or distilled
• use ready-to-feed formula, which contains little fluoride
• introduce solid foods at about 6 months old and transition from formula to whole cow's milk when your child is 1 year old

Proper use of fluoridated toothpaste for children

Our toothpaste guide helps ensure children get the right amount of fluoride for their age and oral health status.

Use fluoridated toothpaste properly

Use toothpaste that contains fluoride to brush your child's teeth twice a day. Remember, toothpaste contains high amounts of fluoride. Because very young children may not have developed the ability to spit, they may swallow toothpaste when brushing. We recommend using the right amount of toothpaste for your child's age. Follow these recommendations: