Q&A With Dr Emma
With everyone drinking bottled water now, is it of any benefit to be taking fluoride tablets? I only ask this as my son is located in a remote area and can only drink rainwater and this has no fluoride and I was wondering whether to send him tablets. Thanks - Helen from Waterford (WA)
I'm generally quite an easy-going person. I don't like conflict and confrontation, but one of my pet peeves is the anti-fluoridation movement. I was once at a trade show, and asked a water filter salesman if his filters removed fluoride. He excitedly replied that they indeed did, then proceeded to pontificate about the evils of fluoride in our water supply until I disappointed him with the news that I was a dentist, and would not be buying his filters for the very reason he thought they were wonderful.
There's an overwhelming amount of evidence to show that the benefits of fluoride preventing tooth decay far outweigh the risks. Since the early 1900s, there has been a lot of research done showing that a fluoridated water supply results in less tooth decay in the population consuming it.
The benefit is just that though, on a population level, so it's not always going to be the most effective means of delivering fluoride for every individual. That's great news for your son, and many other people living in areas which don't have a fluoridated water supply.
When it was first discovered, there was a theory that fluoride being swallowed by young children helped their developing teeth to be more decay resistant. We now know that the primary benefit of fluoride is at a topical level. That is, when it's directly applied to the teeth rather than it being swallowed and then distributed through the body. Fluoridated water has a lot of contact with our teeth when we drink it, but it's at a low concentration to keep it safe to consume, (around 1ppm). A standard adult-strength toothpaste has around 1000ppm, which should only ever be applied topically and not swallowed.
A 2011 review of the research showed that topical fluoride, (such as toothpaste), was just as effective in preventing tooth decay as fluoride supplements, (drops, tablets, lozenges). It was extrapolated from that review that when a fluoride toothpaste is being used daily, extra fluoride supplements are probably going to be of limited benefit. Fluoride tablets also carry a higher risk of accidental overdose than toothpaste does, so it's hard to justify the risk if they're going to be of little value.
If your son is at low risk of decay, i.e. he has a good diet, good oral hygiene, uses a fluoride toothpaste and has had minimal decay in the past, he probably doesn't need any more fluoride than what's in his toothpaste. If your son is at a high risk of decay, I'd recommend using a fluoride mouth rinse or a high fluoride toothpaste (5000ppm) before considering supplements. These will deliver the fluoride exactly where it needs to go, on his teeth, in a much more effective way than fluoride tablets will.