Flouride for Dental Health - Good Science or Bad Science?

[volatile]

There have been a few threads on here about flouride and water flouridation, but the last one was in (yuk!) Conspiracy Theories, so I wanted to start a new one in order to try and rationally and scientifically get to the bottom of what seems to be a pretty contentious issue.

My girlfriend's dentist recently recommended that she start using a flouride-rich toothpaste, as our regular brand is flouride-free. My dentist told me a year or so ago that I should switch to a flouride-free paste because, whilst there was apparently no evidence at all (she claimed) linking flouride to better dental health, there was plenty of evidence suggesting its toxicity.

A cursory Google search for the simple term "flouride" turned up this site, which suggests that "There is not a single scientific or laboratory study from anywhere in the world which proves that fluoridation reduces tooth decay in humans", and this recent article from the Times, which says that there is evidence that dental health is improved by flouride but that flouride poisoning, flourosis, is on the rise and a real risk. It seems that there's a lot of contention here, but I wonder how much is justified.

Now, I'm no scientist, so I thought I'd ask some people who were - you, the JREF Science sub-forum. Should we switch back to flouridated toothpaste, or not?

 

[volatile]

A couple of people have voted "Yes" on this but haven't posted, which is a shame. If it really is the case that there is no evidence for the benefits of flouridation, why as good sceptics would you voite yes? Or is there evidence I'm missing?

I'd appreciate if those who voted would give their justifications, even if it's only briefly.

 

[Ysidro]

I voted yes because I've never heard a good reason why it's wrong from a trusted source. It's always conspiracy theorists. Hell, I never heard of a dentist mentioning it until your post.

I'm also unaware of any reasonable peer-reviewed study suggesting the noneffaciacy or danger of flouridation.

Plus every dentist I have ever had told me it was good. They're the ones who went to school for this stuff. Unless I posit a massive dental conspiracy, I'm going to trust their word. Seems reasonable enough to me. *shrug*

 

[volatile]

Well, here we go. I managed to disprove the first sites' claim that there are no studies claiming that the ingestion of flouride is beneficial (there certainly are), but in doing so I dug up the following meta-analysis:

Hardy Limeback (1999) A re-examination of the pre-eruptive and post-eruptive mechanism of the anti-caries effects of fluoride: is there any anti-caries benefit from swallowing fluoride? Community Dentistry and Oral Epidemiology 27 (1) , 62–71 doi:10.1111/j.1600-0528.1999.tb01993.x

Link to abstract: http://www.blackwell-synergy.com/doi/abs/10.1111/j.1600-0528.1999.tb01993.x

Link to PDF of the article: http://www.blackwell-synergy.com/doi/pdf/10.1111/j.1600-0528.1999.tb01993.x

The paper concludes, quite clearly, that flouride is unnecessary for and probably detrimental to good dental health.

In terms of toxicity, another meta-analysis seems to suggest greatly increased risk of flouride toxicity (flourosis) in ares with flouridated water:

Amid I. Ismail, Rajesh R. Bandekar (1999) Fluoride supplements and fluorosis: a meta-analysis, Community Dentistry and Oral Epidemiology 27 (1) , 48–56 doi:10.1111/j.1600-0528.1999.tb01991.x

Abstract: http://www.blackwell-synergy.com/doi/abs/10.1111/j.1600-0528.1999.tb01991.x

This refers principally to children, though, and the period of tooth development.

 

[Lithrael]

A couple of people have voted "Yes" on this but haven't posted, which is a shame. If it really is the case that there is no evidence for the benefits of flouridation, why as good sceptics would you voite yes? Or is there evidence I'm missing?

Well, your question is about toothpaste, not flouridated municipal water. I've only heard a few conspiracist rumblings about flouridated water being bad. The benefits of flouridated toothpaste and other it's-on-your-teeth-then-you-spit-it-out products, to my knowledge, have never been in doubt.

 

[Jorghnassen]

What the heck is flouride? Is it some kind of flour byproduct?

/orthography nazi

 

[Silly Green Monkey]

Look up Colorado brown spot disease.

 

[James Fox]

I voted Planet X above because my understanding is that it helps developing teeth but can be problematic for other groups.

This whole thing came up fro a public vote in my city a number of years ago. Initially I thought I’d support it as the city I grew up in had fluoridated water and I didn’t have many cavities as a child. Started doing my research and found that a whole population prophylactic administration of a chemical with many known risks for certain groups of the population was not reasonable or tenable. The best article I found that supported fluoridation concerned poor at risk populations with inadequate oral hygiene and dental care and it seemed pretty clear if that was the isolated target group there would be individual and systemic health benefits. In the end I voted against fluoridation mostly because of the flourosis risk and the detrimental effects on bone strength for the elderly. We did however give your children fluoride drops while they were growing up. I do recall reading research supporting fluoride for children but not beyond childhood.

 

[godless dave]

Anecdote: When I switched to drinking filtered tap water instead of straight tap water (for reasons solely of taste - Saint Paul tapwater is safe, AFAIK, but tastes like ass), I started getting more cavities. For the first thirty years of my life I had exactly four cavities. In the last 7 I've had four more.

I consider this anecdote more useless than most however.

 

[Almo]

What Ysidro said.

 

[JoeEllison]

http://www.medicinenet.com/script/main/art.asp?articlekey=15783

Fluoridation of drinking water is considered one of the top achievements in Public Health during the 20th century.

I grew up on fluoridated water... and, at 33 I've had no health issues associated with any stupid woo "toxins", and I've never had so much as a toothache.

 

[volatile]

What the heck is flouride? Is it some kind of flour byproduct?

/orthography nazi

That's how it's spelled in English, doofus.

 

[fls]

Here is a systematic review referenced on the ADA site for the effect of fluoride in adults.

http://www.ncbi.nlm.nih.gov/pubmed/17452559?dopt=Citation

And this is the list of references to systematic reviews for the use of topical fluoride.

http://www.ada.org/prof/resources/ebd/reviews/fluoride_topical.asp

Linda

 

[Big Les]

I developed flourosis as a child, because our water supply was flouridated, toothpaste is, and our dentist told my parents to give me flouride tablets.

My teeth are mottled and stain differentially. Hardly the end of the world, but not ideal.

 

[shadron]

Here is a public-consumption sort of FAQ on Fluoride from the American Dental Hygiene Association: http://www.adha.org/oralhealth/fluoride_facts.htm. I have always believed (from something I read long ago) that it is encouraged bacuse it incorporates fluorine into the crystal growth of enamel, making it more inert to the acids that bacteria use to break it down. Once the teeth are grown, it no longer adds additional help (again, just what I believe, and could be wrong - the article refutes at least some of that).

 

[JoeTheJuggler]

That's how it's spelled in English, doofus.

Is this a joke? You misspelled the word repeatedly, including in the thread title and poll.

Check your dictionary, or at least a tube of toothpaste endorsed by the ADA.

 

[The Atheist]

Well, it's been added to NZ drinking water for 35-odd years and many studies have shown a reduction in decay by 20-60%.

A couple are buried in these district health board papers:

http://www.wairarapa.dhb.org.nz/wdh...pa Final Technical Report - health status.pdf

http://www.westcoastdhb.org.nz/publications/documents/board_papers_docs/board_200506.pdf

I know that tooth decay has reduced by phenomenal amounts in NZ since the introduction of fluoride. On the other hand, I've never seen or heard any details of harmful effects.

Surely, the initial proof of the help fluoride does is just a case of looking up the details of cities which had natural fluoride and low decay rates.

 

[volatile]

Is this a joke? You misspelled the word repeatedly, including in the thread title and poll.

Check your dictionary, or at least a tube of toothpaste endorsed by the ADA.

Doh! My bad. I'd arrogantly assumed it was a color/colour US/UK difference, given that my search for the spelling I used gave a number of hits. Seems like I was wrong!

 

[casebro]

The current claim is that the fluoride does actually replace the ummm phosphorus? in adult enamel, making an enamel more resistant to acids.

But I also found the claim that only Stannous Fluoride works that way- sodium fluoride won't work in the presence of calcium, the white goop that is the quickest to build up on teeth. I haven't been able to find any with stannous in it at the 99 cents store. Anybody care to check the ingredients on their current tube? My tube of Crest Pro that my dentist gave me is Stannous...

 

[shadron]

It probably really ages me, but I can remember TV commercials (Crest, I think) extolling the usefulness of stannous fluoride. In the 50's, early 60's maybe? Back when chemical names meant wonder rather than dread, anyway.