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How does Fluoride Work

What do we know about how fluoride works?

We know that fluoride works most topically i.e. when present on the surface of the tooth. It is also touted that it is most effective when a low level of fluoride is constantly maintained in the oral cavity and has a maximum effect of between 0.02 to 0.04 parts per million (ppm).

This saliva level of fluoride is normal when drinking fluoridated water.

The action of fluoride in the mouth can be summarized to 4 main points: fluoride enhances remineralization by combining with calcium and phosphate to form fluorapatite which is more resistant to demineralization fluoride inhibits demineralization of tooth mineral when present in solution around the tooth surface fluoride interferes with its metabolism by specifically inhibiting the enzyme enolase in the glycoltic pathway (needed for energy production of cells) fluoride affects the morphology of crown of tooth, making the coronal pits and fissures shallower, but some reports note that this is of minimal effect.

Most proponents of fluoride emphasize that the side effects of water fluoridation is dental fluorosis, which is largely an aesthetic problem at our modern level of water fluoridation (0.7-1.2ppm). Little is said about what fluoride does to the rest of the body e.g. skeletal fluorosis (which we posted about previously).

We know fluoride can be beneficial to the teeth, but only when present at the surface (topically). We also know that fluoride is a neurotoxin.

So, some important questions remain for us to ponder upon: Is the chain of delivery of water fluoridation from the source to the target flawed? How do you control how much fluoride the individual gets? Do we need to consume fluoride on an on-going (almost hourly, if you’re constantly drinking water) basis just to reap its benefits for the teeth, while sweeping aside the effects on the other systems like the bone and kidney?

And are we masking modern causes of tooth decay i.e. high sugar intake, mouth breathing, lack of access to oral care etc. with claims of fluoride reducing tooth decay? (Which coincidentally are major causes of other systemic problems such as obesity and high blood pressure.)

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