The American regulatory agency FDA (Food and Drug Administration) has taken steps to limit the use of fluoride supplements used to strengthen children’s teeth. According to them, the products are no longer recommended for children under 3 years of age and for those who, despite being older, do not present a serious risk of tooth decay.
Previously, the products were prescribed for children from six months of age. In May, the agency said they would seek to remove the products from the market, but instead they sent letters to four American companies warning them not to market their products outside the new limits. The FDA also sent a standard letter to dentists and other health care professionals warning them of the products’ risks.
Fluoride lozenges and tablets are sometimes recommended for children and teenagers at higher risk of cavities due to the low concentration of fluoride in local drinking water. Some companies also sell baby drops.
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The FDA on Friday released a new scientific analysis concluding that fluoride supplements have limited benefits for children’s teeth and may be linked to emerging safety concerns, including intestinal problems, weight gain and cognitive impairment.
“For the same reason that fluoride can kill bacteria on teeth, it can also alter the gut microbiome, which can have broader health implications,” the agency said in a statement.
Experts dispute the claims
The American Dental Association has even disputed the claims, saying there are no significant health problems associated with fluoride when used at levels prescribed by dentists.
Supplements can cause teeth staining or discoloration due to excess fluoride, a drawback also noted by the FDA.
— The only evidence that exists of the effect of fluoride, whether from water, toothpaste or other means, is dental fluorosis, which are stains on the tooth enamel – says dental surgeon Jaime Aparecido Cury, professor emeritus at Unicamp and one of the main experts on the subject in the world in a recent interview with GLOBO – but these stains only occur when you have excess fluoride – he adds.
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Fluoride is a mineral naturally present in many foods and available as a dietary supplement. It is also the ionic form of the element fluorine and inhibits or reverses the onset and progression of tooth decay and stimulates the formation of new bone, according to information from the United States National Institutes of Health (NIH).
According to the Centers for Disease Control and Prevention (CDC), fluoride strengthens teeth and reduces cavities by replacing minerals lost during natural wear and tear. In 1962, the agency established guidelines for how much should be added to water.
The FDA regulates most dental products, including fluoride toothpastes, supplements, mouthwashes, and teeth-whitening solutions.
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The agency’s actions do not affect toothpastes, mouthwashes or fluoride treatments used by adults or offered in dental offices.
How fluoride prevents cavities
According to the World Health Organization (WHO), fluoride prevents cavities through several different actions. When present in saliva and teeth constantly and in low concentrations, through the use of toothpaste with the compound, fluoride delays demineralization and accelerates the remineralization of tooth enamel lesions.
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Furthermore, fluoride interferes with glycolysis, the process by which cariogenic bacteria metabolize sugars to produce acid and has a bactericidal action.
Finally, when fluoride is ingested during the period of tooth development, it makes the enamel more resistant to later acid attacks and subsequent development of cavities. This last mechanism of action is what led many countries – including Brazil – to adopt water fluoridation as a way to prevent cavities. Research suggests that drinking water with added fluoride can reduce cavities by up to 25%.
Although the use of toothpaste is an effective and important individual prevention measure, water fluoridation is a form of community prevention, which, according to the WHO, has a “good cost-benefit ratio for preventing tooth decay”.
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According to the entity, the ideal concentration of fluoride in drinking water to prevent cavities without posing health risks varies between 0.5 and 1.0 mg/L. In Brazil, the established range is 0.6 to 0.8 mg/L, with 0.7 considered the “optimal” concentration for caries prevention.
Risks associated with fluoride
On the other hand, like any substance, too much fluoride can be harmful. According to experts, even combining the doses administered in water and toothpastes, the volume of fluoride in the body is not harmful.
The main risk associated with excess fluoride is dental fluorosis, which are stains on tooth enamel resulting from ingestion of excess fluoride.
In most cases, the condition is just cosmetic. But in its most severe form, reduced mineralization can result in pitted teeth. These cases are most common through excessive consumption of groundwater naturally rich in fluoride.
