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What is remineralization and how does it work?

The process of tooth decay causes demineralization or loss of minerals. With the aid of fluorides, minerals are incorporated back into the decayed region through remineralization. Both the demineralization and remineralization processes are continuously ongoing. Basically, it's a tug of war between the two; when remineralization overcomes the demineralization process, decay can actually be reversed and the affected area restored to health. The remineralization process also significantly increases the size of the enamel crystals. Larger crystals are more resistant to acid attack than the enamel you were born with.

Studies have shown that it takes about 3 years from the time a cavity begins until it is large enough to be detected in an x-ray. Therefore, even those you may not have any radiographically detectable decay in your mouth, it's a good idea to consider fluoride as a means of prevention. Studies have also shown that low levels of fluorides (such as in toothpastes and rinses) are more effective than high fluoride concentrations at reversing early decay.

Can topical fluoride applications produce tooth mottling (pitting and discoloration)?

Tooth mottling is caused by excessive systemic use of fluorides during the period of tooth development, not by topical use. Like any nutrient, fluoride is beneficial in the proper  amounts, but harmful in excessive amounts. Some geographical areas do not have fluoridated water. Other areas have naturally fluoridated water. Geographic locations in which the water supply is  not naturally fluoridated have no more than the recommended level of fluoride (which is 0.7 to 1.2 ppm depending on climate) added to the water. To determine if your tap water is fluoridated, check with your local water district. Ingestion of water having a fluoride concentration of two to three times greater than the recommended level can produce white flecks and chalky opaque areas in your teeth. Consumption of water having a fluoride concentration of four times the recommended level can cause brown, pitted and corroded areas.

Other Causes of Enamel Discoloration

• Drug therapy given during tooth development (ie, tetracycline use during pregnancy can result in permanent staining of the child's teeth)
• Formation of an abscess from an infected baby tooth can lead to discoloration of the permanent tooth’s crown.
• Infection
• Trauma to baby teeth causing the damage to permanent dentition.
• Nutritional disturbance during tooth formation can lead to discoloration of enamel.

Is Fluoride Safe?

There have been continuous studies carried out over the years on large sections of the population to determine if there are any adverse health effects from fluoride.  There is no clinical evidence to suggest that fluoride in the recommended concentrations is anything but entirely safe.

Early Gum Disease Control - Fluorides are used to inhibit the bacteria in plaque which contribute to bleeding and tender gums. Fluoride does this by affecting the metabolism and quantity of bacteria. Most of the research in this area  has used stannous fluoride which has demonstrated the ability to metabolically disrupt plaque bacteria.

Advanced Gum Disease Therapy - Periodontal disease is caused by bacteria that attack gum tissue and bone, which supports the teeth. Fluorides help sustain the treatment performed by your hygienist and dentist.

Crown and Bridge Maintenance - Recurrent decay in teeth supporting a crown or bridge threatens the entire restoration. Fluoride will help protect these critical areas.

Gum Maintenance - Because periodontal disease can reoccur at any time, fluorides are used to help prevent reinfection.

Implant Maintenance - Bacterial plaque is the number one cause of premature implant failure. Fluoride aids in blocking plaque formation and helps protect your implants.

Orthodontic Maintenance - Fluorides help control two major problems associated with orthodontic treatment: gingivitis and decalcification.

Sensitivity - Almost 25% of all adults will experience tooth sensitivity at one time or another. Whether caused by receding gums and exposed root surfaces, or as a post operative effect of gum surgery or cleanings, sensitivity is often effectively treated with fluoride containing products.

Dry Mouth (Xerostomia) - Many prescription medications affect salivary flow as a side effect. When salivary flow is absent or minimal, caries destruction is rapid and rampant. Patients experiencing drug or radiation-induced xerostomia (dry mouth) should be treated with professionally applied fluorides, home fluorides, and a strict program of oral hygiene. Drugs producing dry mouth include: antihistamines, diuretics, antihypertensives, anticholinergics, antidepressants, antipsychotics, and decongestants.

Pre-carious Lesions - As mentioned, fluoride has been shown to be highly effective in reversing incipient (just beginning or very small) cavities.

Adjunctive Treatment - Especially, in patients with disabilities preventing normal brushing.