Overview
Fluoride is most commonly used to prevent cavities, and to treat tooth plaque, a mild form of gum disease (gingivitis), and weak and brittle bones (osteoporosis).
How does it work ?
Uses & Effectiveness ?
Effective for
- Cavities. Fluoride, in toothpaste, mouthwash, and other dental products, reduces the formation of cavities in both baby teeth and permanent teeth.
Possibly Effective for
- Tooth plaque. Research shows that using toothpaste containing fluoride, especially when it also contains tin (stannous fluoride), can reduce the amount of plaque build-up on teeth.
- A mild form of gum disease (gingivitis). Research shows that using a toothpaste containing fluoride, especially when it also contains tin (stannous fluoride), can reduce bleeding and swelling of the gums.
- Weak and brittle bones (osteoporosis). Fluoride taken by mouth, either every day or cyclically (some months on and then some months off) might increase bone mineral density, which is an indicator of bone strength. Fluoride seems to work better for improving bone density in older women when combined with hormone replacement therapy. However, it's not clear whether taking fluoride actually reduces the chance of weak bones breaking. There are better medications to use for bone loss for most people.
Insufficient Evidence for
- A type of inflammatory bowel disease (Crohn disease). Early research shows that fluoride might improve bone density in some parts of the body in people with Crohn disease.
- Rheumatoid arthritis (RA). Early research shows that fluoride might improve bone density in some parts of the body in people with Crohn's disease.
- Other conditions.
Side Effects
When applied to the teeth: Fluoride is LIKELY SAFE for most people when used in toothpastes and mouthwashes, and applied by dentists.
Special Precautions and Warnings
Children: Fluoride is LIKELY SAFE in the amounts added to public water supplies and when applied directly to the teeth in toothpastes and mouthwashes. Higher doses of fluoride are POSSIBLY UNSAFE. Toothpaste and fluoride rinses should not be swallowed routinely, particularly by children. It's a good idea to make sure that children under six years of age use only a pea-sized amount of fluoride-containing toothpaste, just in case they swallow some. In addition, for infants under 6 months of age, drinking water should not be mixed with formula if the water is high in natural fluoride.
Interactions ?
We currently have no information for FLUORIDE overview.
Dosing
ADULTS
BY MOUTH:
- For cavities: In the US, fluoride is added to most city water sources to a concentration of 0.7 to 1.2 parts per million (ppm).
- For weak and brittle bones (osteoporosis): 11.3 to 20 mg per day of elemental fluoride.
- For tooth plaque: Brushing the teeth 1-2 minutes two times a day with a toothpaste containing fluoride has been used.
- For a mild form of gum disease (gingivitis): Brushing the teeth 1-2 minutes two times a day with a toothpaste containing fluoride has been used.
BY MOUTH:
- For cavities: In the US, fluoride is added to city water sources to a concentration of 0.7 to 1.2 parts per million (ppm). To prevent dental caries in areas where the fluoride level in drinking water is less than 0.3 ppm (such as in well water), some children should take fluoride supplements as follows: 0.25 mg daily in children 6 months to 3 years, 0.5 mg daily in children 3-6 years, and 1 mg daily in children 6-16 years. For children living in areas where the fluoride level in drinking water is 0.3 to 0.6 ppm, some children should take fluoride supplements as follows: 0.25 mg daily for children 3-6 years and 0.5 mg daily for children 6-16 years. No supplement is needed in areas where the fluoride in drinking water exceeds 0.6 ppm.
- For cavities: Toothpaste, mouthwash, and gels containing fluoride have been used. Gels are usually used once or more per year. Mouthwash and toothpaste are usually used 1-2 times each day.
The daily upper intake levels (UL) for fluoride, which is the highest level that can be taken daily with no harmful effects expected, are: 0.7 mg for infants 0-6 months of age, 0.9 mg for infants 7-12 months of age, 1.3 mg for children 1-3 years of age, 2.2 mg for children 4-8 years of age, and 10 mg for children older than 8 years and all adults.
Adachi JD, Bell MJ, Bensen WG, et al. Fluoride therapy in prevention of rheumatoid arthritis induced bone loss. J Rheumatol 1997;24:2308-13.. View abstract.
Alexandersen P, Riis BJ, Christiansen C, et al. Monofluorophosphate combined with hormone replacement therapy induces a synergistic effect on bone mass by dissociating bone formation and resorption in postmenopausal women: a randomized study. J Clin Endocrinol Metab 1999;84:3013-20.. View abstract.
American Dental Association. "ADA Statement on FDA Toothpaste Warning Labels" https://www.ada.org/prof/prac/issues/statements/fluoride.html (Accessed 18 November 2002).
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Brown JP, Josse RG, et al. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 2002;167:S1-S34.. View abstract.
Campus G, Congiu G, Cocco F, Sale S, Cagetti MG, Sanna G, Lingström P, Garcia-Godoy F. Fluoride content in breast milk after the use of fluoridated food supplement. A randomized clinical trial. Am J Dent. 2014 Aug;27(4):199-202. View abstract.
Canadian Dental Association. CDA position on use of fluorides in caries prevention. March 2012. Available at: https://www.cda-adc.ca/_files/position_statements/fluoride.pdf. Accessed December 9, 2020.
Centers for Disease Control. National Center for Chronic Disease Prevention and Health Promotion. "Dietary Fluoride Supplement Schedule." https://www.cdc.gov/OralHealth/factsheets/fl-supplements.htm (Accessed 18 November 2002).
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dos Santos AP, Nadanovsky P, de Oliveira BH. A systematic review and meta-analysis of the effects of fluoride toothpastes on the prevention of dental caries in the primary dentition of preschool children. Community Dent Oral Epidemiol. 2013 Feb;41(1):1-12. View abstract.
Enamandram M, Das S, Chaney KS. Cheilitis and urticaria associated with stannous fluoride in toothpaste. J Am Acad Dermatol. 2014 Sep;71(3):e75-6. View abstract.
Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academy Press, 1999. Available at: https://books.nap.edu/books/0309063507/html/index.html.
Foti C, Romita P, Ficco D, Bonamonte D, Angelini G. Allergic contact cheilitis to amine fluoride in a toothpaste. Dermatitis. 2014 Jul-Aug;25(4):209. View abstract.
Gong CX, James NE. Association between maternal fluoride exposure and child IQ. JAMA Pediatr. 2020;174(2):212-213. View abstract.
Green R, Lanphear B, Hornung R, et al. Association between maternal fluoride exposure during pregnancy and IQ scores in offspring in Canada. JAMA Pediatr. 2019;173(10):940-8. View abstract.
Grey A, Garg S, Dray M, Purvis L, Horne A, Callon K, Gamble G, Bolland M, Reid IR, Cundy T. Low-dose fluoride in postmenopausal women: a randomized controlled trial. J Clin Endocrinol Metab. 2013 Jun;98(6):2301-7. View abstract.
Guanabens N, Farrerons J, Perez-Edo L, et al. Cyclical etidronate versus sodium fluoride in established postmenopausal osteoporosis: a randomized 3 year trial. Bone 2000;27:123-8.. View abstract.
Guth S, Hüser S, Roth A, et al. Toxicity of fluoride: critical evaluation of evidence for human developmental neurotoxicity in epidemiological studies, animal experiments and in vitro analyses. Arch Toxicol. 2020;94(5):1375-1415. View abstract.
Gutteridge DH, Stewart GO, Prince RL, et al. A randomized trial of sodium fluoride (60 mg) +/- estrogen in postmenopausal posteoporotic vertebral fractures: increased vertebral fractures and peripheral bone loss with sodium fluoride; concurrent estrogen prevents peripheral loss, but not vertebral fractures. Osteoporos Int 2002;13:158-70.. View abstract.
Haguenauer D, Welch V, Shea B, et al. Fluoride for treating postmenopausal osteoporosis.(Cochrane Review). Cochrane Database Syst Rev 2002;(4):CD002825.. View abstract.
Lorenz K, Hoffmann T, Heumann C, Noack B. Effect of toothpaste containing amine fluoride and stannous chloride on the reduction of dental plaque and gingival inflammation. A randomized controlled 12-week home-use study. Int J Dent Hyg. 2019;17(3):237-243. View abstract.
Marinho VC, Chong LY, Worthington HV, Walsh T. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2016 Jul 29;7:CD002284. View abstract.
Marinho VC, Higgins JP, Logan S, Sheiham A. Fluoride gels for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2002;2:CD002280.. View abstract.
Marinho VC, Worthington HV, Walsh T, Chong LY. Fluoride gels for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2015 Jun 15;(6):CD002280. View abstract.
Meunier PJ, Sebert JL, Reginster JY, et al. Fluoride salts are no better at preventing new vertebral fractures than calcium-vitamin D in postmenopausal osteoporosis: the FAVOStudy. Osteoporos Int 1998;8:4-12.. View abstract.
Mullen J; European Association for Paediatric Dentistry. History of water fluoridation. Br Dent J. 2005 Oct 8;199(7 Suppl):1-4. View abstract.
Parkinson C, Amini P, Wu J, Gallob J. A 24-week randomized clinical study investigating the anti-gingivitis efficacy of a 0.454% w/w stannous fluoride dentifrice. Am J Dent. 2018;31(1):17-23. View abstract.
Peters P, Drummond C. Perioral dermatitis from high fluoride dentifrice: a case report and review of literature. Aust Dent J. 2013 Sep;58(3):371-2. View abstract.
Phipps KR, Orwoll ES, Mason JD, Cauley JA. Community water fluoridation, bone mineral density, and fractures: prospective study of effects in older women. BMJ 2000;321:860-4.. View abstract.
Position of the American Dietetic Association: the impact of fluoride on health. J Am Diet Assoc 2001;101:126-32.. View abstract.
Reginster JY, Meurmans L, Zegels B, et al. The effect of sodium monofluorophosphate plus calcium on vertebral fracture rate in postmenopausal women with moderate osteoporosis. A randomized, controlled trial. Ann Intern Med 1998;129:1-8.. View abstract.
Reginster JY, Rovati LC, Setnikar I. Correct regimen of fluoride and calcium reduces the risk of vertebral fractures in postmenopausal osteoporosis [letter]. Osteoporos Int 2001;12:800.
Riddell JK, Malin AJ, Flora D, McCague H, Till C. Association of water fluoride and urinary fluoride concentrations with attention deficit hyperactivity disorder in Canadian youth. Environ Int. 2019;133(Pt B):105190. View abstract.
Ringe JD, Rovati LC. Treatment of osteoporosis in men with fluoride alone or in combination with bisphosphonates. Calcif Tissue Int 2001;69:252-5.. View abstract.
Rubin CD, Pak CY, Adams-Huet B, et al. Sustained-release sodium fluoride in the treatment of the elderly with established osteoporosis. Arch Intern Med 2001;161:2325-33.. View abstract.
Sälzer S, Slot DE, Dörfer CE, Van der Weijden GA. Comparison of triclosan and stannous fluoride dentifrices on parameters of gingival inflammation and plaque scores: a systematic review and meta-analysis. Int J Dent Hyg. 2015 Feb;13(1):1-17. View abstract.
Seddek AL, Ghallab A. Fluoride: No evidence of developmental neurotoxicity due to current exposure levels in Europe. Arch Toxicol. 2020;94(7):2543-2544. View abstract.
Singh A, Purohit BM. Caries preventive effects of high-fluoride vs standard-fluoride toothpastes - A systematic review and meta-analysis. Oral Health Prev Dent. 2018;16(4):307-314. View abstract.
Spak CJ, Ekstrand J, Zylberstein D. Bioavailability of fluoride added by baby formula and milk. Caries Res 1982;16:249-56.
Till C, Green R, Flora D, et al. Fluoride exposure from infant formula and child IQ in a Canadian birth cohort. Environ Int. 2020;134:105315. View abstract.
Till C, Green R, Lanphear B. Association between maternal fluoride exposure and child IQ-reply. JAMA Pediatr. 2020;174(2):216-217. View abstract.
Tubert-Jeannin S, Auclair C, Amsallem E, Tramini P, Gerbaud L, Ruffieux C, Schulte AG, Koch MJ, Rège-Walther M, Ismail A. Fluoride supplements (tablets, drops, lozenges or chewing gums) for preventing dental caries in children. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD007592. View abstract.
von Tirpitz C, Klaus J, Bruckel J, et al. Increase of bone mineral density with sodium fluoride in patients with Crohn's disease. Eur J Gastroenterol Hepatol 2000;12:19-24.. View abstract.
Walsh T, Worthington HV, Glenny AM, Marinho VC, Jeroncic A. Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database Syst Rev. 2019;3(3):CD007868. View abstract.
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