FLUORIDE

OTHER NAME(S):

Acidulated Phosphate Fluoride, Amine Fluoride, Ammonium Fluoride, Atomic number 9, Calcarea Fluorica, F, Fluorophosphate, Fluorure, Fluorure d'Hydrogène, Fluorure de Phosphate Acidulé, Fluorure de Sodium, Fluorure Stanneux, Fluoruro, Hydrogen Fluoride, Monofluorophosphate, MFP, Nombre Atomique 9, Sodium Fluoride, Sodium Monofluorophosphate, Stannous Fluoride.

Overview

Overview Information

Fluoride is a form of the chemical element fluorine. It is used as medicine.

Fluoride is added to public drinking water to prevent tooth decay. Children who do not drink fluorinated public water because their homes use water from a private well often take fluoride tablets to prevent tooth decay. Fluoride is added to toothpaste and mouthwashes so it can be applied directly to the teeth to reduce the formation of a sticky plaque on the teeth, preventing the swelling of gums and tooth decay.

Fluoride is also taken by mouth for treating weakened bones (osteoporosis) and for preventing bone loss in people with rheumatoid arthritis and Crohn's disease.

How does it work?

Fluoride protects teeth from the bacteria in plaque. It also promotes new bone formation. This is different than most medicines used for weak bones (osteoporosis), which fight osteoporosis by keeping bone from being broken down.

Uses

Uses & Effectiveness?

Effective for

  • Tooth decay (dental caries). Fluoride, in toothpaste, mouthwash, and other dental products, reduces the formation of cavities in both baby teeth and permanent teeth.

Possibly Effective for

  • Dental plaque. Research shows that using a toothpaste containing fluoride in the form of stannous fluoride can reduce the amount of plaque build-up on teeth.
  • Swelling of gums (gingivitis). Research shows that using a toothpaste containing fluoride in the form of stannous fluoride can reduce bleeding and swelling of the gums.
  • Osteoporosis (bone loss). 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

  • Rheumatoid arthritis. Early research shows that fluoride might improve the bone density in some parts of the body in people with rheumatoid arthritis.
  • Crohn's disease (an intestinal disorder). Early research shows that fluoride might improve the bone density in some parts of the body in people with Crohn's disease.
  • Other conditions.
More evidence is needed to rate the effectiveness of fluoride for these uses.

Side Effects

Side Effects & Safety

Fluoride is safe for most people in the amounts added to public water supplies and used in toothpastes and mouthwashes, and applied by dentists. Low doses (up to 20 mg per day of elemental fluoride) of supplemental fluoride taken by mouth appear to be safe for most people. Higher doses are UNSAFE and can weaken bones and ligaments, and cause muscle weakness and nervous system problems. High doses of fluoride in children before their permanent teeth come through the gums can cause tooth discoloration.

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.

Special Precautions & Warnings:

Pregnancy and breast-feeding: Fluoride seems to be safe during pregnancy and breast-feeding when taken in doses below the tolerable upper intake level (UL) of 10 mg per day of elemental fluoride and when applied directly to the teeth in toothpastes and mouthwashes. But higher doses are UNSAFE and can weaken bones and ligaments, and cause muscle weakness and nervous system problems.

Interactions

Interactions?

We currently have no information for FLUORIDE Interactions.

Dosing

Dosing

The following doses have been studied in scientific research:

ADULTS

BY MOUTH:

  • For tooth decay (dental caries): 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 bones (osteoporosis): 11.3 to 20 mg per day of elemental fluoride.
ON THE TEETH:
  • For dental plaque: Brushing the teeth 1-2 minutes two times a day with a toothpaste containing stannous fluoride has been used.
  • For swelling of the gums: Brushing the teeth 1-2 minutes two times a day with a toothpaste containing stannous fluoride has been used.
CHILDREN

BY MOUTH:
  • For tooth decay (dental caries): 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.
ON THE TEETH:
  • For tooth decay (dental caries): 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 Adequate Intakes (AI) for fluoride from all sources, including drinking water, are: 0.1 mg daily for infants 0- 6 months of age, 0.5 mg daily for infants 7-12 months of age, 0.7 mg daily for children 1-3 years, 1 mg daily for children 4-8 years of age, 2 mg daily for children 9-13 years of age, 3 mg daily for children 14-18 years of age, 3 mg daily for women 19 years of age and older, and 4 mg daily for men 19 years of age and older.

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.

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View References

REFERENCES:

  • 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).
  • 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.
  • 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).
  • Chitkara M, Rackoff PJ, Beltran LS. Multiple painless masses: periostitis deformans secondary to fluoride intoxication. Skeletal Radiol. 2014 Apr;43(4):529-30, 555-6. View abstract.
  • Choi AL, Sun G, Zhang Y, Grandjean P. Developmental fluoride neurotoxicity: a systematic review and meta-analysis. Environ Health Perspect. 2012 Oct;120(10):1362-8. View abstract.
  • 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.
  • 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.
  • 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.
  • 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, 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.
  • 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.
  • 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.
  • Spak CJ, Ekstrand J, Zylberstein D. Bioavailability of fluoride added by baby formula and milk. Caries Res 1982;16:249-56.
  • 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.
  • Yin XH, Huang GL, Lin DR, Wan CC, Wang YD, Song JK, Xu P. Exposure to fluoride in drinking water and hip fracture risk: a meta-analysis of observational studies. PLoS One. 2015 May 28;10(5):e0126488. View abstract.

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CONDITIONS OF USE AND IMPORTANT INFORMATION: This information is meant to supplement, not replace advice from your doctor or healthcare provider and is not meant to cover all possible uses, precautions, interactions or adverse effects. This information may not fit your specific health circumstances. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on WebMD. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you.

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© Therapeutic Research Faculty 2018.