The Role of Fluoride Toothpastes in Caries Management
Fluoride applications, known for their multifaceted mechanisms of action, are recognized as the most effective method for caries prevention.
Fluoride was added to toothpaste in 1914.1 Fluoride toothpastes developed in 1950 received ADA approval.1
Fluoride affects teeth in many ways Provides benefits.
- It makes demineralisation of tooth enamel more difficult.
- Facilitates remineralisation of enamel.
- Inhibits caries-causing bacteria in the mouth.
- Present in very low concentrations in the mouth even though fluoride is a mineral that removes minerals from tooth enamel. Prevents decomposition.2
- When fluoride toothpastes are used regularly, increased fluoride values in bacterial plaque preserved even 10 hours after brushing.2
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It inhibits demineralization of tooth enamel.
![Demineralization]()
It inhibits demineralization of tooth enamel.
Demineralisation Process
- Acids produced by oral bacteria attack exposed tooth surfaces. Acids attack prismatic areas along the edges of the crystal rod to areas just below the surface (usually starting 15-20 µm below the surface).
- As the process continues, the edges of the rods begin to melt. Calcium and phosphate are removed from the crystal surface decompose, some minerals redeposit near the tooth surface to form a 'solid outer layer' and the rest is lost in saliva.
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Fluoride significantly enhances the natural process of remineralisation.
![Remineralisation]()
Fluoride significantly enhances the natural process of Remineralisation.
Remineralisation Process
- The natural process of remineralisation is due to the fact that saliva gradually buffers the pH of the mouth and It begins by removing acids produced by the bacterial biofilm.
- Calcium and phosphate are diffused back into the tooth from saliva and/or plaque fluid and re-deposited mineral enriches partially demineralised tissue through formation.
- Re-deposited mineral is either normal crystal growth on partially demineralised crystals or new crystal formation in the subsurface areas of enamel or dentin.
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It inhibits caries-causing bacteria in the mouth.
![Girl smiling with healthy teeth]()
The relationship between caries-causing bacteria and fluoride
Dental plaque is composed of a complex community of bacteria which produce acidic by-products when they ingest fermentable carbohydrates.
- This causes a drop in plaque pH.
- There are many different species of bacteria in plaque; some more cariogenic than others.
- Streptococci (Gram-positive cocci) and Lactobacilli (Gram-positive rods) are the two species most associated with caries.
- S. mutans and S. sobrinus are aciduric bacteria; thriving in an acidic environment and are strongly implicated in acid production and caries.
- Species such as Lactobacilli are also aciduric, and are frequently found within caries lesions, although their overall role in caries is not as well understood.
Using age-appropriate fluoride toothpaste, recognized as the most effective method for caries prevention to protect milk teeth and permanent teeth from caries.3 Appropriate fluoride levels are especially important in children therefore fluoride levels in toothpastes are closely monitored and regulated by regulatory authorities.
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