Curaprox Zero

[Liliane Hubright]

Toothpastewith or without fluoride? This is the big question and a hotly debated topic in the world of health. An increasing number of consumers are reconsidering their choices and opting for zero fluoride toothpaste. Dentists, medical associations and authorities advocate for fluoride, explicitly endorsing its usage. Numerous studies have already demonstrated fluoride's efficacy in preventing dental decay.

Fluorides naturally arise from a compound containing fluorine gas. The element with which fluorine binds determines whether sodium, amine or stannous fluoride is formed. The compounds exhibit completely different properties than fluorine. In fact, fluorides are salts with positive properties, while fluorine is a toxic gas.

Fluoride is a naturally occurring substance, not an artificial compound. Fluorine salts are present not only in rock layers but also occur naturally in the human body as essential components of our bones and teeth.

The German Federal Institute for Materials Research and Testing (BAM) has developed a test strip for quickly determining the fluoride concentration in water. This test strip works similar to a pH test strip, indicating the fluoride concentration through a colour change.

Since 1850, the protective effects of fluoride-containing tooth enamel against acids have been recognised. Consequently, scientists realised that fluoride supplementation would help prevent dental decay. Fluoride has, therefore, been recommended for protection against dental decay since 1874.

However, research did not stop there. Meanwhile, over 300,000 scientific studies have explored fluoride's role in combating dental decay, resulting in an abundance of dental care products like gels, varnishes, mouthwashes and, of course, toothpaste containing sodium fluoride.

Did you know that thoroughly rinsing your mouth with water after brushing your teeth diminishes the effectiveness of fluoride in toothpaste? It is better to just spit out the toothpaste and to not rinse your mouth with water. This allows the fluoride to develop its full effect and optimally protect your teeth.

Despite being the hardest material in the human body, tooth enamel is remarkably sensitive. It consists of a super-fine crystalline lattice structure of a mineral known as hydroxyapatite. Minerals such as magnesium, sodium, calcium and phosphorus are bound within this crystalline lattice structure.

Millions of bacteria live in the oral cavity. The majority of them are "good" and essential for digestion. However, there are also "bad" cavity-causing bacteria that attack the tooth enamel. And this is how it works: These bacteria thrive on sugar, which they digest and excrete as acid. Thus, the pH value in the mouth changes and becomes acidic.

Upon acid secretion by bacteria, immediate neutralisation occurs, as minerals like calcium and phosphorus are released directly from the crystalline lattice structure of the tooth enamel. This process is referred to as demineralisation.

The problem: The loosening of the minerals creates gaps in the crystalline lattice structure of the tooth enamel that need to be filled. Saliva is responsible for this task. As soon as the bacteria are done with their acid attack, since the sugar has been digested and the oral pH value neutralised, the saliva is able to re-close the open gaps in the tooth enamel. Because besides water, saliva contains essential minerals such as calcium phosphates. The crystalline lattice structure of the tooth enamel is replenished and the actual tooth enamel becomes hard and durable again. This process of replenishing mineral levels is also called remineralisation.

Serious problems only start to occur when demineralisation and remineralisation are unbalanced. For instance, excessive sugar intake, persistent acid secretion by bacteria and an unbalanced oral pH value may overwhelm your saliva's capacity to replenish minerals. Bacteria can then settle in the crystalline lattice structure of the tooth enamel and easily multiply and spread. This is how dental decay develops.

With the help of fluorides, calcium phosphates can be absorbed more quickly in the tooth enamel after teeth demineralisation caused by an "acid attack". This helps to quickly close any weak spots in the crystalline lattice structure of the tooth enamel, giving bacteria less time to settle in the gaps. The actual fluorides are also stored in the tooth enamel. This means that the tooth enamel is well prepared for efficient and rapid remineralisation after the next acid attack.

Regular use of fluoride toothpaste forms a kind of protective coating over the teeth. Instead of neutralising the acidic pH value with minerals from the tooth enamel, the protective layer is initially attacked, not the actual tooth enamel. When brushing teeth, the fluoride is absorbed into the tooth enamel and replaces hydroxide ions. This results in the formation of a wafer-thin layer of a mineral called fluorapatite. In contrast to hydroxyapatite, which makes up a large percentage of the foundation of our tooth enamel, it is considerably stronger and more resilient. As such, fluoride protects the teeth against acid attacks. Interesting fact: Shark teeth are made mostly of fluorapatite and are, therefore, extremely strong.

Fluoride has an antibacterial effect, which helps to combat bacteria already on or in the tooth enamel. The fluoride penetrates the bacteria and manipulates their metabolism. Consequently, fewer bacteria are able to produce the acids that attack tooth enamel and, ultimately, cause dental decay.

The world of dental health is in agreement: Fluoride offers effective protection against dental decay. This is not only the view of the scientists behind the more than 300,000 studies published on the subject of fluoride and its impact on dental decay but also of official authorities and numerous consumer protection organisations, such as Stiftung Warentest, Germany's leading consumer testing organisation, all of whom recommend using fluoride toothpaste.

In the world of dentistry, it is also an undeniable fact that the use of fluoride toothpaste for brushing teeth is a primary reason for the drastic reduction in dental decay in recent decades. A comprehensive oral health study conducted by the German Dental Association in 2016 came to the conclusion that there were twice as many caries-free teeth in 2014 as in 1997. Besides better preventive dental care, fluoride toothpaste was also stated as one of reasons for this improvement in oral health.

So, if fluorides are so effective against dental decay and are recommended by leading health institutions, why do doubts still remain? Terms such as "nerve poison" or "neurotoxin" can frequently be heard. What effect does fluoride have on the rest of the body? And what happens if you accidentally consume too much fluoride?

Social media posts, internet forums and alternative health blogs are full of content like: "The truth about fluoride". They tend to list the various harmful side effects and use scare tactics to frighten consumers. Let us take a closer look at the actual points of criticism.

Fluoride has been proven to effectively reduce dental decay, but you should adhere to the "less is more" principle and never exceed the recommended amounts. The exact recommendations for fluoride content in children's and adult toothpaste can be found in the table below.

For a long time, scientists debated the question of whether it is better to provide fluoride through toothpastes or tablets. Today, we know that toothpaste is more effective due to its direct contact with the tooth enamel. Fluoride tablets are not necessary if your child uses a fluoride toothpaste. Important: Never give your child fluoride tablets and fluoride toothpaste at the same time. Simply choose which option is best for your child.

If people ingest a particularly large amount of fluoride over a longer period of time, it can lead to bone fluorosis, or skeletal fluorosis. In this case, bone density is abnormally elevated. However, this results in bones losing their natural elasticity, which can ultimately lead to restricted movement.

These values are very high and can only be achieved by drinking highly fluoridated water. Seeing as most European countries do not fluoridate their drinking water, you do not need to worry about skeletal fluorosis. This has also been confirmed by Stiftung Warentest, Germany's leading consumer testing organisation. According to the consumer protection organisation, products that help prevent dental decay cannot damage your bones.

The dose makes the poison. The early modern physician Paracelsus came to this conclusion as early as the 16th century, and it remains as relevant to fluoride today as it did then. Yes, fluoride is poisonous, but only to a very limited extent.

For someone weighing 70 kg, experiencing the initial symptoms of fluoride poisoning, like nausea, abdominal pain, headache, diarrhoea, vomiting and drowsiness, would require them ingesting at least 350 mg of fluoride. The potentially toxic dose is 5 mg of fluoride per kilogram of body weight. In our case, that would be the equivalent of consuming two to three tubes of toothpaste.

But what about children? The German Federal Institute for Risk Assessment (BfR) determined that a child may have an upset tummy at worst after consuming a whole tube of children's toothpaste (with a fluoride concentration of 0.05 per cent). Poisoning by fluoride is therefore unlikely. Nevertheless, it is advisable to restrict your child's access to fluoride toothpaste to prevent any risks.

What we can say is that fluoride is poisonous when large amounts are ingested, yet entirely harmless when used properly. In fact, according to the German Dental Association, it is almost ten times less toxic than table salt.

Often, the misconception that fluoride is detrimental to health or toxic comes from it being confused with the genuinely toxic gas, fluorine. Fluoride, on the other hand, is an entirely different substance with completely different properties.

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