Although fluoride compounds have become widely regarded as an essential contributor to good oral health, they are not flawless. There are imperfections to fluoride toothpaste, and our focus has been to search for an alternative option that can overcome these challenges. There is no denying that fluoride has revolutionised oral health, however, science and technology are constantly advancing allowing further innovations. Alternative remineralising agents in toothpaste are one such area that has gained a lot of attention.
Why is fluoride considered the gold standard in preventing tooth decay?
Cavities are the product of a continuous cycle of demineralisation on the surface of the enamel. Demineralisation occurs when teeth are exposed to an acidic environment, which causes calcium and phosphate ions to leave the enamel [1]. To stop this process and prevent the formation of lesions, remineralisation needs to occur. Fluoride became the gold standard in preventing tooth decay after it was discovered that it could promote remineralisation – the incorporation of calcium and phosphate ions into the tooth. For a long time, fluoride has been unmatched in its ability to do this.
Toxicity
Despite the benefits of fluoride in preventing cavities, it is noteworthy that there is a prominent rise in the demand for fluoride-free products. The fluoride-free approach has gained traction due to rising concerns regarding the toxicity of fluoride and the possible detrimental effects that it can have on the body [2]. The potency of fluoride has been well-known since the invention of the first fluoride toothpaste. However, as the old saying goes, the dose determines the poison. It has been determined that fluoride is safe to use in low concentrations below the safety threshold set by the World Health Organisation [3]. Only recently have scientists chosen to re-evaluate the possible side effects of fluoride on the body, in 2014 a study declared fluoride to be a newly identified developmental neurotoxicant. Now classed alongside other developmental neurotoxicants like lead, mercury, and arsenic [4]. With this being said, most studies investigating the neurotoxicity of fluoride have only focused on the dire contamination of natural water bodies in China, Africa, and India [5]. Although researchers have focused predominantly on the water crisis in these areas, many people are left concerned over the safety of utilising a neurotoxicant in their everyday oral care routine. After all, would you use lead, arsenic, or mercury in your toothpaste, even if it was included in an exceptionally low dose and the benefits were said to outweigh the risks?
Fluorosis and occult caries lesions
Although fluoride may be effective at preventing cavities, excessive fluoride exposure can be detrimental to your teeth, causing occult caries lesions or dental fluorosis in children [6,7]. An occult caries lesion can occur in childhood or adulthood, it is described as a lesion that forms below the enamel surface and is not easily detected. It is caused by the rapid remineralisation of the enamel surface by a high concentration of fluoride [8]. As a result, an acid-resistant layer (fluorapatite) forms and prevents calcium, phosphate, and fluoride ions from reaching the body of the lesion below the surface [9]. The risk of occult lesions is that they are difficult to identify during the stage where they can be repaired, and they can progress to form cavities. Dental fluorosis is more commonly the result of excessive fluoride exposure during childhood, while teeth are developing. The consequences are mottled, discoloured, and weakened teeth [7]. If you choose to use fluoride in your oral care routine, then we would advise that you carefully follow the directions on the tube, to ensure that you are using the correct dose of fluoride. Additionally, children should always be supervised when brushing with fluoride toothpaste because they tend involuntary ingest the toothpaste.
To date, there are several non-fluoride remineralising agents that are under investigation, and some are already being utilised in toothpaste [6]. Among these is hydroxyapatite, a crystal apatite that is naturally found in teeth and bones. Due to promising findings from in vitro and clinical trials, EvaGlo has chosen to use hydroxyapatite as a safer and equally effective alternative to fluoride.
References
- Amaechi, B.T. Remineralization Therapies for Initial Caries Lesions. Curr. Oral Heal. Reports 2015, 2, 95–101, doi:10.1007/s40496-015-0048-9.
- Guth, S.; Hüser, S.; Roth, A.; Degen, G.; Diel, P.; Edlund, K.; Eisenbrand, G.; Heinz, K.; Bernd, E.; Tilman, E.; et al. Toxicity of fluoride: critical evaluation of evidence for human developmental neurotoxicity in epidemiological studies, animal experiments and in vitro analyses; Springer Berlin Heidelberg, 2020; Vol. 94; ISBN 0123456789.
- Pal, P.; Kumar, N.; Pal, D. Molecular basis of fluoride toxicities: Beyond benefits and implications in human disorders. Genes Dis. 2023, 10, 1470–1493, doi:10.1016/j.gendis.2022.09.004.
- Grandjean, P.; Landrigan, P.J. Neurobehavioural effects of developmental toxicity. Lancet. Neurol. 2014, 13, 330–338, doi:10.1016/S1474-4422(13)70278-3.
- Choi, A.L.; Sun, G.; Zhang, Y.; Grandjean, P. Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis. Environ. Heal. Perspect. 2012, 120, 1362–1368.
- Grohe, B.; Mittler, S. Advanced non-fluoride approaches to dental enamel remineralization: The next level in enamel repair management. Biomater. Biosyst. 2021, 4, 100029, doi:10.1016/j.bbiosy.2021.100029.
- Kishor, K.; Singsit, J.S.; Pittman, C.U.; Mohan, D. Demographic study of fluoride excretion vs intake: Influence of variables. J. Hazard. Mater. 2023, 10, 100312–100322, doi:10.1016/j.hazadv.2023.100312.
- García-Godoy, F.; Hicks, M.J. Maintaining the integrity of the enamel surface: The role of dental biofilm, saliva and preventive agents in enamel demineralization and remineralization. J. Am. Dent. Assoc. 2008, 139, 25S-34S, doi:10.14219/jada.archive.2008.0352.
- Anil, A.; Ibraheem, W.I.; Meshni, A.A.; Preethanath, R.S.; Anil, S. Nano-Hydroxyapatite (nHAp) in the Remineralization of Early Dental Caries: A Scoping Review. Int. J. Environ. Res. Public Heal. 2022, 19, 5629–5643, doi:10.3390/ijerph19095629.
