Introduction
Fluoride is a naturally occurring element that benefits oral health. Fluoride helps prevent dental caries by exhibiting antimicrobial properties, enhancing enamel resistance, and promoting enamel remineralization. After decades of fluoridation of municipal water supplies to reduce dental caries, debate has once again arisen about the effectiveness of water fluoridation as a public health strategy for combating dental caries. This renewed discussion takes place in light of extensive evidence that clearly demonstrates the crucial role of fluoride in preventing dental caries.
Untreated dental caries in permanent teeth affects around 2.5 billion people globally. In primary teeth, untreated caries impacts 573 million children. As a result, dental caries remains one of the most common yet often overlooked noncommunicable diseases, especially among children and adolescents, many of whom need urgent oral healthcare.
Objectives
This review examines the benefits, controversies, and potential risks of fluoride. The review highlights the dual role of fluoride in individual oral care and public health, underscores the necessity for safe, equitable, and effective fluoride delivery strategies tailored to the needs of diverse populations, balancing its preventive advantages with potential health concerns.
Topics covered include:
- Mechanism of fluoride action
- Water fluoridation
- Milk fluoridation
- Salt fluoridation
- Fluoridated toothpastes
- Potential adverse effects of fluoride
- Fluoride misconceptions and evidence-based clarifications
Conclusions
Fluoride is crucial in preventing and managing dental caries due to its well-established mechanisms, including promoting enamel remineralization, inhibiting demineralization, and possessing antimicrobial properties. Various methods of fluoride delivery, such as water, milk, salt fluoridation, and fluoride toothpaste, demonstrate significant public health benefits in reducing the prevalence of dental caries.
However, concerns about fluoride toxicity, excessive intake, and potential systemic effects have sparked ongoing debates about its widespread use. While controlled exposure to fluoride is vital for maximizing its benefits for oral health, excessive intake can lead to rare risks such as dental and skeletal fluorosis.
The debate surrounding fluoride underscores the importance of evidence-based public health policies that prioritize safety, efficacy, and equitable access to fluoride. Since the primary benefits of fluoride are topical, strategies that focus on the use of fluoride toothpaste and professionally applied treatments serve as valuable supplementary options to water fluoridation. However, for children with developing permanent teeth, systemic fluoridation is irreplaceable because it incorporates fluoride into the enamel structure, providing lifelong benefits. In contrast, topical fluorides do not enter systemic circulation. To better understand long-term outcomes and improve fluoride recommendations, further high-quality research, including randomized controlled trials, is essential. The need for water fluoridation and its global adoption is critical, given that the burden of dental caries has largely remained unchanged and at a high level for the past 30 years.
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