Can Fluoride Help Adults?

Making sure you get enough fluoride is one of the most important things you can do to avoid cavities.

Fluoride is not just for children.

"Everyone should have fluoride every day," says Dr. Joan Gluch, Assistant Dean for Community Relations and Director of Health Promotion at the University of Pennsylvania School of Dental Medicine. "Fluoride does not only benefit children."

Twenty years ago, dentists thought that fluoride worked mainly by strengthening developing teeth before they entered the mouth, which meant that young children were the main focus of fluoridation efforts. Now, research has shown that topical fluoride (including toothpastes, mouth rinses and fluoride treatments) is probably more important in fighting decay than in strengthening developing teeth.

"Some adults think they are naturally going to get cavities or lose their teeth as they get older," Dr. Gluch says. "They do not have to."

Although everyone should use fluoride every day, some adults are at higher risk for and might need more intensive supplementation. To find out if you might be one of them, ask yourself these questions:

1. Am I taking any medication that causes my mouth to become dry? Do I have a disease that causes dry mouth?
Many adults take medications that can cause dry mouth or xerostomia. Many common medications have this side effect, including allergy medications, antihistamines, anti-anxiety agents and anti-hypertensives.

Some diseases, most notably Sjögren's syndrome and diabetes, can also cause dry mouth.

“Without saliva, you are more susceptible to cavities," Dr. Gluch says. This is because saliva helps neutralise the acids in your mouth and washes away food particles that are fuel for decay-causing bacteria. Saliva also contains many elements, including fluoride, that help keep your teeth decay-free.

If you are experiencing dry mouth, try using a fluoride mouthwash to lubricate your mouth and protect your teeth. Salivary substitutes are also available at the pharmacy and many people use them to replace the saliva they have lost. Also, Dr. Gluch says, "Do not stop taking your medication. Some people suck on boiled sweets to increase their saliva flow, but that just adds more sugar to your mouth. Drink more water, use sugar-free sweets if you have to, and use fluoride daily."

2. Have my gums receded so more of my teeth show or has my dentist told me I have?
By the time you are an adult, you have probably had some form of periodontal disease, which causes your gums to recede and exposes more of your teeth. This gives bacteria more room to roam and makes you particularly susceptible to cavities in the roots of your teeth. For example, 65 per cent of adults over age 60 have had root decay (Slade, 1993). If your dentist has treated you for periodontal disease, your gums may have been reshaped and your tooth roots exposed, which also can lead to decay.

To protect your teeth's roots, your dentist can paint a fluoride varnish or gel on them, and you can use a fluoride mouthwash or a prescription fluoride gel to get more fluoride.

3. Have I needed a filling in the past year?
If you have had recent filling you are at risk for more. Dr. Gluch says, "If you are the type of person who tends to have one [filling] a year or one every other year, something is going on and you need extra fluoride."

4. Do I have crowned teeth and/or bridges?
Crowned teeth are not safe from cavities. As long as some natural tooth remains, you are at risk. "If you have a crown or a crown-and-bridge restoration, the area where the crown meets the tooth is at risk for decay and you need fluoride," Dr. Gluch says.

5. Am I wearing dental braces?
"Many teenagers and adults wear orthodontic appliances. They trap a lot of bacteria and it's hard to brush that off," Dr. Gluch says, "people can get cavities around the brackets, so we recommend fluoride mouthwashes and gels to mineralise the teeth."

6. Am I receiving, or have I received, radiation therapy to the head and neck?
Adults receiving radiation therapy to the head and neck are at very high risk of tooth decay because the radiation damages their salivary glands, causing dry mouth. Saliva fights tooth decay so people suffering from dry mouth are at higher risk for decay.

“We clean patients' teeth before radiation and give them extra fluoride," Dr. Gluch says. "Afterwards, the salivary glands do not grow back, so the dry mouth is a permanent condition. We recommend that these people visit the dentist every two or three months and always use extra fluoride."

What to Do

Regardless of risk, all adults should use fluoride toothpaste. Also, fluoride mouthwashes are available over the counter and can be used once or twice a day. Toothpaste delivers about 1,000-1,450 parts per million of fluoride and mouthwash about 250 parts per million.

If you think you are at high risk for decay, ask about receiving fluoride treatments in the dental surgery. During a treatment, your dentist or dental hygienist will dry off your teeth and either paint a gel on them or put a gel or foam into mouth guards that are placed in your mouth for 1-4 minutes. You can also receive a varnish or gel on the roots of your teeth. You will be asked not to eat or drink anything and to avoid smoking for 30 minutes after the treatment. Dental surgery fluoride treatments provide fluoride at high levels of 9,000-20,000 parts per million, depending on the type.

Ultimately, talk to your dental surgery to determine your risk for dental decay. Dentists and dental hygienists will prescribe fluoride products in combination with good oral hygiene habits, control of snacking and dietary carbohydrates, and use of antimicrobial products to reduce the chance of new decay.

"Adults should feel confident that dental problems do not have to be a part of aging," Dr. Gluch says. "Using fluoride and other preventive programmes can ensure that adults keep their teeth healthy as they age."

1Slade, G. (1993). Table 5. Dental Caries Experience: Coronal and Root Caries Among 54 Examined, Dentate Persons. In Australian Dental Journal 1993, 38, 376.

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