Is fluoride harmful? Fluoride and fluoride-free toothpaste, the right amount and fluorosis

• It makes enamel more resistant to acid.
• It helps early decay on the enamel surface (a chalky white spot) to re-harden.
• It reduces acid production by bacteria in plaque.

This is why the World Health Organization and dental organisations recommend fluoride toothpaste for children and adults. We explain how decay starts in signs and stages of tooth decay.

Spit the toothpaste out after brushing but don't rinse with water, so the fluoride stays on the teeth longer. An adult should help children brush until about age 7–8 and make sure they don't swallow the toothpaste. We cover fluoride varnish and fissure sealants applied by the dentist in fluoride and fissure sealants for children.

• Fluorosis: if too much fluoride is taken in over a long period while teeth are forming (before about age 8), white lines and spots can appear on the teeth. Most cases are mild and purely cosmetic. The most common cause is young children swallowing toothpaste. We cover treating white spots in white spots on teeth.
• Swallowing a lot at once: a small child swallowing most of a tube can cause nausea and vomiting. Keep toothpaste out of children's reach; if it happens, call the poison information line (114 in Turkey) or seek medical advice.
• High fluoride in drinking water: in Turkey, fluoride isn't added to tap water, but some regions have naturally high-fluoride water. Fluorosis is more common in children in these areas.

Debates about fluoride's effects on the thyroid, brain development and bones are mostly based on studies of high fluoride levels in drinking water. Using toothpaste as recommended doesn't create exposure comparable to those levels.

Fluoride-free toothpastes clean and freshen the mouth but don't give the protection against decay that fluoride does. True allergy or sensitivity to fluoride is extremely rare. If you want to use a fluoride-free toothpaste, discuss your decay risk with your dentist.

• Hydroxyapatite toothpastes: some studies show promising results in re-hardening early decay, but the evidence is not as strong as for fluoride.
• Charcoal and “natural” toothpastes: most contain no fluoride and can be quite abrasive. See whitening and charcoal toothpaste.
• Sensitivity and erosion: fluoride and sensitivity toothpastes help protect enamel. See tooth sensitivity and dental erosion.

For people at high risk of decay, those wearing braces, people with dry mouth and those with exposed root surfaces from gum recession, a dentist may suggest a high-fluoride prescription toothpaste, a fluoride mouthwash or fluoride varnish in the clinic. We explain how to use mouthwash correctly in can you use mouthwash every day?

At Dent32 we look at your decay history, eating habits and saliva together during the examination and suggest the toothpaste and fluoride support that suits you. For children's first visits, see a child's first dental visit.

Dent32 is at Barış Mah., Ginza Lavinya, E-5 Yanyolu No:30 D:179, 34520 Beylikdüzü, Istanbul and is open seven days a week. To book, call or WhatsApp +90 555 011 33 68, or use our contact page. At the examination we share the findings, the options and the approximate cost in writing; you are under no obligation to start treatment afterwards.