Dr. Abha Bali

Fluoride is a mineral that occurs naturally in many foods and water. Every day, minerals are added to and lost from a tooth's enamel layer through two processes, demineralization and remineralization. Minerals are lost (demineralization) from a tooth's enamel layer when acids -- formed from plaque bacteria and sugars in the mouth -- attack the enamel. Minerals such as fluoride, calcium, and phosphate are redeposited (remineralization) to the enamel layer from the foods and waters consumed. Too much demineralization without enough remineralization to repair the enamel layer leads to tooth decay.

a)Fluoride helps prevent tooth decay by making the tooth more resistant to acid attacks from plaque bacteria and sugars in the mouth.

b)It also reverses early decay.

c)In children under 6 years of age, fluoride becomes incorporated into the development of permanent teeth, making it difficult for acids to demineralize the teeth.

d) Fluoride also helps speed remineralization as well as disrupts acid production in already erupted teeth of both children and adults.

In What Forms Is Fluoride Available?

As mentioned, fluoride is found in foods and in water. It can also be directly applied to the teeth through fluoridated toothpastes and mouth rinses. Mouth rinses containing fluoride in lower strengths are available over-the-counter; stronger concentrations require a doctor's prescription.

We dentists, apply fluoride to the teeth as a gel, foam, or varnish. These treatments contain a much higher level of fluoride than the amount found in toothpastes and mouth rinses. Varnishes are painted on the teeth; foams are put into a mouth guard, which is applied to the teeth for one to four minutes; gels can be painted on or applied via a mouth guard.(as shown in figure)

When Is Fluoride Intake Most Critical?

It is certainly important for infants and children between the ages of 6 months and 16 years to be exposed to fluoride. This is the timeframe during which the primary and permanent teeth come in. However, adults benefit from fluoride, too. New research indicates that topical fluoride -- from toothpastes, mouth rinses, and fluoride treatments -- are as important in fighting tooth decay as in strengthening developing teeth.

In addition, people with certain conditions may be at increased risk of tooth decay and would therefore benefit from additional fluoride treatment. They include people with:

• Dry mouth conditions : Also called xerostomia, dry mouth caused by diseases such as Sjögren's syndrome, certain medications (such as allergy medications, antihistamines, anti-anxiety drugs, and high blood pressure drugs), and head and neck radiation treatment makes someone more prone to tooth decay. The lack of saliva makes it harder for food particles to be washed away and acids to be neutralized.
• Gum disease : Gum disease, also called periodontitis, can expose more of your tooth and tooth roots to bacteria increasing the chance of tooth decay. Gingivitis is an early stage of periodontitis.
• History of frequent cavities: If you have one cavity every year or every other year, you might benefit from additional fluoride.
• Presence of crowns and/or bridges or braces: These treatments can put teeth at risk for decay at the point where the crown meets the underlying tooth structure or around the brackets of orthodontic appliances.

Are There Risks Associated With Fluoride Use?

Fluoride is safe and effective when used as directed but can be hazardous at high doses (the "toxic" dosage level varies based on an individual's weight). For this reason, it's important for parents to carefully supervise their children's use of fluoride-containing products and to keep fluoride products out of reach of children, especially children under the age of 6.

In addition, excess fluoride can cause defects in the tooth's enamel that range from barely noticeable white specks or streaks to cosmetically objectionable brown discoloration. These defects are known as fluorosis and occur when the teeth are forming -- usually in children younger than 6 years. Fluorosis, when it occurs, is usually associated with naturally occurring fluoride, such as that found in well water. If you use well water and are uncertain about the mineral (especially fluoride) content, a water sample should be tested. Although tooth staining from fluorosis cannot be removed with normal hygiene, your dentist may be able to lighten or remove these stains with professional-strength abrasives or bleaches.

Keep in mind, however, that it's very difficult to reach hazardous levels given the low levels of fluoride in home-based fluoride-containing products. Nonetheless, if you do have concerns or questions about the amount of fluoride you or your child may be receiving, talk to your child's dentist, pediatrician, or family doctor.

A few useful reminders about fluoride include:

• Store fluoride supplements away from young children(these are not available in India).
• Avoid flavored toothpastes because these tend to encourage toothpaste to be swallowed.
• Use only a pea-sized amount of fluoridated toothpaste on a child's toothbrush.
• Be cautious about using fluoridated toothpaste in children younger than age 6. Children younger than 6 years of age are more likely to swallow toothpaste instead of spitting it out.

Oral cancer is the name given to cancer that develops in the tissues of the mouth or oral cavity. If you interact with a specialist, you will know that oral cancers belong to a larger group of cancers called head and neck cancers. And more importantly, oral cancers are one of the most preventable cancers. You may already be aware that cancers develop when cells begin to divide indiscriminately forming malignant tumors. In oral cancers, the dividing cells are the ‘squamous’ cells found in the lining of your mouth, tongue, and lips.

An implausible fact about oral cancers is that these are most often discovered after they have spread to the lymph nodes of the neck- which means at the stages III and IV. All cancers including oral cancers become more difficult to cure at these later stages. This is why early detection is key to surviving oral cancer.

Types of oral cancers

1. Oral cancers, to be precise, including cancers of the:
2. Lips
3. Tongue
4. Gums
5. Cheek
6. Floor of the mouth
7. Roof of the mouth, including hard and soft palate

Usually, it’s your dentist who is the first to notice the first signs of oral cancer.

Risk factors
Tobacco use is the biggest risk factor for oral cancer. Tobacco includes smoking cigarettes, cigars, hookahs, and pipes, as well as chewing tobacco. Alcohol is another big risk factor. So, if you are one of those heavy drinkers, be aware of the scourge of oral cancer and get yourself tested periodically to rule out this killer. The risk for oral cancer also increases exponentially when both alcohol and tobacco are used together.

Other important risk factors are:

1. HPV infection i.e. human papillomavirus is a sexually transmitted virus that spreads through unprotected vaginal as well oral sex
2. Chronic sun exposure on the face, especially the lips
3. Family history of oral or other types of cancer
4. Men are more susceptible to oral cancers
5. Being older than 45
6. Radiation exposure
7. Having any other form of head and neck cancer

Symptoms of oral cancer

1. Sore lip or mouth that is not healing
2. Any growth inside your mouth
3. Bleeding from the mouth, including jaws
4. Loose teeth
5. Difficulty or pain while swallowing
6. Major trouble wearing dentures
7. A lump in neck or cheek
8. Chronic earache
9. Serious weight loss
10. Numbness in lower lip, face, neck, or chin
11. Any colored patch in the mouth or lips

Diagnosis of oral cancer

1. Diagnosis starts with a physical exam of your mouth. The physician will examine the roof and floor of your mouth, the back of your throat, tongue, and cheeks, and the lymph nodes in your neck.
2. If your doctor finds any tumor, growth, or suspicious lesions in your mouth, she/he will perform a biopsy to collect cells from a tumor. This tissue is then examined for cancerous cells.
3. Other tests include X-rays to see if cancer cells have spread to your jaw, chest, or lungs; a CT scan to check for and reveal any tumors in your mouth; PET scan to see whether the cancer has traveled to the lymph nodes or other organs like the lungs.

Prevention

1. An excess of sun exposure on your face and lips increases the risk of oral cancer so you can start reducing the danger of getting this cancer by using a lip balm or cream with SPF regularly.
2. Another way to reduce risk is alcohol and tobacco cessation.
3. Eating a balanced diet containing fruits and vegetables
4. Removing your dentures at night and using them the next day only after cleaning them
5. Visiting your dentist on a regular basis so that she/he can warn you about any alarming change in your mouth.

In case you have a concern or query you can always consult an expert & get answers to your questions!