Dr. Irfan Motiwala

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.

An obvious gap between the teeth may be caused due to a condition known as Diastema. This usually manifests as space between two teeth. This condition is caused due to a mismatch between the size of the bones in the jaw and the size of the teeth. This in turn, gives rise to extra space between the two teeth and may also lead to overcrowding of teeth in the mouth. The space usually occurs when the teeth are too small and the jaw is larger. Also, an oversized tissue known as the labial frenum can cause a gap between two teeth. Let us look at the ways in which this condition can be prevented and treated.

1. Prevention: Not pushing your tongue between the teeth during the teeth growing stage can ensure that this condition does not occur. Children tend to rub their tongue along the jawline when the teeth are growing, whether it is the milk teeth or the permanent ones. This can cause a gap. Also, maintaining good oral health and hygiene can help in preventing this condition. One must brush at least twice a day and floss regularly too, in order to ensure that the gap between the two teeth does not widen.

2. Orthodontic Treatment: Braces are one of the most common ways of fixing this problem. The orthodontic surgeon will usually install these braces,  which will remain in the mouth of the patient for a year or more, depending on the severity of the condition. On a monthly basis, the braces will need to be tightened so that the jaw can facilitate the movement of the teeth to close the gap.

3. Tooth Extraction: In many cases, when the braces are installed, the doctor may also have to remove or extract teeth on the sides to make space for the teeth and their movement. This is usually done when there is a related ailment like overcrowding of the teeth.

4. Crowns and other Dental Installations: Crowns, veneers as well as bonding can help in cases where the lateral incisors may be smaller than what is normal. Also, dental implants or a bridge or even a partial denture may be required in cases where extensive dentistry will be called for.

5. Frenectomy: This surgery can help in closing the gap formed by a large labial frenum. 

6. Gum Health: In case there is an infection or any other problem in the gums due to implants or braces, the gum health will have to treated and restored first and then the implants or braces can be reinstalled.

One should also wear retainers for a while after the gap has closed so that it does not appear again.