To Fluoride or not to Fluoride, that is the question.
Lets break it down:
FLUORIDE: Stannous? Sodium? Or Monoflorophosphate? Oh My!
I love the phrase: The dose make the toxin. I think it's important to remember that even water is DEADLY if too much has been ingested in too short a period of time. While I do not take the stance the majority of my colleagues do on fluoride, (everyone should have it!) I'm also not throwing the baby out with the bath water.
In my house, we're fans of nano-hydroxyapatite based toothpaste. Okay to be fair, my husband and son just go along with what I say we're using. It deeply concerns me how our country has such little regard for toxin ingestion and everything is so black and white around health. That's unscientific. We're designed to detox naturally, if we treat our bodies in a way that allow detox to occur and also not constantly flood it with said toxins. We're supposed to be taking a break from toxin exposure but that has become impossible in our society. While I still feel I came in a little late to the functional medicine/dental game, I've been conscious of what's in our consistently used and consumed products and foods, long before RFK made it popular.
As a dental hygienist you'd think I come out of college knowing the ins and outs of products and ingredients, their mechanism of action and how they impact our oral health as a WHOLE, not just decay. But no. I wasn't taught anything about products or their ingredients. While I feel I received a very comprehensive and shockingly (shocking b/c don't hygienists just clean teeth?) thorough deep dive into human anatomy, physiology, chemistry, microbiology and more. Yet, I don't know why your mouthwash is good for you, or so they say. It just is. Or is it?!
The reality is, its your choice and fluoride is simply cheaper than our biomimetic option, nano-hydroxyapatite. By not constantly soaking your teeth in acids, sugars and bad carbs (bread, crackers, noodles), you can avoid the chronic exposure to fluoride AND decrease your risk of decay. No fluoride or other strengthener will save you from poor diet and lifestyle choices. Those are yours to make, just know your risks. If you're simply unwilling to cut back on the choices leading to decay AND you're unwilling/unable to spend the money on a quality nHAP toothpaste, then you should probably use a fluoride based toothpaste. I want SAFE and EFFECTIVE products and you should too. This is also why SOURCING is factor for our products and the other ingredients they're paired with. I'm inherently against fluoride in our water due to inability to control individuals' dosing, but that doesn't mean there's zero room for fluoride at the table. Topical and systemic are two different things and as usual, dose matters.
There are various forms of commercial fluoride available. When I'm limited to what's in my drawer at work, I choose stannous fluoride (SnF2) for most patients (not dry mouth patients because it has SLS) who have inflammation because it helps fight specific bacteria related to that inflammation. But remember, WHY is there inflammation? Toothpaste can only do so much. Get to the SOURCE of the inflammation. Stannous fluoride also helps with sensitivity and decay prevention, so it is nice to have something that helps with multiple SYMPTOMS.
Sodium fluoride (NaF) is recommended for the rare person who doesn't have inflammation and perhaps has acid reflux or clenches and grinds (bruxism) that causes recession and/or notches in the tooth along the gumline. (Ever find your fingernail fits into a divot along your gumline that creates a sharp zing? That's it.) Sodium fluoride is only formulated to help with decay, not inflammation or sensitivity. This is the type of fluoride chosen by Sensodyne, the toothpaste associated with sensitivity. They add another ingredient, which is safe and non toxic, called potassium nitrate that helps with sensitivity but in a slightly different way than stannous fluoride.
Potassium Nitrate works by numbing the nerves themselves while Stannous Fluoride fills/blocks the tubules leading to the nerves. Think of those tubules like mini tunnels.
Sodium monofluorophosate (MFP) is generally used in children's toothpaste (and that's typically who I give it to) because its deemed safest. I guess the rest of us just need to deal. It is formulated to help with decay prevention only, like sodium fluoride. Because the fluoride is released more gradually, MFP is considered less aggressive on calcium-containing surfaces, our teeth.
I have to laugh every time a patient asks me which toothpaste out of my drawer I would use because I won't touch any of them. I'd rather brush with plain water and we have. One time ever, I forgot toothpaste when going camping (I used it before leaving and put it away out of habit) and instead of stopping at a gas station to buy Crest, Colgate or other, we brushed with water all weekend and chewed slightly more than normal amounts of Spry or Pur gum.
Most over the counter toothpastes are 'dirty'. And I mean bactericidal ingredients that kill our good bacteria, thins the layers of the tissue in our mouth, dries it out, and makes us more susceptible to canker sores, tissue that exfoliates or other irritations. All of those 'inactive ingredients' go down the gut lining too because we're always going to swallow some. Small amounts yes, but some people are more sensitive to that chronic exposure and there's no informed consent. Just the small writing, which no one reads, that warns to 'seek medical attention or contact a poison control center immediately." Hmmm...
When patients ask me if they should use fluoride, I carefully respond with, "The dentist will certainly want you to use fluoride." I'm not looking to lose my job and not all patients are ready to learn and accept all the unnecessary things in their products and make a switch. Some people are more aware that we need to proceed with caution and are ready to learn. Having those conversations are fun for me, especially when I see the lights go off as they connect the dots and they're so grateful to finally find a hygienist who is not utterly biased but has an open mind and listens to the research in this field.
Because of these and other conversations, so many patients over the years have asked me if I have a website, podcast or teach a class, so here you are!
Not everyone will shop online, some of my patients want what they can get locally. This is when I typically recommend Hello brand with Vitamin C or the 8-1 version for those who want fluoride or Boka with nHAP, for those who don't. Hello brand is cheaper by about $4 currently and I like that they take out the artificial colors, sweeteners, parabens, sulfates, etc and overall just have less junk. This brand has a fluoride or fluoride free option to appease various people and budgets. I do warn the patients who are using non-fluoridated toothpaste but also do not use nHAP, that they really should use a strengthener unless their diet is close to primal and/or they have a very limited history with decay.
If you're willing to shop online and want fluoride for reasons specific to you and your household, a company I love is www.supermouth.com as they are backed by the EWG (www.EWG.org) and all ingredients are tested for safety and purity.