What is fluoride?

Fluoride is found in many foods and some water. The amount of fluoride in water varies from area to area. In the West Midlands it is added to water at a level of 1ppm.

What are the benefits of fluoride?

Fluoride disincorporated into developing tooth enamel, making it more resistant to tooth decay. This forms a harder version of the enamel.

Children who grow up in fluoridated areas have less dental decay. The addition of fluoride to water has been researched for over 50 years, and water fluoridation has been proven to reduce decay by 40-60%. Even so, very few areas of the UK have fluoride in the water.

What about fluoride toothpaste?

Almost all toothpastes contain fluoride. Fluoride toothpaste is very effective in preventing tooth decay

In areas where the water supply is fluoridated, fluoride toothpaste gives extra protection.

All children up to three years old should use a toothpaste with a fluoride level of at least 1000ppm (parts per million).

After three years old they should use a toothpaste that contains 1350ppm to 1500ppm.

Parents should supervise their children’s tooth brushing, and use only a pea-sized smear of fluoride toothpaste until they are about 7 years old.

Are there any side effects?

Dental fluorosis’ is the main side effect, a white or brown mottling appearance on the teeth caused by having too much fluoride when the teeth are developing. It is often caused by children having too much toothpaste on the brush leading them to swallow the toothpaste. The severity varies from very mild, almost indiscernible white marks, to severe opacity of the tooth and or more unsightly brown marks.

Extra Fluoride

With fluoridated water in the West Midlands and fluoride toothpaste, there is little indication for the use of extra fluoride. One of the more useful ways in which it can be provided is by the use of a high fluoride mouthwash such as Colgate Fluoriguard. This is available in alcohol free formulations for younger patients. We would only recommend the use of this is some situations, where decay rates are high or where there is a lot of sensitivity or erosion. Your dentist can advise if you would benefit.


Many reports have been published throughout the world about the pros and cons of fluoride. After many years the scientific conclusion is that fluoride toothpaste and correctly fluoridated water, salt and milk are of great benefit to dental health, help to reduce decay, and cause no harmful side effects to general health. Studies carried out for the government by York University and the Medical Research Council have failed to find any evidence that fluoride added to water causes harmful side effects.

Opponents of fluoridation claim they have firm evidence that fluoride added to water is harmful. However, scientific analysis has not supported their claims.

Worldwide, over 300 million people drink fluoridated water supplies. Many millions more regularly use fluoridated toothpaste. In America for example, well over half of the population have fluoridated water supplies. This has led to improved levels of dental health which in turn benefits general health.


Although optimal levels of fluoride are protective, too much can lead to:
• White opacities in the teeth.
• Brown spots.
• Mottled teeth.
• Pits.
• Deeper Fissures.

Most of these issues are generally cosmetic in nature and are usually caused by ingestion of toothpaste at a young age, sucking it off the toothbrush, using too much or not using children’s toothpaste. All of this will have occurred before the tooth erupts. Once the tooth erupts it is no longer affected by these factors.

What can be done?

Most mottled or mildly discoloured teeth ail gradually blend in as the child grows. However in severe cases veneer (extreme) or whitening may help. This must generally be done when older, usually after 18.

The picture below shows the effects of mottling in a moderate case of fluorosis. Click on the picture to see what happens after whitening.

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