Kanak Kanak
terlebih Fluorida
SOURCES OF FLUORIDE
"Estimation of the amount
of fluoride ingested from all environmental and dietary sources is important so
that rational and scientifically sound decisions can be made when guidelines for
the use of fluorides are reviewed periodically and modified." (Journal of
Dental Research 1992)
DENTAL PRODUCTS
Dental
products are a major source of fluoride exposure, particularly for children.
Fluoridated dental products include toothpastes, mouth rinses, fluoride gels,
fluoride varnishes, and fluoride supplements.
How Much Fluoride Are in these Products?
Fluoride Toothpastes (1,000
to 1,500 ppm)
·
Over 95% of toothpastes now
contain fluoride.
·
A single strip of toothpaste
covering the length of a child’s brush contains between 0.75 to 1.5 mg of
fluoride. This exceeds the amount of fluoride in most prescription fluoride
supplements (0.25 to 1.0 mg).
·
Many young children swallow
over 50% of the paste added to their brush, particularly if they use candy-flavoured
varieties and if they are not supervised during brushing to ensure they spit
and fully rinse. Research has shown that some children
swallow more fluoride from toothpaste alone than is recommended from all
sources combined.
·
Although dentists now recommend
that children only use “a pea-sized amount” of toothpaste, many children use
more than this, particularly when the toothpaste has bubble gum and watermelon flavours.
·
Ingesting toothpaste during
childhood is a major risk factor for dental
fluorosis, and can also cause symptoms of
acute fluoride toxicity (e.g., stomach pain, etc).
·
The FDA now requires a poison warning on all fluoride
toothpastes sold in the U.S.
Fluoride Mouth rinses (230
ppm)
·
Some mouth rinses now contain
fluoride.
·
A single mL of fluoride mouth
rinse contains roughly 0.25 mg of fluoride.
·
Between 5 to 15 mL are
generally used per rinse, which equates to 1.25 to 3.75 mg of fluoride.
·
Little data is available to
show how much of the rinse is ingested.
Fluoride Gels (Self-Applied) (5,000
ppm)
·
Dentists prescribe self-applied
gels to those at high-risk of tooth decay.
·
Each mL of gel contains 5 mg of
fluoride.
·
Without taking extraordinary precaution
to limit the amount of gel that is applied and reduce the amount of gel that is
ingested, self-application can result in dangerously high fluoride exposures.
Fluoride Gels (Professionally Applied) (12,300
ppm)
·
A single mL of gel contains
12.3 mg of fluoride.
·
Dentists are now recommended to
apply no more than 4 mL when treating children (=49 mg of fluoride), and no
more than 8 mL when treating adults (=98 mg of fluoride).
·
The highly
acidic nature of the gel greatly increases saliva flow, which
makes it largely impossible to avoid swallowing large amounts of it. While few
measures were used in the past to limit the amount of fluoride ingested,
dentists are now advised to use suction devices and to encourage the child to
fully rinse and spit at the end of the treatment.
·
Even when precautionary
measures are taken, children swallow an average of 7.7 mg per treatment
·
Adults swallow an average of
10.3 mg per treatment.
·
Symptoms of acute fluoride
toxicity (e.g., nausea and vomiting) are common in children
receiving fluoride gels.
·
Although dental researchers
only recommend topical fluoride gels for patients with high risk for cavities,
surveys have shown that dentists routinely apply gels to most of their
patients.
Fluoride Varnishes (22,600
ppm)
·
A single mL contains 22.6 mg of
fluoride. Dentists apply 0.5 to 1 mL per treatment.
·
Since the varnish eventually
wears off the teeth, all of the fluoride that is applied (=11.3 to 22.6
mg) is ingested.
·
Dentists apply varnishes up to
4 times a year in children with high risk for cavities.
Fluoride Supplements
·
Supplements contain
between 0.25 to 1 mg of fluoride per drop, tablet, or lozenge. The amount
depends on the age of the child.
·
Supplements are available by
prescription only. Unlike dietary supplements, fluoride supplements cannot be
purchased over the counter.
·
Despite being prescribed for
over 50 years, the FDA has never approved
fluoride supplements as safe or effective.
·
The ADA no longer recommends
for infants under
6 months of age.
·
Supplements were designed to
only be used in non-fluoridated areas as a substitute for fluoridated water.
Surveys have repeatedly found, however, that some dentists prescribe
supplements to children living in fluoridated areas as well.
·
Current supplement use greatly
increases a child’s risk of developing dental fluorosis, while doing little to
prevent tooth decay.
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