My Thoughts on Fluoride

At the turn of the last century, most Americans could expect to lose their teeth by middle age. That situation began to change with the discovery of the properties of fluoride…
– Oral Health in America: A Report of the Surgeon General

In 1945, responding to research that fluoride seemed to prevent tooth decay, the city government of Grand Rapids, Michigan took a vote and decided to become the first municipality in the world to manually introduce fluoride into the community water supply. They also commenced a 15 year study to determine whether this change would affect cavity rates among 30,000 children. After only 11 years, cavity rates among children born after the change dropped 60%.

Grand Rapids schoolchildren were examined once a year for 15 years after the introduction of fluoride into the city's water supply.

Grand Rapids schoolchildren were examined once a year for 15 years after the introduction of fluoride into the city’s water supply.

Since that time the majority of communities have followed suit and dental cavities are no longer considered a public health problem.

The issue of water fluoridation has become a controversy (in Naples as well), with many claims that fluoride is in fact a health hazard, causes cancer and other diseases, and is a violation of individual rights.

In this article I am going to avoid the controversy (there’s plenty to be found with a Google search) and give a little background on what fluoride is, how it protects against cavities, and give some common sense advice on choices regarding fluoride.

What Is Fluoride?

A chemistry teacher would explain that fluoride is a negative ion (an anion) of fluorine, which is an element you can find on the Periodic Table (F). The term fluoride is also a general term to describe a compound that contains fluoride. Calcium fluoride and sodium fluoride are both examples of fluorides.

Fluoride exists commonly in nature, mostly in the Earth’s crust. Consequently fluoride exists naturally in both seawater, fresh water, and certain foods. In some areas of the country (parts of Colorado, for example) fluoride levels are much higher than in places like Southwest Florida.

Fluoride Slows Down Tooth Decay

Tooth enamel is made up mostly of hydroxyapatite crystals and is the hardest substance in the body. A cavity begins with a bacterial infection, specifically of two common bacteria, in plaque. When these bacteria combine with the carbohydrates in food debris, it produces an acid which can dissolve, or demineralize, the enamel.

This process takes time.

The body, through minerals such as calcium and phosphate, ingested in food and presented in the saliva, has the ability to naturally rebuild lost enamel. However, in many cases and for different reasons, natural processes are unable to stop decay.

The introduction of fluoride into the saliva accelerates and improves upon this natural process of remineralization. Exposure to fluoride, in a dentist’s office, through the water supply, in toothpastes, varnishes and other means, introduces fluoride ions into the saliva. These ions combine with dissolving hydroxyapatite to form a harder and more acid resistant veneer on the teeth.

This is why the dental community is overwhelmingly in support of fluoridation. It gives teeth more protection from the acid that leads to cavities.

Should You Drink Fluoridated Water?

My recommendation is that you not worry about fluoride in tap water. Although I don’t drink gallons every day, I do consume tap water. However, this is a personal choice. If you have concerns, then don’t drink it. This will keep you from ingesting fluoride into the stomach and into your body.

Should You Avoid Fluoride Altogether?

I do not recommend avoiding fluoride altogether. For the reasons explained, fluoride gives your teeth additional protection from demineralization and decay. Fluoridated toothpaste, used twice a day, gives your teeth significant additional protection against demineralization, and gives the body a leg up on protecting teeth. Avoiding fluoride toothpaste deprives you of the benefits that come with stronger tooth enamel, including the potential to keep your natural teeth for a lifetime. Used correctly, fluoride toothpaste is not swallowed and is a sensible middle ground between ingesting fluoridated water systemically and avoiding fluoride altogether.

I also recommend using fluoridated mouth rinses, which are also not ingested, but afford additional protection to the teeth, particularly in hard to reach areas such as at dental crown margins and between the teeth.

The Bigger Picture

As seen by the very first use of fluoride in a public water supply, the protective benefits of fluoride for our teeth are without reasonable dispute. However regular dental checkups and cleanings are also important for optimal oral health and for detecting and treating dental caries which can occur even with the use of fluoride. So make sure to practice good oral hygiene habits and see your oral health care provider regularly.

Ten Oral Health Reasons to Quit Smoking

Naples Periodontist Smoking Article

Everyone Knows They Should Quit Smoking. Here Are Some Specific Oral Health Related Reasons Why

Regarding Periodontal Disease

  1. The number one risk factor for chronic destructive periodontal disease is smoking.
  2. Smoking is associated with acute necrotizing ulcerative gingivitis (ANUG), otherwise known as trench mouth. This aggressive bacterial infection destroys the gums and is also seen in HIV patients and soldiers who are subjected to long periods of combat stress.
  3. Smoking is associated with periodontal treatment failures and the relapse of oral disease.
  4. The nicotine in smoke decreases vascularity and blood flow to the gums which results in poor healing and nutrition.
  5. Smoking initiates a process of bone loss, attachment loss, pocket formation and eventually tooth loss.
  6. Smoking impairs the immune response to infection which allows periodontal infections to cause more damage.
  7. Smoking interferes with salivary flow, which reduces its antimicrobial property.

Cancer Related Risks

  1. Smoking can mutate and damage invaluable tumor suppressor genes. One known as p53, is sometimes called the “guardian of the genome”, because it can recognize a cell with damaged DNA (which in many cases becomes a cancer cell) and cause it to repair itself, self destruct (apoptosis) or stop multiplying.
  2. Immunosurveillance, the ability of the immune system to seek and destroy initial clones of cancer cells, is diminished in smokers.
  3. Tobacco use is estimated to account for over 90 percent of oral cancer deaths and often results in disfigurement to survivors, which in some cases creates a social death of its own.

Source: Oral Health in America: A Report of the Surgeon General

Stress and Oral Health

Naples Dental Implants Dr. Denise Gay


As a Naples periodontist, I have the privilege of seeing most of my patients on an ongoing basis. Many of my patients have been coming to me for years and over the years I get to know them.  I hear about developments in their personal lives, their families, businesses, vacations, kids getting married, new grandkids and many other things.

I sometimes also hear about events that are more unfortunate.  These include economic issues, health issues, relationship issues, divorce and the loss of loves ones or close friends.  We all have events in our lives that have made us unhappy, and brought psychological stress with them.

I’ve always been interested in the ways that stress affect oral health.  In dental school I wrote a research paper on stress and periodontal disease.  During my research, I found that the physical body reacts strongly to prolonged psychological stress by releasing certain mediators that among other things induce inflammation.

Although the cause and effect mechanisms are not completely understood, stress is now commonly assumed to have a negative effect on health.

What Is Stress?

Stress is a response to a perceived threat.  In the animal kingdom mammals occasionally experience threats in their struggle to survive, usually from predators making a violent attempt to kill them for food. Their brains perceive this threat through the senses and in an effort to survive excrete adrenaline, cortisol and many other hormones to give the body instantaneous strength, speed and protection from pain.

This is commonly known as the “fight or flight” response.

In the modern world human beings no longer worry about being killed by predators, but we worry about a lot of other things. In our busy lives as human beings, many of these stressors are continuous and ongoing. The daily round of life initiates stress.

Our brain is ancient in origin, and in some people it responds to modern stress in the same way it used to thousands of years ago. This response affects our immunology, neurology, endocrinology and psychology.

What Kind of Events Cause Major Stress? Researchers have given specific events a score based on the relative amount of stress they may cause:

Death of a spouse – 100 points
Divorce – 73
Death of close relative – 63
Sickness – 53
Marriage – 50
Loss of work – 47
Retirement – 45
Birth – 39
Moving – 20
Christmas – 12
Holmes and Rahe (1967)

Why Is Stress So Bad for Us?

The first reason that stress is bad for our health is that it changes our behavior. Human beings respond to stress by coping. Everyone has different coping mechanisms but everyone performs at a reduced level when we are under stress.

In my profession, I’ve noticed that patients under stress tend to have inflammed gums that are red and bleed, and are at a higher risk for periodontal disease. It has been shown in studies that people with high stress levels also neglect their oral hygiene . It is important that we seek healthy ways to reduce and relieve stress such as eating healthy, exercising, getting plenty of sleep and focusing on maintaining a positive attitude. Gum disease, if left untreated, can lead to tooth loss so make sure to have your teeth and gums checked routinely.

Nutrition Tips for Reducing Inflammation

A study from the Harvard School of Public Health showed that women who eat sixteen or more strawberries per week are 14% less likely to have elevated levels of C-Reactive protein (CRP), a key marker of inflammation in the body.

Strawberries are also an excellent source of Vitamin C, fiber, Potassium, Lutein and Folic acid.

My colleague and friend, Dr. Susan Summerton, an Optometrist in Naples, made reference to this benefit on her Facebook page today.

I thought it was a timely post, because Sunday I bought several baskets of fresh grown organic strawberries at a local Naples farmer’s market (Pine Ridge and Airport Road) and wanted to share this nutritional pearl.

Gum Disease is More Prevalent Than You Might Think

Periodontal Survey

Periodontal disease is much more prevalent than many people think. Fifty percent of adults over 30 and seventy percent of adults over 65 have periodontal disease.

Periodontitis can lead to tooth loss and there is a systemic connection between gum disease and inflammatory diseases such as diabetes and heart disease.