"Fluoride is most effective when used topically, after the teeth have erupted."
SOURCE: Cheng KK, et al. (2007). Adding fluoride to water supplies. British Medical Journal 335(7622):699-702.
"it is now accepted that systemic fluoride plays a limited role in caries prevention."
SOURCE: Pizzo G, Piscopo MR, Pizzo I, Giuliana G. (2007). Community water fluoridation and caries prevention: a critical review. Clinical Oral Investigations 11(3):189-93.
“the major anticaries benefit of fluoride is topical and not systemic.”
SOURCE: National Research Council. (2006). Fluoride in Drinking Water: A Scientific Review of EPA's Standards. National Academies Press, Washington D.C. p 13.
"Since the current scientific thought
is that the cariostatic activity of fluoride is mainly due to
its topical effects, the need to provide systemic fluoride supplementation
for caries prevention is questionable."
SOURCE: European Commission. (2005). The
Safety of Fluorine Compounds in Oral Hygiene Products for Children
Under the Age of 6 Years.
European Commission, Health & Consumer Protection Directorate-General,
Scientific Committee on Consumer Products, September 20.
“The results of more recent epidemiological and laboratory
studies can be summarized by stating that posteruptive
(topical) application of fluoride plays the dominant role in caries
prevention."
SOURCE: Hellwig E, Lennon AM. (2004). Systemic versus topical
fluoride. Caries Research 38: 258-62.
"When it was thought that fluoride had
to be present during tooth mineralisation to 'improve' the biological
apatite and the 'caries resistance' of the teeth, systemic fluoride
administration was necessary for maximum benefit. Caries
reduction therefore had to be balanced against increasing dental
fluorosis. The 'caries resistance' concept
was shown to be erroneous 25 years ago, but the new paradigm is
not yet fully adopted in public health dentistry, so we
still await real breakthroughs in more effective use of fluorides
for caries prevention."
SOURCE: Fejerskov O. (2004). Changing paradigms in concepts on
dental caries: consequences for oral health care. Caries
Research 38: 182-91.
“Current evidence strongly suggests
that fluorides work primarily by topical
means through direct action on the teeth and dental plaque. Thus
ingestion of fluoride is not essential for caries prevention."
SOURCE: Warren JJ, Levy SM. (2003). Current and future role of
fluoride in nutrition. Dental Clinics of North America
47: 225-43.
"[T]he majority of benefit from fluoride
is now believed to be from its topical, rather than systemic,
effects."
SOURCE: Brothwell D, Limeback H. (2003). Breastfeeding is protective
against dental fluorosis in a nonfluoridated rural area of Ontario,
Canada. Journal of Human Lactation 19: 386-90.
"For a long time, the systemic effect
of fluoride was regarded to be most important, resulting in recommendations
to use fluoride supplements such as tablets or drops. However,
there is increasing evidence that the local effect of fluoride
at the surface of the erupted teeth is by far more important."
SOURCE: Zimmer S, et al. (2003). Recommendations for the Use of
Fluoride in Caries Prevention. Oral
Health & Preventive Dentistry
1: 45-51.
"By 1981, it was therefore possible to propose a paradigm
shift concerning the cariostatic mechanisms of fluorides in which
it was argued that the predominant, if not the
entire, explanation for how fluoride controls caries lesion development
lies in its topical effect on de- and remineralization
processes taking place at the interface between the tooth surface
and the oral fluids. This concept has gained wide acceptance...
With today's knowledge about the mechanisms of fluoride action,
it is important to appreciate that, as
fluoride exerts its predominant effect... at the tooth/oral fluid
interface, it is possible for maximum
caries protection to be obtained without the ingestion of fluorides
to any significant extent."
SOURCE: Aoba T, Fejerskov O. (2002). Critical Review of
Oral Biology and Medicine 13: 155-70.
"[F]luoride's predominant effect is posteruptive
and topical."
SOURCE: Centers for Disease Control and Prevention. (2001).
Recommendations for Using Fluoride to Prevent and Control Dental
Caries in the United States. Morbidity
and Mortality Weekly Report
50(RR14): 1-42.
"The prevalence of dental caries in a
population is not inversely related to the concentration of fluoride
in enamel, and a higher concentration of enamel fluoride is not
necessarily more efficacious in preventing dental caries."
SOURCE: Centers for Disease Control and Prevention. (2001). Recommendations
for Using Fluoride to Prevent and Control Dental Caries in the
United States. Morbidity and
Mortality Weekly Report
50(RR14): 1-42.
"Fluoride incorporated during tooth development
is insufficient to play a significant role in caries protection."
SOURCE: Featherstone, JDB. (2000). The Science and Practice of
Caries Prevention. Journal of the American Dental Association
131: 887-899.
"Current evidence suggests that the predominant
beneficial effects of fluoride occur locally at the tooth surface,
and that systemic (preeruptive) effects are of much less importance."
SOURCE: Formon, SJ; Ekstrand,
J; Ziegler, E. (2000). Fluoride Intake and Prevalence of Dental
Fluorosis: Trends in Fluoride Intake with Special Attention to
Infants. Journal of Public Health Dentistry 60:
131-9.
"Fluoride supplementation regimens suffer from several shortcomings,
the first of which may be their derivation from a time when the
major effect of fluoride was thought to be systemic. Although
evidence that fluoride exerts its effects mainly through topical
contact is great, supplementation schemes still focus on the ingestion
of fluoride."
SOURCE: Adair SM. (1999). Overview of the history and current
status of fluoride supplementation schedules. Journal
of Public Health Dentistry 1999 59:252-8.
"The case is essentially a risk-benefit issue - fluoride
has little preeruptive impact on caries prevention, but presents
a clear risk of fluorosis."
SOURCE: Burt BA. (1999). The case for eliminating the use of dietary
fluoride supplements for young children. Journal
of Public Health Dentistry
59: 260-274.
"Until recently the major caries-inhibitory effect of fluoride
was thought to be due to its incorporation in tooth mineral during
the development of the tooth prior to eruption...There
is now overwhelming evidence that the primary caries-preventive
mechanisms of action of fluoride are post-eruptive through 'topical'
effects for both children and adults."
SOURCE: Featherstone JDB. (1999) Prevention and Reversal of Dental
Caries: Role of Low Level Fluoride. Community Dentistry
& Oral Epidemiology 27: 31-40.
"[L]aboratory and epidemiologic research suggests that fluoride
prevents dental caries predominately after eruption of the tooth
into the mouth, and its actions primarily are topical for both
adults and children."
SOURCE: Centers for Disease Control and Prevention. (1999). Achievements
in Public Health, 1900-1999: Fluoridation of Drinking Water to
Prevent Dental Caries. Morbidity
and Mortality Weekly Report
48: 933-940.
"[R]esearchers are discovering that the topical
effects of fluoride are likely to mask any benefits that ingesting
fluoride might have... This has obvious implications for the use
of systemic fluorides to prevent dental caries."
SOURCE: Limeback, H.
(1999). A re-examination of the pre-eruptive and post-eruptive
mechanism of the anti-caries effects of fluoride: is there any
caries benefit from swallowing fluoride? Community Dentistry
and Oral Epidemiology 27: 62-71.
"Although it was initially thought that
the main mode of action of fluoride was through its incorporation
into enamel, thereby reducing the solubility of the enamel, this
pre-eruptive effect is likely to be minor. The evidence
for a post-eruptive effect, particularly its role in inhibiting
demineralization and promoting remineralization, is much stronger."
SOURCE: Locker D. (1999). Benefits and Risks of Water Fluoridation.
An Update of the 1996 Federal-Provincial Sub-committee Report.
Prepared for Ontario Ministry of Health and Long Term Care.
"Recent research on the mechanism of action
of fluoride in reducing the prevalence of dental caries (tooth
decay) in humans shows that fluoride acts topically (at the surface
of the teeth) and that there is neglible benefit in ingesting
it."
SOURCE: Diesendorf, M. et al. (1997). New Evidence on Fluoridation.
Australian and New Zealand Journal of Public Health 21 : 187-190.
"On the basis of the belief that an adequate intake of fluoride
in early life is protective against caries in later life, fluoride
supplements are recommended for infants and children living in
areas in which the fluoride content of the drinking water is low.
However, critical reviews of the evidence have
led to the conclusion that the effect of fluoride in decreasing
the prevalence and severity of dental caries is not primarily
systemic but exerted locally within the oral cavity. Because
fluoride supplements are quickly cleared from the mouth, the possibility
must be considered that they may contribute to enamel fluorosis,
which is unquestionably a systemic effect, while providing relatively
little protection against dental caries."
SOURCE: Ekstrand J, et al. (1994). Fluoride pharmacokinetics in
infancy. Pediatric Research 35:157–163.
"It is now well-accepted that the primary
anti-caries activity of fluoride is via topical action."
SOURCE: Zero DT, et al. (1992). Fluoride
concentrations in plaque, whole saliva, and ductal saliva after
application of home-use topical fluorides. Journal
of Dental Research 71:1768-1775.
"I have argued in this paper that desirable
effects of systemically administered fluoride are quire minimal
or perhaps even absent altogether."
SOURCE: Leverett DH. (1991). Appropriate uses of systemic fluoride:
considerations for the '90s. Journal
of Public Health Dentistry
51: 42-7.
"It, therefore, becomes evident that a
shift in thinking has taken place in terms of the mode of action
of fluorides. Greater emphasis is now placed on topical rather
than on systemic mechanisms..."
SOURCE: Wefel JS. (1990). Effects of fluoride on caries development
and progression using intra-oral models. Journal
of Dental Research 69(Spec
No):626-33;
"[E]vidence has continued to accumulate to
support the hypothesis that the anti-caries mechanism of fluoride
is mainly a topical one."
SOURCE: Carlos JP. (1983) Comments on Fluoride. Journal
of Pedodontics Winter. 135-136.
"Until recently most caries preventive programs
using fluoride have aimed at incorporating fluoride into the dental
enamel. The relative role of enamel fluoride in caries prevention
is now increasingly questioned, and based on rat experiments and
reevaluation of human clinical data, it appears to be of minor
importance... [A]ny method which places particular emphasis
on incorporation of bound fluoride into dental enamel during formation
may be of limited importance."
SOURCE: Fejerskov O, Thylstrup A, Larsen MJ. (1981). Rational
Use of Fluorides in Caries Prevention: A Concept based on Possible
Cariostatic Mechanisms. Acta Odontologica Scandinavica
39: 241-249.
