Recent studies have confirmed how the use of fluoride toothpastes is of great help in preventing dental caries in children from the appearance of their first tooth.

fluoride is an element found abundantly in nature and is used topically in dentistry for the treatment and prevention of dental caries due to its anticariogenic and antimicrobial properties.

How do fluorides work?

As we know, caries is the result of an imbalance between the loss of enamel minerals (demineralization) and their recovery (remineralization). Knowing the caries formation process allows us to detect the risk factors that each patient presents in order to be able to act on possible prevention strategies in a personalized manner.

Fluorides present in rinses, toothpastes and products for exclusive use in the dental office usually have a topical action. Some of the benefits of fluoride in these cases are:

• Strengthening of dental enamel and remineralizing capacity:
  fluoride strengthens tooth enamel in two ways. First, upon contact with the tooth, it forms fluorhydroxyapatite, a mineral that is less soluble than the hydroxyapatite naturally present in the enamel, which increases its resistance to acid attack by bacteria. Secondly, when it reacts with the calcium present in the mouth, a calcium fluoride precipitate is formed with cariostatic properties, which prevents the formation of dental caries.

• Inhibits bacterial activity: it interferes in the formation of dental biofilm, since it acts on glycolysis and interferes in the colonization and aggregation of bacteria, which reduces the formation of caries.

There are significant anatomical differences that make the primary dentition more susceptible to the development of dental caries than the permanent dentition, among them are:

• Reduced thickness of enamel and dentin.

• Presence of aprismatic enamel on all tooth surfaces.

• Higher percentage of organic matter.

• Deeper grooves.

• Larger interproximal contact areas.

This is why it is so necessary to inform parents of the importance of oral hygiene from the eruption of their first teeth.

Strategies for caries prevention

Once the child's caries risk is determined, we must move on to planning the treatment plan. According to the personalized situation of each case we can act taking into account details such as:

• Oral hygiene education for parents and child: brochures, guides and information sessions can be provided on the importance of oral hygiene, brushing techniques adapted to each stage and the importance of fluoride.

• Healthy diet: evaluate and raise awareness about the type of food consumed by the child and try to persuade the child to eat a diet that is as cariogenic as possible (reduce the consumption of sugars).

• Regular check-ups: establish the appropriate times between sessions to be able to perform hygiene or detect early the appearance of caries. The frequency of these check-ups should be directly proportional to the caries risk of each child.

Toothpaste recommendations and preventive treatments

In general, in a healthy situation, toothpastes with 1000 ppm of fluoride are recommended from 0 to 6 years of age; while for children 6 years of age and older, toothpastes with 1450 ppm of fluoride can be used. A small amount of toothpaste is usually recommended for children up to 2 years of age, such as a grain of rice, and from 3 to 6 years of age the amount should be the size of a pea. The concentration of fluoride to be used will depend on the risk of developing dental caries of each patient, so it should be evaluated in consultation.

Preventive treatments play a fundamental role in the care of children's oral health. Measures such as fluoride application, dental sealants and professional cleanings are key to avoid more invasive treatments in the future and help them maintain a healthy smile.

• Deep pit and fissure sealants: to prevent the accumulation of food debris and dental biofilm in the deepest grooves of the teeth. Sealants help to facilitate the cleaning of the occlusal surfaces of the teeth.

• fluoride applications in the dental clinic:
  • fluoride gels: one of the main formulations available is the 1.23% acidified fluoride phosphate gel which provides a concentration of 12,300 ppm F-^. The time interval between sessions should be determined based on the patient's caries risk.
  • fluoride varnish: is a concentrated solution of fluoride containing 5% sodium fluoride, which represents a concentration of 22,600 ppm F-^. It is usually applied specifically in those teeth where a remineralizing action is needed.

The main dental associations agree on the importance of children brushing their teeth at least twice a day for two minutes with a soft toothbrush, especially before going to bed. They should do so under the supervision of an adult until they are 8 or 9 years old, by which time they have developed the fine motor skills to do it well on their own without the risk of ingesting the toothpaste improperly.

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Risks associated with the use of fluorides

While fluoride is safe for young children and provides many benefits in adequate amounts, when fluoride is ingested in higher than recommended amounts it can lead to dental fluorosis, an enamel disorder that occurs when developing teeth are exposed to high levels of fluoride. It does not usually cause serious problems, it only affects the esthetics of the tooth with the appearance of small white spots.

However, toothpaste is not necessarily the cause of fluorosis; there are many other factors that can favor the appearance of fluorosis: genetics, diet and the concentration of fluoride in the water in the region, mainly. As dentists, we must offer a treatment according to the context and the real needs of each patient.

In short, fluoride is one of the most effective ingredients for preventing dental caries in children, although, like everything else, it must be used in a controlled manner. It is still common to find some misinformation regarding the use of fluoride toothpastes. Current recommendations are different from those of years ago, although, of course, they are supported by scientific evidence obtained through studies comparing different treatments and methods in large groups of patients.

As with other health sciences, dentistry is constantly evolving and it is necessary to adapt practices as professionals to the latest research. In this case, it is important to inform parents about the reasons behind these modifications so that they can be confident that it is the best option at the present time. Similarly, it should be remembered that fluoride is not everything; caries prevention must also be accompanied by proper oral hygiene, a healthy diet and regular visits to the dentist.