Fluoride has primarily been utilised as an anti-caries agent

Most people should have at least heard of a substance called fluoride. Toothpaste manufacturers prominently include the effects of fluoride on the teeth in their advertisements. But while fluoride contained in common toothpastes have some cavity prevention characteristics, there have been recent advances in this respect which prove to be more efficient. Fluoride has primarily been utilised as an anti-caries agent. Fluoridated toothpastes are probably the most commonly used method of caries prevention and have been cited as one of the central factors associated with worldwide decrease in caries prevalence.
The most commonly used fluoride compounds are sodium monofluorophosphate (MFP). We who work in the dental profession utilise fluoridated mouth rinse. Fluoride combines with a mineral compound on the surface of the teeth to form fluoropatite which is extremely resistant to the corrosive action of the acids produced in dental plaque. The fluoride now being used primarily reduces the solubility of the enamel. But this is clearly not enough to ensure adequate oral health.
Extensive research has demonstrated that a new compound known as amine fluoride combined with stannous fluoride is superior to compounds in most toothpaste. It was shown that stannous fluoride acts as an anti-microbial agent which not only slows down the process of tooth decay but also possesses an anti-plaque, contributing to prevention of gingivitis. In effect, here is a substance which promotes and maintains the integrity of the gums apart from the teeth.
When the experiment was conducted the objectives included studying the effectiveness of the new substance on 300 fifteen-year school children. No pre-study cleanings were given, no oral hygiene instruction was offered and no close supervision was followed during the trial. The design was intended to represent conditions of the general public as far as possible. The teenage population was chosen as these subjects are known to often practice inadequate oral hygiene, experience gingivitis, but rarely demonstrate symptoms of periodontal (gum) disease.
While fluoride exists naturally in ground water, its content is critical. I have found, for example, that many young people who have lived on the East Coast of Demerara from Plaisance to Mahaicony have permanent brown to white discolouration on their teeth due to excess fluoride in the drinking water of that area. The condition is call fluorisis and it cannot be cured.
Chlorhexidine mouth rinse has been recognised in the literature as having optimal and effective effect on the control of plaque, gingivitis and periodontal disease. However, as a result of certain side effects, including severe staining, taste impairment and strong anti-bacterial virulence, chlorhexidine is usually contraindicated for prolonged daily usage.
Mouth rinses containing alternative compounds have been tested in numerous studies, including among special care patients, and it has been demonstrated that their effectiveness has been similar to that of chlorhexidine, without most of the side effects and significantly less staining. In contrast to mouth rinses, clinical studies observing the amine-stannous fluoride compound have observed no staining problems. In addition, it is chemically stable to room temperature even after being stored for two years.
Teenage participants at baseline did not present severe gingival pathology but a general improvement in gingival health was revealed over the interventional period. This meant that it was the first time that any toothpaste was proven to actually cure any oral disease. The significance of this discovery represents the beginning of a new and exciting era for dental public health and we who work in this field are striving to keep up.

(Dr. BERTRAND R. STUART D.D.S)