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Prevention and reversal of dental caries: role of low level fluoride
Abstract
Abstract –: Dental caries is a bacterially based disease that progresses when acid produced by bacterial action on dietary fermentable carbohydrates diffuses into the tooth and dissolves the mineral, that is, demineralization. Pathological factors including acidogenic bacteria (mutans streptococci and lactobacilli), salivary dysfunction, and dietary carbohydrates are related to caries progression. Protective factors which include salivary calcium, phosphate and proteins, salivary flow, and fluoride in saliva can balance, prevent or reverse dental caries. Fluoride works primarily via topical mechanisms which include (1) inhibition of demineralization at the crystal surfaces inside the tooth, (2) enhancement of remineralization at the crystal surfaces (the resulting remineralized layer is very resistant to acid attack), and (3) inhibition of bacterial enzymes. Fluoride in drinking water and in fluoride‐containing products reduces tooth decay via these mechanisms. Low but slightly elevated levels of fluoride in saliva and plaque provided from these sources help prevent and reverse caries by inhibiting demineralization and enhancing remineralization. The level of fluoride incorporated into dental mineral by systemic ingestion is insufficient to play a significant role in caries prevention. The effect of systemically ingested fluoride on caries is minimal. Fluoride “supplements” can be best used as a topical delivery system by sucking or chewing tablets or lozenges prior to ingestion.
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“Fluoride primarily exerts its effects through topical mechanisms, including inhibiting the demineralization of tooth enamel, enhancing remineralization at crystal surfaces (thereby forming a highly acid-resistant layer) and suppressing bacterial enzymatic activity [9].”
From Severity-dependent alterations in oral microbiota and antibiotic resistance in children with dental fluorosis (2026) · cites this paper as [9]
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Cited by
Pitts, N. B., Zero, D. T., Marsh, P. D., Ekstrand, K., Weintraub, J. A., Ramos-Gomez, F., Tagami, J., Twetman, S., Tsakos, G., & Ismail, A. (2017) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2017.30 · Cited by 1,823
Fluoride varnishes for preventing dental caries in children and adolescents
Marinho, V. C., Worthington, H. V., Walsh, T., & Clarkson, J. E. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002279.pub2 · Cited by 1,022
Fluoride toothpastes for preventing dental caries in children and adolescents
Marinho, V. C., Higgins, J., Logan, S., & Sheiham deceased, A. (2003) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002278 · Cited by 845
Dental caries: a dynamic disease process
Featherstone, J. (2008) · Australian Dental Journal · doi:10.1111/j.1834-7819.2008.00064.x · Cited by 507
Self-citationFluoride mouthrinses for preventing dental caries in children and adolescents
Marinho, V. C., Higgins, J. P., Logan, S., & Sheiham, A. (2003) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002284 · Cited by 395
Principles of fluoride toxicity and the cellular response: a review
Johnston, N. R., & Strobel, S. A. (2020) · Archives of Toxicology · doi:10.1007/s00204-020-02687-5 · Cited by 356
The Evidence for Caries Management by Risk Assessment (CAMBRA®)
Featherstone, J. D. B., & Chaffee, B. W. (2018) · Advances in Dental Research · doi:10.1177/0022034517736500 · Cited by 164
Self-citationSilver diamine fluoride therapy for dental care
Zheng, F. M., Yan, I. G., Duangthip, D., Gao, S. S., Lo, E. C. M., & Chu, C. H. (2022) · Japanese Dental Science Review · doi:10.1016/j.jdsr.2022.08.001 · Cited by 114
How to maintain a cariostatic fluoride concentration in the oral environment
Cury, J. A., & Tenuta, L. M. A. (2008) · Advances in Dental Research · doi:10.1177/154407370802000104 · Cited by 101
Effect of sodium fluoride on the virulence factors and composition of Streptococcus mutans biofilms
Pandit, S., Kim, J.-E., Jung, K.-H., Chang, K.-W., & Jeon, J.-G. (2011) · Archives of Oral Biology · doi:10.1016/j.archoralbio.2010.12.012 · Cited by 67
Dong, H., Yang, X., Zhang, S., Wang, X., Guo, C., Zhang, X., Ma, J., Niu, P., & Chen, T. (2021) · Ecotoxicology and Environmental Safety · doi:10.1016/j.ecoenv.2021.112439 · Cited by 46
Augustsson, A., & Berger, T. (2014) · Environment International · doi:10.1016/j.envint.2014.03.014 · Cited by 45
Enerbäck, H., Möller, M., Nylén, C., Ödman Bresin, C., Östman Ros, I., & Westerlund, A. (2019) · European Journal of Orthodontics · doi:10.1093/ejo/cjy025 · Cited by 41
CPP–ACP and Fluoride: A Synergism to Combat Caries
Naik, S. V., Attiguppe, P., Malik, N., & Ballal, S. (2019) · International Journal of Clinical Pediatric Dentistry · doi:10.5005/jp-journals-10005-1608 · Cited by 38
Nitrate and Phosphate Transporters Rescue Fluoride Toxicity in Yeast
Johnston, N. R., & Strobel, S. A. (2019) · Chemical Research in Toxicology · doi:10.1021/acs.chemrestox.9b00315 · Cited by 16
A Qualitative and Comprehensive Analysis of Caries Susceptibility for Dental Fluorosis Patients
Li, Q., Shen, J., Qin, T., Zhou, G., Li, Y., Chen, Z., & Li, M. (2021) · Antibiotics · doi:10.3390/antibiotics10091047 · Cited by 13
Matar, M. A., Darwish, S. S., Salma, R. S., & Lotfy, W. A. (2023) · European Archives of Paediatric Dentistry · doi:10.1007/s40368-023-00811-4 · Cited by 5
Xia, Y., Peng, S., Yu, J., Wang, Y., Ye, Y., Liu, M., Shang, L., Cui, X., Wang, P., & Ding, Z. (2026) · Journal of Oral Microbiology · doi:10.1080/20002297.2026.2714622
Metadata
- Authors
- Featherstone, J. D. B.
- Venue
- Community Dentistry and Oral Epidemiology
- Publisher
- Wiley
- Published
- 1999-02
- Volume
- 27
- Issue
- 1
- Pages
- 31-40
- ISSN
- 0301-5661 (ISSN-L)
- 1600-0528
- OpenAlex
- W2077556352
- Cited by
- 989
- References
- 0
- FWCI
- 23.04
- Type
- journal article
- Language
- en
- Open access
- closed
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