Module #8

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Diet, Nutrition and Fluoride; Caries Prevention


Fluoride has played a major role in the marked reduction in caries incidence and prevalence. Under normal conditions there is a constant exchange of ions between the enamel surface of teeth and the surrounding saliva, resulting in a dynamic equilibrium. This equilibrium is disturbed when organic acids are produced by the bacterial metabolism of fermentable carbohydrates. The acids lower the pH of plaque on the enamel surface, then penetrate the enamel subsurface, causing enamel crystals to dissolve and leave the enamel. This process is called demineralization. The presence of fluoride ions on or in the enamel surface can inhibit or reverse this process. In other words, fluoride ions in saliva protect against demineralization and facilitate remineralization.


Today, scientists agree that maintaining fluoride at and within the enamel surface of the teeth is an important factor in determining whether an early carious lesion, i.e: a demineralized area of the tooth, will progress to a cavity or will be remineralized.


In the United States, community water fluoridation is recommended at a concentration ranging from 0.7 to 1.2 parts per million (PPM) of fluoride, depending upon the community’s mean maximum daily temperature. New York City water is fluoridated at 1.10 ppm.


Fluoridated drinking water acts both systemically and topically. Other forms of topically applied fluoride include professionally applied and self applied fluoride treatments, fluoride dentifrices, fluoride mouthrinses, and fluoride varnishes.

Dietary fluoride supplements are prescribed by practitioners for children living in areas with a suboptimal level of fluoride in the drinking water. They are administered either as drops or tablets with or without vitamins. However, before prescribing a fluoride supplement, a physician or dentist should know the child’s age and the concentration of fluoride in the child’s “primary” source of drinking water. (Note: the “primary” water source is often not the child’s “home” water source).




Age in Years

Concentration of Fluoride in Drinking Water


<0.3 PPM

0.3 to PPM

>0.6 PPM

Birth – 6 mos.




6 mos. – 3 yrs.

0.25 mg.



3 – 6 yrs.

0.50 mg.

0.25 mg.


6 – 16 yrs.

1.0 mg.

0.50 mg.


Dosages are in milligrams F/day



Improper use of dietary fluoride supplements and ingestion of fluoride dentifrices by small children, particularly in fluoridated communities, may result in dental fluorosis. Dental fluorosis is defined as hypoplasia or hypomaturation of tooth enamel produced by chronic ingestion of excessive amounts of fluoride as the teeth are developing, and are manifested as whitish opacities on the teeth. In severe cases, mottled enamel may occur.


Although fluoride ingested by a mother can cross the placenta, for lack of conclusive evidence that it will reduce dental caries in her offspring, prenatal fluoride supplementation for the expectant mother is not recommended.





Nutrition comprises all the processes involved in intake and utilization of food. Good nutrition provides nutrients to build healthy bodies, strong bones, decay-resistant teeth and healthy gums. Diet is the type and amount of food eaten daily. A balanced diet is essential for a child’s growth and development.


One of the most common birth defects is cleft lip and/or palate, encountered in 1 in 900 births. A variety of nutrient deprivations or excesses and systemic disturbances can produce this congenital anomaly in animals.


Teeth are particularly susceptible to nutritional insult during the critical period of development through age three. Changes in the structural integrity of the teeth provide a history of deficiencies of Vitamins A, C and D, iodine and excess of fluorides during tooth formation. Changes in the oral mucosa signal deficiencies of iron, riboflavin, niacin, folic acid, protein and vitamins B12, C and K.






Vitamin A Hypoplasia, defective enamel and dentin
Vitamin C Degeneration of pulpal tissue, irregular, canalized secondary dentin
Vitamin D Imperfections in enamel formation, including hypoplasia, interglobular dentin
Iodine Delayed eruption of primary and secondary teeth, malocclusion
Calcification defects, including mottled enamel


Iron Mucosal pallor, glossitis, angular stomatitis, aphthae and burning mouth syndrome
Riboflavin Angular cheilosis and glossitis
Niacin Pellagrous stomatitis affecting lips, tongue, mucosal lining of the mouth, and gingiva (which may develop into Acute Necrotizing Ulcerative Gingivitis)
Folic Acid Stomatitis, particularly glossitis with early manifestation of small white ulcers
Vitamin B12 Stomatitis, particularly glossitis in anterior two thirds of tongue.Can be very painful
Vitamin B6 Bilateral angular cheilosis; glossitis with pain, edema, papillary atrophy and purple discoloration
Vitamin C Scurvy. In infants (6 to 8 months), spongy gingiva around erupting and newly erupted teeth. Beyond infancy, scorbutic gingivitis
Vitamin K Bleeding from gingival margins
  1. Kwashiorkor – pellagra-like oral lesions
  2. Nutritional marasmus – effects resemble those of iron deficiency anemia




Children that have similar findings to photos C, D, E should have a dental evaluation in the near future. Oral hygiene instruction and review of nursing bottle/breast feeding habits should be reviewed by the primary care provider.

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