This interview with Dr. Richard Van Gurp first appeared in The Charlotte Weekly – 4/25/2008

Q: I think that most parents recognize that fluoride is a proven means to protect the dental health of children primarily by making teeth more resistant to cavities. But today, you wanted to talk about how fluoride can benefit adults as well.

Dr. Van Gurp: That’s right. Research now indicates that everyone – children and adults – can benefit from fluoride.

Q: Now, when you talk about fluoride, are you focusing on fluoride in our community water supply, in toothpaste or are you talking about additional supplementation?

Dr. Van Gurp: It depends. For the healthy individual without a history of or any current dental problems, fluoridated water and toothpaste may be enough. But for the dental patient who has issues with cavities, sensitive teeth and/or gum disease, fluoride supplementation may be prudent.

Q: Most everyone knows that fluoride helps to prevent cavities in younger children because their teeth are still forming. How does fluoride help the adult patient whose teeth are already formed?

Dr. Van Gurp: The positive effects of fluoride against cavities in adults are twofold. First, topically, in areas where a cavity is just starting to form, fluoride can cause re-mineralization or repair of the tooth. It may prevent the cavity from getting bigger or even reverse the process.

Secondly, systemic fluoride in one’s saliva provides a reservoir of fluoride that can infiltrate the tooth surface to prevent the formation of cavities.

Additionally, no other agents have been so thoroughly reviewed and found safe and effective for the prevention of tooth decay.

Q: What if I already have caps or crowns on my teeth? Don’t crowns protect my teeth from new cavities?

Dr. Van Gurp: A common misconception. Even if you have crowns on some or all of your teeth, cavities can still form at the margin of the crown — where the crown meets the tooth.
And recurring decay on teeth that are supporting a crown or a bridge threatens the entire restoration and can require costly replacement. Fluoride can help to protect these critical areas and help protect the investment that patients have already made in crowns and bridges.

Q: What about the roots of the teeth? Are they more or less susceptible to cavities?

Dr. Van Gurp: When it comes to protection from cavities in adults, we have to take into account that a lot of adults have gum recession, where the gum has pulled away from the teeth thus exposing the roots.

This can be a problem in two significant ways. First, the roots are not nearly as mineralized as the natural crowns of the teeth. In other words, the roots are not as strong and are more susceptible to cavities. Thus, cavities on a root surface may progress rapidly. As with the crowns of the teeth, fluoride can also be incorporated into the roots of the teeth, making them stronger and more resistant to decay.

Q: How does fluoride help those people with sensitive teeth?

Dr. Van Gurp: That’s the second issue related to gum recession. Exposed roots can be very sensitive, particularly to cold. Microscopically, think of the roots as being porous with channels or tubules that lead to the nerve of the tooth. Studies show that by regularly treating these areas with stannous fluoride, the pores of the tubules are filled with fluoride ions.
The fluoride that does penetrate the pores (tubules) serves as a catalyst that helps build strong and resistant mineral in dentin root surfaces and within the tubules. That serves to block or inhibit the stimuli from reaching the nerves and causing sensitivity.

Q: I thought that fluoride would only help with the teeth. How can it help someone who has gum disease?

Dr. Van Gurp: Studies, even dating back to the mid 1980’s, show that fluoride supplementation can decrease the levels of bacteria that cause not only cavities but also gum disease.
Fluoride does so by altering bacterial metabolism at low concentrations and actually killing the bacteria at high concentrations.

Q: What kind of fluoride supplementation are you recommending? Can an adult basically use the same type of fluoride as children?

Dr. Van Gurp: Remember that for all patients, I recommend using a fluoride containing toothpaste recommended by the American Dental Association. Fluoride in one’s drinking water is also a plus. But for those who qualify, I do recommend fluoride supplementation.

As for using the same type of fluoride in adults as one would use for children, not necessarily.

For children, since we are focusing for the most part on cavity prevention, we have the option to use stannous fluoride, sodium fluoride or sodium monofluorophosphate. These are all indicated for tooth decay.

For adults, we only use stannous fluoride, because it is the only one of the three fluorides above that help to treat all three problems we discussed – cavities, sensitive teeth and gum disease.

In treating adults, we recommend a two-prong approach. At hygiene appointments, we do a treatment that involves a higher concentration of fluoride. This may involve a swish or the application of a fluoride varnish. This acts as an initial boost.

For many of our patients, we then recommend the use of a fluoride rinse on a daily basis. This is more the maintenance phase, which keeps the fluoride levels up. This rinse also provides antimicrobial activity for up to 8 hours.

Q: This sounds like the triple force for fluoride as it can be a benefit for those patients who are concerned about any or all three of the problems you’ve discussed –cavities, gum disease and sensitive teeth.

Dr. Van Gurp: That’s right.

Dr. Richard Van Gurp, a Charlotte area dentist and regional leader in Dental Care and Technology, maintains a general dental practice in Charlotte, North Carolina at the Belle Grove Office Park at the Arboretum. He can be contacted at 704-542-2884.

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