A lot has changed in recent years regarding the use of fluoride in The Netherlands. Think of the drinking water fluoridation that was quickly phased out, the upgrading of the fluoride content in toddler toothpaste and the fluoride tablets that have only been removed from the basic fluoride advice since 1998. The advisory report was subsequently revised in 2001 and 2011, one of the results of which was that fluoride applications are no longer simply done every six months in practice. Several types of fluoride have also been introduced in the field of oral care. The commonly used sodium fluoride faced competition from, among others, tin fluoride, amine fluoride and calcium fluoride. In this article you can read more about the latter type of fluoride: what is the difference with sodium fluoride and why would you choose it?

The basis of fluoride

Fluorine is the pure form of fluoride. Fluorine is a toxic gas and should always be bound with another substance before use in food or other products. This can be a metal (such as tin) or a salt. Sodium fluoride (NaF) is an ionic compound between sodium and fluoride. It is easily soluble in water and breaks down into sodium and fluoride ions. It’s good water solubility is one of the reasons it is widely used in oral care products: it is easy to use in toothpastes and mouth rinses. 

A healthier kind of fluoride

Calcium fluoride is an inorganic compound with the molecular formula CaF2. Unlike sodium fluoride, calcium fluoride is very difficult to dissolve in water. The disadvantage of this is that it is difficult to process in oral care products. Nevertheless, there is also a major advantage to this. The low water solubility ensures that calcium fluoride is much less toxic than other types of fluoride with a high solubility.  The European Food Safety Authority wrote in The EFSA Journal (2008): “Overall, calcium fluoride, being much less soluble and less bioavailable than other soluble forms of fluoride, can be considered less toxic”.


Another look at fluoride

Fluoride is a controversial subject in dentistry. Nowadays, more and more patients are asking about the effects of fluoride and practitioners are becoming more critical about the many uses of fluoride. Among other things, the increase in the number of people with implants contributes to this. For example, it is known that people with implants are better off not using fluoride because of the risk of corrosion of the implant. We also see a growing number of people with a conscious lifestyle, who are often looking for body-friendly alternatives to unnatural products. 

The necessity for fluoride

Fluoride remains a toxic substance in the base, especially the water-soluble variants. If one looks at scientific research, it shows that fluoride in low concentrations has in principle no harmful effects. On the other hand, research shows that fluoride is not necessary in the fight against caries: it only offers extra protection. So is it necessary to have everyone polished with fluoride as standard? If one looks at the multifactorial cariesetiology according to Keyes and Jordan (1963), the main causes are plaque (bacteria) and substrate (sugar). With good oral hygiene and a healthy, low-sugar diet with sufficient nutrients, the risk of caries will be low. One might wonder whether it is necessary to advise fluoride in these cases.

Alternatives to sodium fluoride

Do you have a patient who asks for alternatives to sodium fluoride or does your patient have a very low caries risk? You can choose between two options: fluoride-free toothpaste or a healthier type of fluoride. Calcium fluoride is a safer option than sodium fluoride and also offers protection against caries. blue®m toothpaste with calcium fluoride even has a double anti-cariogenic effect: in addition to fluoride, it also contains xylitol and active oxygen. If you choose fluoride-free toothpaste, it is important to look for a replacement ingredient that is active against caries. blue®m fluoride-free toothpaste contains a complete formula with active oxygen, honey, xylitol and lactoferrin. In fact, a recent clinical study shows that this toothpaste is just as effective against gingivitis as toothpaste with triclosan. 



Listen carefully to your patient

The most important thing is to watch and listen to your patient. Does a patient not want to use fluoride for health reasons but oral hygiene does not allow it? Then discuss that there are alternatives such as calcium fluoride. And do you see a patient with good oral hygiene and low caries risk? Consider whether brushing with fluoride is necessary. Be the critical oral care professional and give the best advice to your patient!


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