The effects of Sodium Fluoride and fluoride on tooth enamel and the body

1. The effects of Sodium Fluoride and fluoride on tooth enamel and the body Larissa michel

2. About this project • I originally wanted to know the effects of calcium carbonate in toothpaste on tooth enamel over time, but it turns out that none of the toothpastes I looked at contained calcium carbonate. Since that was a dead end, I looked at the other ingredients, and saw that sodium fluoride was a common active ingredient in toothpaste. I decided to investigate it instead. • After I learned a bit about fluoride and sodium fluoride, I wanted to look up the effects fluoride had not just on tooth enamel, but also on other parts of the human body.

3. Definitions used • Calcium Carbonate – a white, insoluble solid occurring naturally as chalk, limestone, marble, and calcite, and forming mollusk shells and stony corals • Sodium Fluoride – a poisonous crystalline salt NaF that is used in trace amounts in the fluoridation of drinking water, toothpastes, and oral rinses and in metallurgy, as a flux, as an antiseptic, and as a pesticide • Fluoride ion (Fluorine) – the chemical element of atomic number 9, a poisonous pale yellow gas of the halogen series .It is the most reactive of all the elements, causing severe burns on contact with skin • Oxidative Stress – an imbalance between the production of free radicals and the ability of the body to detoxify their harmful effects through neutralization by antioxidants • Antioxidant – a substance such as vitamin C or E that removes potentially damaging oxidizing agents in a living organism • Polyphenol – an antioxidant phytochemical that tends to prevent or neutralize the damaging effects of free radicals • Phytochemical – of, relating to, or being phytochemistry • Phytochemistry – the chemistry of plants, plant processes, and plant products • Black Tea – tea of the most usual type, that is fully fermented before drying • White Tea – tea that is light in color and made from buds and immature leaves that are covered with fine white hairs and undergo little to no oxidation before drying

4. Definitions used (continued) • Pharmaceutical – a compound manufactured for use as a medicinal drug • Organofluorine – an organic chemical compound that contains carbon and fluorine bonded in the (polarized) and remarkably strong carbon-fluorine bond • Metabolize – (of a body or organ) process (a substance) by metabolism • Metabolism – the chemical processes that occur within a living organism in order to maintain life • Anesthetic – a substance that induces insensitivity to pain • Isoflurane – a widely used inhalation anesthetic • Sevoflurane – a sweet-smelling, non-flammable, highly fluorinated methyl isopropyl ether used for induction and maintenance of general anesthesia • Cipro – ciprofloxacin, an oral antibiotic used against serious bacterial infections of the skin, respiratory tract, urinary tract, bones or joints • Niflumic Acid – a drug used for joint and muscular pain • Flecainide – an oral antiarrhythmic medication used as a last resort in treating arrhythmias. Using it increases the risk of sudden death in heart attack patients • Voriconazole – a triazole antifungal medication that is generally used to treat serious, invasive fungal infections

5. Definitions used (continued) • Skeletal Fluorosis – a bone disease caused by excessive consumption of fluoride • Arthritis – painful inflammation and stiffness of the joints • Fibromyalgia – a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas • Tooth Enamel – a hard white substance covering the crown of a tooth; a porous, calcified substance made from crystalline calcium phosphate • DMFT – Decayed, Missing, or Filled Teeth

6. Research overview • I investigated 5 different toothpastes: Colgate Sensitive Enamel Protect, Crest Complete Multi-Benefit Whitening + Scope, Crest Cavity Protection, Aquafresh Advanced, and Sensodyne Maximum Strength with Fluoride. • I started off with three basic questions about each toothpaste: What are the active ingredients, what are the inactive ingredients, and how much sodium fluoride is in it?

7. Colgate sensitive enamelprotect overview • Active Ingredients: Potassium nitrate 5% for antisensitivity, Sodium fluoride 0.24% (0.15% w/v fluoride ion) for anticavity • Inactive Ingredients: Water, sorbitol, glycerin, hydrated silica, PEG-12, sodium lauryl sulfate, flavor, cellulose gum, tetrasodium pyrophosphate, sodium saccharin, xanthan gum, titanium dioxide • Amount (percentage) of sodium fluoride: 0.24%

8. Crest complete multi-benefit whitening + scope overview • Active Ingredient: Sodium fluoride 0.243% for anticavity toothpaste • Inactive Ingredients: Sorbitol, water, hydrated silica, disodium pyrophosphate, sodium lauryl sulfate, flavor, sodium hydroxide, alcohol (0.7%), xanthan gum, sodium saccharin, glycerin, carbomer, cellulose gum, polysorbate 80, sodium benzoate, cetylpyridinium chloride, benzoic acid, titanium dioxide, blue 1, yellow 5 • Amount (percentage) of sodium fluoride: 0.243%

9. Crest cavity protection overview • Active Ingredient: Sodium fluoride 0.243% (0.15% w/v fluoride ion) for anticavity toothpaste • Inactive Ingredients: • Amount (percentage) of sodium fluoride: 0.243%

10. Aquafresh advanced overview • Active Ingredient: Sodium fluoride (0.14% w/v of fluoride ion) for anticavity • Inactive Ingredients: Carrageenan gum, D&C red #30, FD&C blue #1 lake, flavor, glycerin, hydrated silica, PEG-8, sodium lauryl sulfate, sodium saccharin, sorbitol, titanium dioxide, water, xanthan gum • Amount (percentage) of sodium fluoride: 0.24%

11. Sensodyne maximum strength with fluoride overview • Active Ingredients: Potassium nitrate (5%) for antihypersensitivity; Sodium fluoride (0.15% w/v fluoride ion) for anticavity • Inactive Ingredients: D&C yellow #10, FD&C blue #1, flavor, glycerin, hydrated silica, sodium lauryl sulfate, sodium saccharin, sorbitol, titanium dioxide, trisodium phosphate, water, xanthan gum • Amount (percentage) of sodium fluoride: 0.24%

12. Table of toothpastes and their amounts of sodium fluoride

13. study • You could do a study just based off of this information, and compare the long-term effects of using different types of toothpastes, each with different amounts of sodium fluoride.

14. About fluoride Here you’ll learn more about fluorine, fluoride, and sodium fluoride before we jump into the research

15. The Periodic Table

16. Fluorine • Fluorine is element number 9 • It is a toxic yellow gas • Chlorine, bromine, and iodine belong to the same family of elements • Fluorine is highly reactive, because it needs one more electron to fill its outer electron ring. • Luckily, Sodium (element number 11, a silver-colored, highly-reactive, solid metal at room temperature, in the same family as lithium and potassium) has only one electron in its outer shell, and it wants to give it away. • Na + F = NaF, now a happy compound! -Sourced from http://www.mom.smart.brain

17. About fluoride (in toothpaste) • The main active ingredient found in almost all toothpastes • It helps with calcium uptake, so it strengthens enamel. Stronger enamel is less susceptible to decay • Most toothpastes have only 0.1% to 0.2% fluoride • Prescription-strength fluoride toothpastes can contain more than 1% fluoride.

18. About sodium fluoride (NaF) • Inorganic chemical compound • Colorless solid • Is a source of the fluoride ion (fluorine) • Soluble in water • Melting point: 1,819°F • Sodium fluoride is stable because sodium gives up the 1 electron in its outer shell to fluorine, which has 7 electrons in its outer shell. 7+ 1 = 8 • It is sold in tablets for cavity prevention • It is used to fluoridate water in the U.S. • Australia, Brazil, Canada, Chile, Ireland, Malaysia, and Vietnam also fluoridate their water supply • Water fluoridation is used by 5.7% of people worldwide

19. Effects of fluoride on teeth and other parts of the human body I found some really interesting data about the sources from which we ingest fluoride, fluoridated water, tooth decay trends, and more

20. Where we get our fluoride • Dental Products (toothpaste, mouthwash, etc.) • Processed Foods & Drinks • Pesticides • Tea • Fluorinated Pharmaceuticals • Mechanically Deboned Meat • Workplace Exposure • There is some debate as to whether or not using Teflon-coated pans also increases our exposure to fluoride • Fluorinated Water • Fluorinated Salt (some European countries)

21. Dental products • Over 95% of toothpastes contain fluoride • Many young kids swallow over 50% of toothpaste on their brush, especially if it is candy, watermelon, or bubble gum-flavored • A strip of toothpaste covering the length of a child’s brush contains 0.75 – 1.5 mg fluoride • One mL of fluoride mouthwash contains about 0.25 mg fluoride • One mL of self-applied fluoride gel contains 5 mg fluoride • One mL of professionally applied fluoride gel contains 12.3 mg fluoride • One mL of fluoride varnish contains 22.6 mg fluoride • Per tablet, lozenge, or drop, fluoride supplements contain 0.25 – 1 mg of fluoride

22. tea • Tea plants absorb fluoride from the soil they grow in • Brewed black tea in the US contains an average of 3 – 4 ppm fluoride • Commercial iced tea drinks contain 1 – 4 ppm fluoride • Recently, there have been several reports documenting skeletal fluorosis among heavy tea drinkers (people who drink about 1 gallon of tea every day) in the US • These tea drinkers are often misdiagnosed as having arthritis or fibromyalgia • It is believed that fluoride damages cells in the body using oxidative stress. Tea contains high levels of antioxidants and polyphenols, which counteracts oxidative stress • Tea made from old leaves (black tea) has low levels of antioxidants and high levels of fluoride, while tea made from young leaves (white tea) has high levels of antioxidants and low levels of fluoride

23. About free radicals & oxidative stress • https://www.youtube.com/watch?v=VnAhAX98HY4 (optional skip to 1:17)

24. Fluorinated pharmaceuticals • Some modern pharmaceuticals contain organofluorines, or chemical compounds that contain carbon and fluorine • In these drugs, the fluorine usually forms a very strong bond with the carbon and resists metabolism into the fluoride ion (fluorine) • Some of these drugs do metabolize into fluoride. We know this because of studies finding elevated levels of fluorine in the blood or urine of individuals after they used the drug • Known organofluorine drugs that metabolize are fluorinated anesthetics (isoflurane, sevoflurane), cipro, niflumic acid, flecainide, and voriconazole. Others may exist.

25. how much fluoride do we need?

26. Tooth decay trends

27. A brief history of water fluoridation • Dr. Frederick McKay pressed the dental community for an investigation into dental fluorosis • McKay studied 2,945 children, and of them, 87.5% had some degree of the disease, and all of them lived in the Pikes Peak region. These children also had fewer cavities than children living in other communities • In 1931, researchers from the Aluminum Company of America concluded that the cause of dental fluorosis in those children was the high concentration of fluoride ions (fluorine) in Pikes Peak’s drinking water (range 2-13.7 mg/L) • ALCOA also found that areas with lower concentrations (1 mg/L or less) had no signs of the dental fluorosis • After this, researchers started working to find a safe level of fluoride chemicals to be added to water supplies. One of their goals was to warn communities such as Pikes Peak about the dangers of high levels of fluoride in their water, with the purpose of reducing levels of fluoride in the water in order to reduce cases of dental fluorosis. Their other goal was to encourage communities with a low concentration of fluoride in their water to add fluoride chemicals to help prevent tooth decay • On January 25, 1945, Grand Rapids, MI was the first community in the US (and the world) to add fluoride chemicals to its drinking water to prevent tooth decay and provide benefits for dental health • By 2006, 61.5% of the total US population was receiving fluoridated water

28. The report published by the NAS • In 2006, the NAS (National Academy of Science) published a 500-page review of fluoride’s toxicity • The report said that fluoride is an endocrine disruptor and can affect your bones, brain, thyroid gland, pineal gland, and blood sugar levels • Studies on if & how current exposures to fluoride in the US are contributing to bone disorders, thyroid disease, low intelligence, dementia, and diabetes have yet to be conducted

29. The brain • Over 100 studies conducted in the past 3 decades have found that fluoride exposure can damage the brain. Of these . . . • More than 40 animal studies show that prolonged exposure to fluoride can damage the brain, especially if the subject had an iodine deficiency or aluminum excess • 37 human studies linking reduced intelligence with exposure to moderately high levels of fluoride • 29 animal studies showing that the ability of rats & mice to learn or remember was impaired after they ingested fluoride • 12 studies (5 animal and 7 human) linking fluoride exposure with neurobehavioral deficits • 3 human studies showing that exposure to fluoride impaired fetal brain development

30. Skeletal fluorosis • Osteomalacia(poor or weak bones) is a disorder of decreased/defective mineralization of newly formed osteoid (bone tissue that has not been calcified yet) at sites of bone turnover. • At any given time, about 7 percent of the bone surface is in the process of forming new bone. • The osteoclast (bone-breaker) begins the cycle by excavating a cavity on the bone surface. • This is then followed by refilling of the cavity by activated osteoblasts (bone-maker), which deposit organic matrix (osteoid). • The osteoid is then mineralized (calcium carbonate is deposited, then converted to hydroxyapatite). • High doses of fluorides (as from ingestion of excessive quantities in the form of fluoride toothpastes and certain teas) may interfere with this mineralization process, resulting in osteomalacia.

31. Dental fluorosis • Dental fluorosis (see pictures on the next slide) • Mild: limited to surface appearance; results in a white-flecked or lacy appearance to the enamel • Moderate: opaque white appearance of teeth • Severe fluorosis: brown discoloration of teeth • Much less common than mild fluorosis • Can make the teeth more susceptible to wear and breakage • Appears to be due to a direct effect of the fluoride ion on the rate of mineral formation by ameloblasts, resulting in disruption of the enamel matrix

32. Dental Fluorosis

33. Dental fluorosis (continued) • Excess fluoride consumption (generally greater than 0.05 mg/kg per day) can cause fluorosis or hypomineralizationof the dental enamel. • According to data from the National Health and Nutrition Examination Survey, the prevalence of fluorosis among persons aged 6 to 39 years was 23 percent during 1999 to 2002 • A child's fluoride intake is most important during the critical months of enamel maturation (up to 48 months of age [4 years]), when the developing anterior permanent teeth are most vulnerable to excessive fluoride that can cause fluorosis. • Fluorosis can be prevented by limitation of excessive fluoride consumption (as through the swallowing of fluoridated toothpaste or mouth rinses) early in life and appropriate fluoride supplementation. • To avoid fluorosis, fluoride-containing toothpaste should be used in very small amounts in young children. The appropriate amount of toothpaste for infants and toddlers (younger than three years) is a “smear” – a very thin layer of toothpaste that covers less than half of the bristle surface of a child-size toothbrush. This can be increased to a “pea-sized” amount at age three years, and older preschoolers can use slightly more than a “pea-sized” amount. • Using optimally fluoridated water to reconstitute powdered infant formula concentrate increased the risk of dental fluorosis in at least one study.

34. conclusion • In conclusion, we need fluoride to keep our teeth healthy and cavity-free • However, if we ingest too much fluoride, we are susceptible to getting several diseases, including . . . • Dental fluorosis • Skeletal fluorosis • Brain disorders Remember, just because something is good for you doesn’t mean more of it is better!