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Fluoride contributes significantly to maintaining dental health.
Today, however, our children do not receive fluoride in their drinking water.
Despite the updated recommendations of the Ministry of Health, most children's toothpastes sold today do not contain fluoride in sufficient concentrations to protect the teeth.
Therefore, if we want to guarantee our children healthy teeth and without cavities, it is not enough that we brush their teeth twice a day and make sure that they do not eat too many foods that are harmful to the teeth, we must also make sure that the toothpaste we use gives them sufficient protection.
If so, what is fluoride and why is it important to pay attention to the issue in order to protect our children's teeth?
Fluoride, the negative ion of the element fluorine, affects the health of the teeth in several ways: it prevents the mass of minerals from the enamel crystal, the outer and strongest layer of the tooth, encourages the addition of minerals that strengthen the enamel and interferes with the activity of the bacteria that damage the teeth by excreting acid.
Until the early 1980s, more than 90 percent of all children in Israel suffered from dental problems, and tooth decay was a very common problem among children.
Since 1981, the year in which the drinking water fluoridation project began in the country, the condition of Israeli children's teeth has been improving.
More about brushing teeth in children:
Big mouth: this is how to brush teeth correctly for preschool children
Here is a really good reason to make your child brush their teeth
When fluoride is absorbed in the body systemically through drinking water, it strengthens the enamel of the teeth from the stages of their development and before they erupt into the oral cavity, and later when it is excreted in saliva and maintains sufficient levels of fluoride in the mouth, which continue to protect the teeth.
Check the toothpaste.
A toddler brushing his teeth (Photo: ShutterStock, Vitalinka)
However, although the fluoridation of drinking water is considered one of the greatest successes of public health in the 20th century, in 2013 the Minister of Health at the time, Yael German, decided to stop water fluoridation, and from 2014 until today, the drinking water in the country does not contain the fluoride required to maintain health the teeth, and the results are a continuous damage to the condition of children's teeth.
A study carried out by the Macbident research unit examined the incidence of tooth decay in children between 2014 and 2019.
The study indicated that the cessation of fluoridation of drinking water in Israel resulted in a very significant increase in dental morbidity in children.
The study, published this year in the Israel Journal of Health Policy Research, also confirms findings from previous studies on the importance of fluoridation, that the damage to the children's teeth increases the lower the socio-economic status of their family.
This serious injury not only increased the morbidity, but, of course, caused higher treatment costs for both the individual and the state.
The recommendations have been changed but the fluoride is still missing
Following the ongoing damage to the health of children's teeth, in June 2021, the Ministry of Health published updated recommendations regarding toothpastes for children, which were adapted to the latest international recommendations.
The concentration of fluoride in toothpastes is measured by an index that examines the number of particles per million (PPM - an accepted index for measuring the concentration of substances).
Studies show that a fluoride concentration below PPM1,000 (parts per million) in toothpastes is too low to benefit tooth health.
According to the updated recommendations of the Ministry of Health, children's teeth should be brushed, from the moment the first tooth erupts, with toothpastes with a fluoride concentration of 1,000 PPM.
Up to the age of two, states the updated procedure of the Ministry of Health, a small amount of paste the size of a grain of rice should be put on the brush, and from the age of two to six a paste the size of a pea should be put on the brush.
Above the age of six, the recommendations are to switch to a toothpaste with a fluoride concentration of PPM 1,400-PPM 1,500.
The problem is that, despite the recommendations, until today the companies that produce the children's toothpastes have not changed the concentration of fluoride in the toothpastes to match the new conditions.
As of today, the toothpastes for children up to two years of age that are sold in Israel, some of them, do not contain fluoride at all.
In the toothpastes for children between the ages of two and six that are sold today, the concentrations of fluoride in a significant part of the pastes range from PPM500 to PPM600, and only in a small part of the toothpastes can you find fluoride concentrations that approach the required concentration according to the updated recommendations and the lack of fluoride in the drinking water in Israel.
Therefore, until fluoride is returned to the drinking water, we the parents are the only ones who can act to protect our children's teeth.
By brushing the teeth twice a day and checking the fluoride concentration in the toothpaste we purchase.
Remember to check the amount of fluoride in the ointments, and check that it contains 1000 units per million of fluoride, as recommended by the Ministry of Health.
Prof. Jonathan Man is the director of medical research, Maccabi-Dent and the Department of Community Dentistry
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fluoride