The World Health Organisation (WHO) classifies dental caries as a public health concern due to its prevalence and impact on populations worldwide, especially its painful and unbearable effects on children and some adults who do not use fluoridated toothpaste.

Fluoride in toothpaste has been found, through painstaking research, to be safe for caries prevention and was, therefore, introduced into toothpaste formulation in the early 1970’s.

The WHO promotes the use of fluoride as a key preventive strategy for dental caries and, therefore, recommends its use for tooth brushing twice daily.

Fluoride, a naturally occurring mineral ion, can be found in water, some food sources and even saliva.Over time, it has been accepted as the most important delivery agent in toothpaste for oral health.

The forms of fluoride compatible for toothpaste formulation are sodium fluoride (NaF), sodium monofluorophosphate (Na2PO3F), and stannous fluoride (SnF2). As indicated by the WHO and the Cochrane Database of Systematic Reviews, the recommended concentration of fluoride in toothpaste by most regulatory bodies around the world is within 1100ppm to 1500ppm.

Fluoride ions prevent cariogenic bacteria from producing acids in sugars and carbohydrates that potentially bind to these substances to break down the structure of the enamel.

This process is known as enamel remineralisation. In recent years, research has shown a sharp decline in dental caries among children in urban Ghana, driven by the availability of affordable fluoride toothpastes.

The benefits of fluoride in toothbrushing have been established for many years; however, there are lingering negative concerns about the use of fluoride in toothpaste formulations worldwide, especially on social media.

Myths and facts

Some published articles state that the use of fluoride during pregnancy was associated with learning disabilities in children. It is argued that the presence of fluoride in the brain could affect the sensory and emotional nerves of children and should, therefore, be discouraged for use by pregnant women.

Another school of thought also indicates that fluoride poisoning/toxicity could be detrimental to the thyroid gland, causing conditions like depression, weight gain or cancer, etc. For children, excessive fluoride exposure can potentially weaken bones and cause dental fluorosis, a cosmetic effect characterised by white stains on the enamel.

Given these concerns, it is noteworthy that the WHO’s permissible levels of fluoride do not indicate fluorosis as a public health threat. Research indicates that most of the risk from fluoride ingestion is based on the dose of fluoride intake by children and not necessarily on fluorosis. No research has demonstrated that the dose of fluoride intake by children has been severe enough to affect their health.

No established data in literature exists on the toxicity or carcinogenic effects of fluoride toothpaste because the levels for toxicity to happen are extremely high, far above the WHO recommendation. Additionally, fluoride in toothpaste is always in regulatory recommendations.

To date, it is arguable that carcinogenicity is related to high levels of fluoride in toothpaste, and that assertion remains a myth that should be ignored. There has not been any correlation between fluoride use and the thyroid gland or cancerous cells.

Emerging alternatives

Plant and marine sources have long been used in the formulation of toothpastes due to the effects of secondary metabolites – antiviral, antibacterial, antimicrobial properties, etc. Modern trends of fluoride therapy in toothpastes seek the incorporation of more natural extracts because of the belief that natural products are safe and cost-effective. An example is the use of camellia sinensis and neem extracts in toothpaste to eliminate plaque and control dental caries due to their antibacterial properties.

Chewing sticks are still in use in most parts of Africa as the only source of oral care. Studies indicate that bioactive extracts from plants and marine sources possess a wide range of antimicrobial properties that disrupt the cell walls of cariogenic bacteria. Mahendra Gunde et al (2017) demonstrated that guava or neem leaves exhibit antimicrobial activity against Streptococcus mutans.

Conclusion

In summary, consumers should note that fluoride toothpaste is non-carcinogenic as it is researched to be safe for good oral hygiene, promotes confidence and a healthy life. The following recommendations should be considered:

• Fluoride toothpaste should be readily accessible and made affordable throughout Ghana, especially in the rural areas.
• Toothbrushing with fluoride toothpaste should be practised twice daily as it is the most effective way of keeping teeth clean and healthy.
• The public should always ensure that the maximum concentration of fluoride on their toothpaste label is up to 1500ppm.
• Children under six years old are recommended to use a pea-sized amount of toothpaste and should be supervised to avoid swallowing.
• Regulatory agencies should engage in continuous public sensitisation to debunk the myths of fluoride use, especially on social media platforms.
• It should be noted that fluoride is the only element that has been researched and shown to clean the teeth and prevent dental caries.
• The combined formulation of natural extracts with fluoride should also be encouraged to achieve the optimum results.