Chapter 12. Trace Minerals
Fluoride’s Functional Role
Fluoride is known mostly as the mineral that combats tooth decay. It assists in tooth and bone development and maintenance. Fluoride combats tooth decay via three mechanisms:
- Blocking acid formation by bacteria
- Preventing demineralization of teeth
- Enhancing remineralization of destroyed enamel
Fluoride is added to drinking water in 45% of communities in Canada. In British Columbia, only 3.7% of the population has access to fluoridated water. Fluoridation of water prevents, on average, 27 percent of cavities in children and between 20 and 40 percent of cavities in adults but it can be expensive.
The optimal fluoride concentration in water to prevent tooth decay ranges between 0.7–1.2 milligrams per liter. Exposure to fluoride at three to five times this concentration before the growth of permanent teeth can cause fluorosis, which is the mottling and discoloring of the teeth.
Figure 12.7 A Severe Case of Fluorosis
Fluoride’s benefits to mineralized tissues of the teeth are well substantiated, but the effects of fluoride on bone are not as well known. Fluoride is currently being researched as a potential treatment for osteoporosis. The data are inconsistent on whether consuming fluoridated water reduces the incidence of osteoporosis and fracture risk. Fluoride does stimulate osteoblast bone building activity, and fluoride therapy in patients with osteoporosis has been shown to increase BMD. In general, it appears that at low doses, fluoride treatment increases BMD in people with osteoporosis and is more effective in increasing bone quality when the intakes of calcium and vitamin D are adequate.
Dietary Reference Intake
The Adequate Intakes (AI) for fluoride, but has not yet developed RDAs. The AIs are based on the doses of fluoride shown to reduce the incidence of cavities, but not cause dental fluorosis. From infancy to adolescence, the AIs for fluoride increase from 0.01 milligrams per day for ages less than six months to 2 milligrams per day for those between the ages of fourteen and eighteen. In adulthood, the AI for males is 4 milligrams per day and for females is 3 milligrams per day. The UL for young children is set at 1.3 and 2.2 milligrams per day for girls and boys, respectively. For adults, the UL is set at 10 milligrams per day.
Table 12.10 Dietary Reference Intakes for Fluoride
|Age Group||AI (mg/day)||UL (mg/day)|
|Infants (0–6 months)||0.01||0.7|
|Infants (6–12 months)||0.50||0.9|
|Children (1–3 years)||0.70||1.3|
|Children (4–8 years)||1.00||2.2|
|Children (9–13 years)||2.00||10.0|
|Adolescents (14–18 years)||3.00||10.0|
|Adult Males (> 19 years)||4.00||10.0|
|Adult Females (> 19 years)||3.00||10.0|
Source: Institute of Medicine. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. January 1, 1997. http://www.iom.edu/Reports/1997/Dietary-Reference-Intakes-for-Calcium-Phosphorus-Magnesium-Vitamin-D-and-Fluoride.aspx..
Dietary Sources of Fluoride
Table 12.11 Fluoride Content of Various Foods
|Food||Serving||Fluoride (mg)||Percent Daily Value*|
|Fruit Juice||3.5 fl oz.||0.02-2.1||0.7-70|
|Crab, canned||3.5 oz.||0.21||7|
|Rice, cooked||3.5 oz.||0.04||1.3|
|Fish, cooked||3.5 oz.||0.02||0.7|
|* Current AI used to determine Percent Daily Value|
Micronutrient Information Center: Fluoride. Oregon State University, Linus Pauling Institute. lpi.oregonstate.edu/mic/minerals/fluoride . Updated in April 29, 2015. Accessed October 22, 2017.