Carl Maronich (Host): This is BayCare HealthChat. I'm your host Carl Maronich, and with me today is Dr. Frank Sierra, pediatric dentist from BayCare Health System, and we'll be talking about fluoride and kids' dental health. Dr. Sierra, welcome to the podcast.

Dr. Frank Sierra: Thank you, Carl. Thank you.

Carl Maronich (Host): Yeah. Well, let's start maybe by talking about just what fluoride is and how it contributes to the strength and health of our teeth, especially in children.

Dr. Frank Sierra: Certainly, fluoride is a naturally occurring mineral. It's found in soil, water, and certain foods. And in dentistry, and in medicine, we use fluoride because it has a proven ability to protect teeth from cavities. It's been studied for decades endorsed by the American Academy of Pediatric Dentistry, the American Dental Association, and the American Academy of Pediatrics as a safe and effective way to prevent tooth decay when used correctly.

Carl Maronich (Host): And fluoride in drinking water. Perhaps we could talk a little bit about that and what the prevailing thought is these days on fluoride in drinking water.

Dr. Frank Sierra: Certainly, water fluoridation was introduced decades ago, and introduced as a public health measure after strong evidence showed that it significantly reduced cavities in children and adults. The Centers for Disease Control and Prevention has recognized that water fluoridation is one of the greatest public health achievements in the 20th century because of its benefits to everyone, regardless of income, access to dental care. And at optimal levels, currently the recommended levels of 0.7 PPAR per million, it provides a low, consistent exposure to fluoride that helps protect teeth throughout the day.

Carl Maronich (Host): Many communities add fluoride to the water, but I understand that in July of 2025, Florida decided to stop adding additional fluoride to all public water. Is that correct?

Dr. Frank Sierra: It is, there's not so much that there's been any real controversy regarding the fluoridation benefits, but basically is, do we want to add other things to our drinking water?

Carl Maronich (Host): Sure. Are there any risks associated with fluoride?

Dr. Frank Sierra: Well, like many things in health care, fluoride is safe when it's used in the right amount. And it can cause problems if it's used excessively. The most common risk in children is dental fluorosis. This happens when there's too much fluoride, which is swallowed while the permanent teeth are still forming.

Mild fluorosis looks like white spots on the teeth. Generally doesn't affect the health or the function, but it can create some structural issues. And in some areas of where naturally occurring fluoride is very high, in certain natural water sources and wells, fluorosis can be endemic in areas, even those that are not added fluorides.

The other concerns are the amount that they're ingesting from other sources, like toothpaste where the child is actually eating the toothpaste, not spitting, but swallowing the toothpaste. So, to minimize this risk is we recommend the correct amount of toothpaste, supervising toothbrushing, and the thoughtful use of any additional fluoride sources like fluoride supplements.

Carl Maronich (Host): The white spots on teeth, is that treatable? And it sounds like in many cases it's just a cosmetic issue more than a structural issue, although it can be, as you said. But is that something that's treatable or can be taken care of?

Dr. Frank Sierra: Absolutely, the mild fluorosis and other white spot issues of where areas are hypo mineralized or just some other small cosmetic defects of where those can be addressed, with very conservative dental treatments, such as bonding or some other techniques of which two structures not removed at all, but just augmented to create a smooth surface.

Carl Maronich (Host): Doctor, how often should children be seeing a pediatric dentist for fluoride treatments, if that's necessary, or just checkups?

Dr. Frank Sierra: We consider that on a case-by-case basis so that there is an individualized approach to the timing of our dental recalls and our preventive care. For the most part, it takes approximately six months for cavities from a non-detectable level to become detectable. And so, in practice, the majority of our children would be optimal for every six months of where they would have dental checkups. The fluoride application would also depend on their caries [dental cavities] risk, their caries experience and their age. So that, while we're speaking of dental visits, fluoride varnishes can also be applied at the pediatrician's office as well.

And it's part of the well-baby protocols until about two or three years old. And so, it would depend on the caries experience that the child may have. It depends on the primary caregiver’s caries experience as well because we're sharing the same bacteria so that the parent that has a high cavity rate may require a more frequent fluoride application for the child. And those at low risks, approximately every six months would be optimal.

Carl Maronich (Host): Is there a way for the parent at home to detect or keep an eye on fluoride in their kids' teeth, or is that really something that is done at the dentist?

Dr. Frank Sierra: There's no indicators from a parental standpoint, or even from other medical standpoints to see where we're at as far as the need for fluoride other than to be seen by their dental provider to assess their caries risks and their caries status, gingival health and just overall oral health. And then, as part of that preventive plan, determine the optimal fluoridation. So, it would be a professional approach.

Carl Maronich (Host): Yeah, you mentioned earlier the idea of supervision over brushing and back to the swallowing of toothpaste and such. So really parents at that point are able to affect some level of monitoring of their kids by making sure and reminding them not to swallow the toothpaste, but spit it out, that kind of thing.

Dr. Frank Sierra: Absolutely. I'm glad you brought that up. If you remember, many, many, many years ago though, TV commercials for toothpaste had a very large ribbon of toothpaste on the toothbrush, and you don't see that anymore. We've been able to remove that from ads so that the idea of the amount of toothpaste on the toothbrush needs to be metered. We don't usually have it as a certain age, but more of developmental and how the child is functioning. So a child that is not spitting on command so that they spit before they swallow. And that can happen at three, four, five, maybe eight years old. It all depends on the child, until they're actively spitting, then we should use about a grain of rice amount of toothpaste on the toothbrush. And that be placed by the parent. Once they are consistently spitting and before, swallowing, then we would increase that to about a pea size amount of the toothpaste on the toothbrush.

Carl Maronich (Host): So kind of the size of that would grow as the kids get older and are better at brushing their teeth and spitting, not swallowing.

Dr. Frank Sierra: Exactly. That would assure the systemic ingestion of that toothpaste does not occur. And that would limit the only asystemic fluoridation that we'll be achieving would be through our fluoridated water sources.

Carl Maronich (Host): Speaking of diet, Doctor, are there things from a diet standpoint related to fluoride that parents might want to be aware of?

Dr. Frank Sierra: From the dietary standpoint, I think many people assume that processed foods would not contain fluoride and that is not true. Even drinking water that's derived from springs and has all of the appearance of a “natural source,” may have fluoride. Many times unregulated.

All of our processed foods are processed with water that is likely to have been fluoridated. So you'll gain a little background fluoride from those sources. Those that are concerned of their water sources being optimal from a water filtration standpoint, only reverse osmosis filtration systems are effective at removing fluoride from our drinking water. All others that are simple charcoal filters or even very advanced filters that do not include reverse osmosis actually do not remove fluoride.

And answer to your question, the fluoride can be received from other sources in the diet.

Carl Maronich (Host): Which reinforces the idea of making sure you're seeing the dentist regularly so the fluoride's impact on the teeth is being monitored by a professional.

Dr. Frank Sierra: That is correct.

Carl Maronich (Host): Doctor, overall, you have an opportunity here to remind parents of some of the things they want to keep in mind when it comes to their children's health.

What would you say is kind of general guidelines, the fluoride issue, other things, as a word to parents about their kids' teeth health?

Dr. Frank Sierra: I am glad you asked because we look at fluoride and we look at brushing as being the largest contributor to our dental health. When we're looking at caries prevention, the amount of sugar in our diet, which can be natural sugars, it doesn't mean it necessarily is candy and sticky favors, but can be just background, fermentable, carbohydrates that are in our diet. That is what the fuel that is used by the bacteria in our mouth to create the acid, which creates the cavities. So toothbrushing will disrupt the bacteria, the fluoride works in many ways. But the main function is creating a more resistant enamel to the acid, but we also need the bacteria that is naturally occurring in our mouth. There isn't at this point in technology, a significant way of altering the bacteria in our mouth and the virulence of the bacteria in our mouth. So we have little control over that.

But, the third is the fuel for the cavities which is the sugars. If we improve on any one of those, if we have a very strong enamel structure, if we have a low sugar diet and we have a bacterial load that is less virulent. We have a lower chance of having cavities.

But the same is if you just remove one of those factors, you'll reduce your chances of cavities greatly. But you do need all three to have cavities.

Carl Maronich (Host): Some great thoughts there, Doctor. We appreciate it. A lot of great information about the things parents need to remember when it comes to their children's tooth health. Well, Doctor, thanks so much for being a part of the podcast.

Dr. Frank Sierra: Well, appreciate the opportunity and thank you very much.

Carl Maronich (Host): Yeah, that's Dr. Frank Sierra, pediatric dentist with BayCare Health System, and this has been BayCare HealthChat. Head over to the website BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all other air podcasts.

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