Floundering in fluoride fog.

In the last century, fl uoride, like penicillin, was heralded as a major public health advance in mankind's battle against disease and its eff ects. Today, fl uoride, like antibiotics, is under attack, a victim of its success, popularity, and ubiquity. When it comes to fl uoride in dental practice, today's clinician often has diffi culty separating fact from fi ction, solid from junk science, professional organization paranoia from pathophysiology. I, for one, am fl oundering in a fl uoride fog, fostered by frequent fears and fed by fragmented factual and fi ctitious factoids! I'm no longer sure about how fl uoride fi ts into the health of my patients. The recent " interim statement " by the American Dental Association (ADA) 1 about mixing baby formula with non-fl uoridated water is the latest illustration of the confusing information confronting clinicians. The ADA has just recommended that formula that requires mixing be constituted with fl uoride-free water, to reduce the likelihood of fl uorosis in teeth forming during this period of life. Systemic fl uoride is recommended for all people, beginning at six months of age 2 yet, this recent recommendation says not. Further confusing me is the ADA's support of the Food and Drug Administration's acknowledgement of the anti-caries benefi t of fl uoridated bottled water. 3 So, why not put fl uoridated water in formula? I am not the only one in a quandary. This past summer, in diff erent settings, I overheard two general dentists, with over 50 years of dental practice between them, reveal their fl uoride knowledge. One touted fl uoride given to mothers during pregnancy as the solution for early childhood caries. The other said she tried to avoid fl uorosis by always trying to keep topical fl uorides on the posterior teeth when giving of fi ce treatments! Today, I cannot speak to pediatricians about any aspect of pediatric dentistry without the conversation eventually shifting to fl uoride and their puzzlement about prescribing for today's Perrier-ed and PUR-ifi ed patients! When it comes to fl uoride, I fear we have become a profession of paranoia. In spite of the fact that the early childhood caries juggernaut just keeps rolling along, fl uorosis now has center stage as dentistry's chief pediatric concern. Michael Crichton, MD, the well-known author of science-based fi ction, aptly describes what is happening in dentistry in his recent book, " …