Aida Mulic, Senior Scientist at NIOM

Tips and insights from NIOM’s webinar:

Recommended use of Fluoride


NIOM’s first webinar of 2018, Recommended Use of Fluoride was held earlier this month. 212 participants from the Nordic countries and the rest of the world were split into two sessions where NIOM Senior Scientist Aida Mulic held a 20-minute presentation. Mulic covered topics such as fluorides for caries reduction, the most effective and recommended fluoride products, patients at high caries risk and dental erosive wear.

If you missed the opportunity to join in on the webinar, the video-presentation is now available on NIOM’s webpage and YouTube channel. If you have specific questions regarding the topic, please contact us by email.

Each session had a subsequent 60-minute Q&A where Mulic and other NIOM staff answered more than 60 questions posed from interested attendees.

Below are the webinar presentation and more comprehensive answers to some of the received questions from the two sessions.


Expanded Q&A:

  • What is your current view of the relevance of fluoride toxicity arguments?

The recommended use of fluorides does not pose any health risk and daily use of fluoride toothpaste must be advocated to all patients. In addition patients at caries’ risk should be advised to use fluoride supplements. Some patients and their guardians may have concerns related to the use of fluoride and its toxicity. Most of these concerns are based on misunderstandings related to chemistry and effects of different fluoride compounds. If current recommendations are followed to prevent caries, the toxic effect of fluoride is almost non-existing.


  • Do you think we should recommend toothpaste with SnF to patients with erosive wear?

Active erosive lesions will progress if no adequate preventive measures are implemented. The most important measure in individuals with dental erosive lesions is to limit or eliminate acidic exposure. However, since the existing preventive, non-operative and non-invasive dental therapy concept to prevent caries is also implemented into prevention of dental erosive wear, patients at risk should be encouraged to use fluoride supplements.

Laboratory studies have been done (in vitro and in situ studies) showing promising effect of metal fluorides (stannous (SnF2) and titanium tetra (TiF4)) against dental erosive wear, so we recommend patients to use commercial products with metal fluorides, especially with SnF2. However, the availability of such commercial products is limited, and side effects such as metallic taste, numbness and discoloration have been reported.


  • Should we recommend fluoride rinse to every patient?

Today’s recommendations suggest that fluoride toothpaste is of primary importance and forms the foundation of caries prophylaxis. Therefore, regular use of fluoride toothpaste two times per day must be recommended to all patients: children, adolescents, adults and elderly. And for most patients this recommendation is sufficient when it comes to fluoride. However, for different reasons, there are patients who are not able to stay cavity-free, and for those we should have more to offer, in addition to dietary and oral hygiene instructions. These patients are recommended supplementary use of fluoride agents in addition to regular fluoride toothpaste. Toothpaste with a high fluoride concentration (e.g. 5000 ppm), fluoride mouth rinse (0.2% NaF) and fluoride tablets are all good candidates. An assessment based on the individual`s risk for developing caries disease decide the most appropriate product.