Work

The Cariostatic Mechanisms of Fluoride—An Updated Review

Year: 2026

Type: article

Abstract: Fluoride remains the keystone of evidence-based caries prevention by stabilizing the mineral balance at the tooth-biofilm-saliva interface. Contemporary understanding emphasizes a predominantly post-eruptive, topical mode of action where fluoride inhibits demineralization and accelerates remineralization. This interfacial catalysis is reinforced by pH-responsive calcium-fluoride-like reservoirs that release fluoride during acid challenges. While community water fluoridation confers population-level reductions, the most effective approach is sustaining low-level fluoride in the biofilm environment. Evidence confirms that toothpastes with 1000-1500 ppm fluoride provide a dose-response benefit in children, while 5000 ppm concentrations are indicated for high-risk scenarios such as root caries and xerostomia. Beyond physicochemical effects, fluoride modulates the oral microbiome by inhibiting bacterial enzymes and proton pumps, shifting community function toward a health-associated state without reducing overall diversity. In restorative dentistry, glass ionomer cements offer superior preventive effects against secondary caries compared to amalgam; however, marginal integrity, adhesive performance, and clinical technique, rather than fluoride release alone, remain the primary determinants of success. Despite well-known risks associated with high systemic intake, such as fluorosis, current evidence does not indicate genotoxic or adverse microbiome effects in humans from routine topical use of standard fluoride products at recommended preventive concentrations. Overall, fluoride's cariostatic value rests on frequent, low-level exposures that maintain tissues in a repair-favoring state.

Source: Dentistry Journal

DOI: 10.3390/dj14070390

Authors: Ivana Šutej, Krešimir Bašić, Kristina Peroš

Institution: University of Zagreb

Language: English

Topic: Dental Health and Care Utilization

Subfield: Periodontics

Field: Dentistry

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,413