Physicochemical perspectives on the cariostatic mechanisms of systemic and topical fluorides.

The cariostatic mechanisms of systemic and topical fluoride agents are considered in light of a previously proposed model for the caries process. It is noted that fluoride, in principle, can induce a cariostatic effect: by (1) reducing enamel solubility when incorporated into the mineral structure; (2) by fostering the remineralization of incipient enamel lesions and the deposition of fluoridated phases (within dental plaque) which provide a source of mineral ions (Ca, P, F) under acidic conditions; and (3) by reducing the net rate of transport of matter out of the enamel surface, under acidic conditions, by inducing the reprecipitation of fluoridated hydroxyapatite phases within enamel. It is also noted that relatively high (approximately 12,000 ppm) concentrations of professionally applied topical fluorides significantly reduce the rate of acid production of cariogenic organisms (e.g., S. mutans). Based on an analysis of available clinical and laboratory data, it is concluded that the benefits provided by water fluoridation result, to a large degree, from a topical effect. It is suggested that clinical procedures be developed to establish and maintain low levels of free fluoride in plaque fluid. It appears that this will require frequent exposure to topical fluorides.