FLUORINE AND DENTAL CARIES 195 While the literature does not offer satisfactory evidence as to the comparative topical effectiveness of fluorine in various forms, it would seem reasonable that the caries- reducing effectiveness of fluorine might be reduced as much as its toxicity by admixture with other products which lower its absorb- ability. With more specific reference to the possible deleterious effects of the topical application of fluorine DeEds (26) reported on the use of ammonium fluoride to produce a rapid bleaching of teeth, and stated that there was a danger of producing mottled enamel. An editorial in the yourhal of the ztmerican Medical ztssociation (28) warned that the topical use of fluorine would produce mottling, although this was vigor- ously denied by Visscher (55) and Wilbur (59). While it may be improbable that the topical application of fluorine would produce mottling, it does not seem impossible that whatever shell of enamel was affected sufficiently to alter the caries process might also be rendered brittle just as fluorosed enamel has been reported to be fragile by Applebaum (2) and Smith (52). If it is assumed that as a result of topical application fluoride is to be held in contact with the teeth in a sufficiently strong solution for a sufficiently long time to permit adsorption on enamel, there may also be adsorption on root areas which might exaggerate the hard- ness of any calculus deposits present, and stimulate the further formation of calculus. An editorial in the yourhal of the Canadian Dental ztssociation (30) advises against the addition of fluorine to drinking water, citing among the reasons the observations of Gottlieb that fluorine is bad for the tooth root, leading to more peridontal disease and loss of teeth. Dean (21) has also observed that fluorine in drinking water as high as 4 ppm. seems to predispose to gingivitis. CONCLUSION Opinions as to the justification for the addition of fluoride to dentifrices range from a conviction that such a step would be useless if not positively dangerous, to the opinion of one author that the incorporation of fluoride in denti- frices should be made compulsory. It is the writer's present judgment that the effectiveness of adding minor amounts of fluoride to a dentifrice for lay use is not estab- lished, that the potential dangers of adding fluorine to a dentifrice are not to be ignored, and that, for the present, the use of' fluorides should be limited to applications which are under strict clinical supervision. REFERENCES (1) A.D.A. Research Commission, 7. Am. Dent. Assn., 32, 350-351 (March, 1945). (2) Applebaum, E., Dent. Cosmos, 78, 969-980 (September, 1936). (3) Armstrong, W. D., and Brekhus, P. J., 7- Dent. Res., 17, 27-30 (February, 1938), (4) Armstrong, W. D., North West Dentis- try, 21, 125-128 and 142 (July, 1942).
196 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS (5) (6) (7) (8) (9) (lO) ,(11) ß (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24) (25) (26) (27) (28) Arnim, S.S., Aberle, S. D., and Pitney, E. H., y. rim. Dent. dssn., 24, 478480 (March, 1937). Atkins, A. Paul, Ibid., 31, 353-357 (March, 1944). Bibby, B. G., and Van Kesteren, M., y. Dent. Res., 19, 391402 (August, 1940). Bibby, B. G.,Ibid., 23, 202 (June, 1944). Bibby, B. G., y. rim. Dent. dssn., 34, 26-32 (Jan. 1, 1947). Bibby, B. G., Zander, H. A., Mc- Kelleget, Mary, and Labunsky, Bertha, y. Dent. Res., 25, 207-211 (August, 1946). Black, G. V.', and McKay, F. S., Dent. Cosmos, 58, 132-156 (February, 1916). Box, Harold K., and Hodgins, H. J., Eng. & Contract Record, 57, 10-13, 28 (May 31, 1944). Bunting, Russell W., Crowley, Mary, Hard, Dorothy G., and Keller, Mar- garet, Dent. Cosmos, 70, 1002-1009 (October, 1928). Buonocore, Michael G., and Bibby, Basil G., y. Dent. Res., 24, 103-108 (April, 1945). Cheyne, Virgil D., 3. rim. Dent. dssn., 804-807 (May, 1942). Cheyne, Virgil D., y. Dent. Res., 21, 320 (June, 1942). Churchill, H. V., Ind. Eng. Chem., Ind. Ed., 2:3, 996-998 (September, 1931). Cox, Gerald J., Matuschak, Margaret C., Dixon, Sara F., Dodds, Mary L., and Walker, W. E., 3- Dent. Res., 18, 469-490 (December, 1939). Cox, Gerald J., and Levin, Margaret Matuschak, "Fluorine and Dental Health," rim. dssn. ddv. Sci., 68-73 (1932). Crichton-Browne, James, Lancet, 2, 6 (July 2, 1892). Dean, H. T., .e. rim. Med., 107, 1269- 1273 (October' 1936). Dean, H. Trendley, "Dental Science and Dental Art," Chapter XII, pp. 387-414, Lea & Febiger (1938). Dean, H. Trendley, Jay, Philip, Arnold, Francis A., Jr., McClure, Frank J., and Elyore, Elias, Pub. Health Reports, 54, 862'-888 (May 26, 1939). Dean, H. Trendley, Jay, Philip, Arnold, Francis A., Jr., and Elyore, Elias, Ibid., 56, 365-381 (Feb. 28, 1941). Deatherage, Chas. F., y. Dent. Res., 22, 173-180 (June, 1943). DeEds, Floyd, y. rim. Dent. dssn., 19, 861-862 (May, 1932). Editorial, Ibid., 27, 1115-1118 (July, 1940). Editorial, 7. din. Med. .dssn., 124, 98 (Jan. 8, 1944). (29) Editorial, Brit. Med. 7., 461462 (April 1, 1944). (30) Editorial, 7. Can. Dent. dssn., 10, 547-549 (December, 1944). (31) Gay-Lussac, DeM. and Berthollet, /Inn. de Chim., 55, 258-275 (1805). (32) Greenwood, D. A., Blayney, J. R., Skinsnes, O. K., and Hodges, P. C., 7. Dent. Res., 25, 311-326 (October, 1946). (33) Hodge, Harold C., Proc. Dental Cen- tenary Celebration (March, 1940), pp. 640-646. (34) Hodge, Harold C., 3. rim. Dent. dssn., 29, 2063-2068 (November, 1942). (35) Irving, J. T., Nature, 154, 149-150 (July 29, 1944). (36) Jay, Philip, "Fluorine and Dental Health," rim. dssn. ddv. Sci., 63-67 (1942). (37) Jay, Philip, and Arnold, F. A., Jr., rim. Coll. Dentists, 12, 54-56 (March, 1945). (38) Jordan, E. A., Wood, O. B., Allison, James A., and Irwin, Vern D., 7. drn. Dent. Atssn., :33, 1385-1391 (November, 1946). (39) Klein, Henry, _Pub. Health Reports, 60, 1462-1467 (Dec. 7, 1945). (40) Knutson, John W., Armstrong, Wallace D., Ibid., 58, 1701-1715 (Nov. 19, 1943). (41) Knutson, John W., and Armstrop. g, Wallace D., Ibid., 60, 1085-1090 (Sept. 14, 1945). (42) Knutson, John W., and Armstrong, Wallace D., Ibid., 61, 1683-1689 (Nov. 22, 1946). (43) Lawrenz, M., and Mitchell, H. H., Nutrition, 22, 91-101 (July 10, 1941). (44) Lipmann, F., Blochem. Zeitsche, 196, 3 (1928). (45) Machle, Willard, Scott, E. W., and Largent, E. J., 7. Ind. Hygiene and Tox., 24, 199-204 (September, 1942). (46) Machle, Willard, and Largent, E. J., Ibid., 25, 112-123 (March, 1943). (47) McClure, F. J., 7. Nutrition, 22, 391- 398 (October, 1941). (48) McClure, F. J., and Kinset, C. A., _Pub. Health Reports, 59, 1543-1558 (Dec. 1, 1944) 1575-1591 (Dec. 8, 1944). (49) Miller, Benjamin J., _Proc. Soc. Exp. Bid. & Med., 39, 389-393 (November, 1938). (50) Morgareidge, Kenneth, and Finn, Sid- ney B., 7. Nutrition, 20, 75-84 (July, 1940). (51) Phillips, Paul H., and Lamb, Alvin R., drch. _Path., 17, 169-176 (January, 1934). (52) Smith, Margaret Cammack, Lanz, Edith M., and Smith, H. V., U. Ariz. Agri. Exp. Sta. Tech., Bulletin No. 32 (June 10, 1931).
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FLUORINE AND DENTAL CARIES 195 While the literature does not offer satisfactory evidence as to the comparative topical effectiveness of fluorine in various forms, it would seem reasonable that the caries- reducing effectiveness of fluorine might be reduced as much as its toxicity by admixture with other products which lower its absorb- ability. With more specific reference to the possible deleterious effects of the topical application of fluorine DeEds (26) reported on the use of ammonium fluoride to produce a rapid bleaching of teeth, and stated that there was a danger of producing mottled enamel. An editorial in the yourhal of the ztmerican Medical ztssociation (28) warned that the topical use of fluorine would produce mottling, although this was vigor- ously denied by Visscher (55) and Wilbur (59). While it may be improbable that the topical application of fluorine would produce mottling, it does not seem impossible that whatever shell of enamel was affected sufficiently to alter the caries process might also be rendered brittle just as fluorosed enamel has been reported to be fragile by Applebaum (2) and Smith (52). If it is assumed that as a result of topical application fluoride is to be held in contact with the teeth in a sufficiently strong solution for a sufficiently long time to permit adsorption on enamel, there may also be adsorption on root areas which might exaggerate the hard- ness of any calculus deposits present, and stimulate the further formation of calculus. An editorial in the yourhal of the Canadian Dental ztssociation (30) advises against the addition of fluorine to drinking water, citing among the reasons the observations of Gottlieb that fluorine is bad for the tooth root, leading to more peridontal disease and loss of teeth. Dean (21) has also observed that fluorine in drinking water as high as 4 ppm. seems to predispose to gingivitis. CONCLUSION Opinions as to the justification for the addition of fluoride to dentifrices range from a conviction that such a step would be useless if not positively dangerous, to the opinion of one author that the incorporation of fluoride in denti- frices should be made compulsory. It is the writer's present judgment that the effectiveness of adding minor amounts of fluoride to a dentifrice for lay use is not estab- lished, that the potential dangers of adding fluorine to a dentifrice are not to be ignored, and that, for the present, the use of' fluorides should be limited to applications which are under strict clinical supervision. REFERENCES (1) A.D.A. Research Commission, 7. Am. Dent. Assn., 32, 350-351 (March, 1945). (2) Applebaum, E., Dent. Cosmos, 78, 969-980 (September, 1936). (3) Armstrong, W. D., and Brekhus, P. J., 7- Dent. Res., 17, 27-30 (February, 1938), (4) Armstrong, W. D., North West Dentis- try, 21, 125-128 and 142 (July, 1942).
196 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS (5) (6) (7) (8) (9) (lO) ,(11) ß (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24) (25) (26) (27) (28) Arnim, S.S., Aberle, S. D., and Pitney, E. H., y. rim. Dent. dssn., 24, 478480 (March, 1937). Atkins, A. Paul, Ibid., 31, 353-357 (March, 1944). Bibby, B. G., and Van Kesteren, M., y. Dent. Res., 19, 391402 (August, 1940). Bibby, B. G.,Ibid., 23, 202 (June, 1944). Bibby, B. G., y. rim. Dent. dssn., 34, 26-32 (Jan. 1, 1947). Bibby, B. G., Zander, H. A., Mc- Kelleget, Mary, and Labunsky, Bertha, y. Dent. Res., 25, 207-211 (August, 1946). Black, G. V.', and McKay, F. S., Dent. Cosmos, 58, 132-156 (February, 1916). Box, Harold K., and Hodgins, H. J., Eng. & Contract Record, 57, 10-13, 28 (May 31, 1944). Bunting, Russell W., Crowley, Mary, Hard, Dorothy G., and Keller, Mar- garet, Dent. Cosmos, 70, 1002-1009 (October, 1928). Buonocore, Michael G., and Bibby, Basil G., y. Dent. Res., 24, 103-108 (April, 1945). Cheyne, Virgil D., 3. rim. Dent. dssn., 804-807 (May, 1942). Cheyne, Virgil D., y. Dent. Res., 21, 320 (June, 1942). Churchill, H. V., Ind. Eng. Chem., Ind. Ed., 2:3, 996-998 (September, 1931). Cox, Gerald J., Matuschak, Margaret C., Dixon, Sara F., Dodds, Mary L., and Walker, W. E., 3- Dent. Res., 18, 469-490 (December, 1939). Cox, Gerald J., and Levin, Margaret Matuschak, "Fluorine and Dental Health," rim. dssn. ddv. Sci., 68-73 (1932). Crichton-Browne, James, Lancet, 2, 6 (July 2, 1892). Dean, H. T., .e. rim. Med., 107, 1269- 1273 (October' 1936). Dean, H. Trendley, "Dental Science and Dental Art," Chapter XII, pp. 387-414, Lea & Febiger (1938). Dean, H. Trendley, Jay, Philip, Arnold, Francis A., Jr., McClure, Frank J., and Elyore, Elias, Pub. Health Reports, 54, 862'-888 (May 26, 1939). Dean, H. Trendley, Jay, Philip, Arnold, Francis A., Jr., and Elyore, Elias, Ibid., 56, 365-381 (Feb. 28, 1941). Deatherage, Chas. F., y. Dent. Res., 22, 173-180 (June, 1943). DeEds, Floyd, y. rim. Dent. dssn., 19, 861-862 (May, 1932). Editorial, Ibid., 27, 1115-1118 (July, 1940). Editorial, 7. din. Med. .dssn., 124, 98 (Jan. 8, 1944). (29) Editorial, Brit. Med. 7., 461462 (April 1, 1944). (30) Editorial, 7. Can. Dent. dssn., 10, 547-549 (December, 1944). (31) Gay-Lussac, DeM. and Berthollet, /Inn. de Chim., 55, 258-275 (1805). (32) Greenwood, D. A., Blayney, J. R., Skinsnes, O. K., and Hodges, P. C., 7. Dent. Res., 25, 311-326 (October, 1946). (33) Hodge, Harold C., Proc. Dental Cen- tenary Celebration (March, 1940), pp. 640-646. (34) Hodge, Harold C., 3. rim. Dent. dssn., 29, 2063-2068 (November, 1942). (35) Irving, J. T., Nature, 154, 149-150 (July 29, 1944). (36) Jay, Philip, "Fluorine and Dental Health," rim. dssn. ddv. Sci., 63-67 (1942). (37) Jay, Philip, and Arnold, F. A., Jr., rim. Coll. Dentists, 12, 54-56 (March, 1945). (38) Jordan, E. A., Wood, O. B., Allison, James A., and Irwin, Vern D., 7. drn. Dent. Atssn., :33, 1385-1391 (November, 1946). (39) Klein, Henry, _Pub. Health Reports, 60, 1462-1467 (Dec. 7, 1945). (40) Knutson, John W., Armstrong, Wallace D., Ibid., 58, 1701-1715 (Nov. 19, 1943). (41) Knutson, John W., and Armstrop. g, Wallace D., Ibid., 60, 1085-1090 (Sept. 14, 1945). (42) Knutson, John W., and Armstrong, Wallace D., Ibid., 61, 1683-1689 (Nov. 22, 1946). (43) Lawrenz, M., and Mitchell, H. H., Nutrition, 22, 91-101 (July 10, 1941). (44) Lipmann, F., Blochem. Zeitsche, 196, 3 (1928). (45) Machle, Willard, Scott, E. W., and Largent, E. J., 7. Ind. Hygiene and Tox., 24, 199-204 (September, 1942). (46) Machle, Willard, and Largent, E. J., Ibid., 25, 112-123 (March, 1943). (47) McClure, F. J., 7. Nutrition, 22, 391- 398 (October, 1941). (48) McClure, F. J., and Kinset, C. A., _Pub. Health Reports, 59, 1543-1558 (Dec. 1, 1944) 1575-1591 (Dec. 8, 1944). (49) Miller, Benjamin J., _Proc. Soc. Exp. Bid. & Med., 39, 389-393 (November, 1938). (50) Morgareidge, Kenneth, and Finn, Sid- ney B., 7. Nutrition, 20, 75-84 (July, 1940). (51) Phillips, Paul H., and Lamb, Alvin R., drch. _Path., 17, 169-176 (January, 1934). (52) Smith, Margaret Cammack, Lanz, Edith M., and Smith, H. V., U. Ariz. Agri. Exp. Sta. Tech., Bulletin No. 32 (June 10, 1931).

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