Systemic versus topical fluoride

The actual mechanism of fluoride action is still a subject of debate. A dogma has existed for many decades, that fluoride has to be ingested and acts mainly pre-eruptively. However, recent studies concerning the systemic effect of fluoride supplementation concluded that the caries-preventive effect of fluoride is almost exclusively posteruptive. Moreover, epidemiologists have cast doubt on the validity of the 'old' studies dealing with fluoride use. The concept of the posteruptive fluoride effect is supported by in vitro and in situ investigations demonstrating that the mode of action of fluoride can be attributed mainly to its influence on de- and remineralization kinetics of dental hard tissues. Therefore, topical fluoride application (e.g. in the form of fluoridated dentifrices) should be encouraged. There are still important questions open that need to be answered despite existing knowledge about the caries-preventive effect of fluoride.