Contribution to the physicochemical rationale for the caries reducing effect of fluoride

The effect of fluoride on the stability of apatites containing Na+ and CO3(2)- ions is described qualitatively. Also the boundaries of the apatite stability field in the quasi-septary system CaO - P2O5 - H2O - Na2O - CO2 - NaF - MX are presented. At these boundaries brushite (or monetite), octocalciumphosphate, calcite and calcium fluoride can become stable solid phases. As a consequence, certain mechanisms for the caries reducing effect of fluoride gain probability over other proposed mechanisms. First, it is likely that endemic fluoride yields more fully mineralized enamel which in turn results in a lower initial rate of the caries process. Second, after eruption the mineral in the tooth superficial layer is bound to accumulate fluoride on the surface of its crystals. This causes a slower rate of the crystal surface dissolution at that site and, hence, a thicker and denser intact superficial layer over the lesion. Finally, the formation of a precipitate of fluorhydroxyapatite and perhaps also of calcium fluoride is promoted in the plaque during cycles of metabolic activity. Subsequent dissolution of the CaF2 and transformation of the fluorhydroxyapatite sets free Ca+ and F- ions. Both of these ions promote the remineralization of the lesion during periods of metabolic rest whereby brushite or monetite are transformed back into apatite.