New findings: Fluoridation safety update, TMD pain concerns in teens, success of SDF for caries patients

TMD pain in teens highlight greater need for psychosocial screenings 

Although many temporomandibular disorders (TMDs) emerge during adolescence, there is a significant research gap examining how TMDs affect this age group. However, a recent cross-control study found that teens who self-report TMD symptoms are in greater pain than those who don’t. 

This suggests a growing need for more intentional psychosocial screenings in the dental setting, as these screening allow providers to identify patient stress, depression, and anxiety—which are the most common self-reported side effects of TMD-related pain.¹ 

These psychosocial screenings can prevent both physical pain and the mental health conditions that result from TMD; they are especially important considering many teens struggling with mental health do not have regular visits with primary care providers. However, many of them do receive consistent dental care. 

A 2025 study in the National Library of Medicine found that although 62% of dentists believed mental health screenings were feasible to conduct and 59% felt comfortable doing them, only 35% were willing to run them in their practice.² 

Journal of the American Dental Association (JADA) researchers noted that: “Incorporating psychosocial screening and headache assessment into routine care for adolescents with TMDs may improve early identification of those at greater risk of developing pain-related disability and facilitate timely, targeted intervention.”¹ 

New research underscores fluoride’s multifaceted benefits 

Community water fluoridation (CWF) is safe, financially beneficial, and effective at preventing caries and therefore should not be discontinued, according to new research.³ 

Discourse and skepticism surrounding the safety of fluoridated water (purported in part by 2024 study associating fluoride with low IQ scores in children ) had led to numerous states pushing for fluoridation bans.⁴ 

JADA examined dental literature from January 1, 2014, through December 31, 2025, analyzing national and independent reports on CWF as a caries prevention tactic. They found that fluoridated water consumed at safe levels reduced caries by roughly 25%. Those who drank unfluoridated water displayed higher caries levels and a greater need for restorative dental procedures.³ 

Thus, CWF protected community dental health and saved individuals from spending money on dental care. Researchers concluded that “its cost is consistently a small fraction of the increased treatment costs expected in the absence of fluoridation.” This is especially true for those in rural or underserved areas where access to dental care can be stymied by  both physical and financial barriers; an inability to either get to a dental office or pay for expensive dental treatment can be alleviated by the type of protection CWF has to offer. 

As a result, dental professionals should advocate for community water fluoridation and advise policy makers and patients pushing for fluoride bans to think twice about the consequences a lack of CWF could initiate.³ 

SDF as a protective measure for adults with caries 

Silver diamine fluoride (SDF) is typically applied in pediatric dentistry, but it can also protect the longevity of treated teeth in adult patients with caries. 

Caries is a growing threat for adults, particularly older patients vulnerable to rapidly progressing root caries that are difficult to restore and costly to manage. JADA analyzed 1,772 patients and 2,985 SDF-treated teeth to determine SDF’s effectiveness on adult teeth. Results showed that: 

• Tobacco use was linked to more subsequent treatments, whereas multiple SDF applications reduced them 

• Teeth with preexisting crowns were more likely to require root canal therapy or extraction⁵ 

Overall, SDF offers a minimally invasive, low-cost way to reduce caries and significantly improve tooth survival, especially through multiple applications. “Recognizing the benefits of SDF and understanding the potential challenges posed by means of certain patient characteristics can guide clinical practice and inform strategies for optimizing SDF treatment in adults,” said the researchers. 

The results of this study point to SDF as a solution for managing caries, reducing the need for complex restorations, and supporting equitable access to treatment for those in underserved communities. As the aging population expands and with more adults retaining natural dentition longer, JADA notes that “these advantages often outweigh the drawback of SDF causing black staining of the caries dentin.” 

References 

1. Marando CA, Sangalli L, Ayscue R, et al. Temporomandibular disorders: a cross-sectional case-control study. J Am Dent Assoc. 2026;157(4):383-394. doi:10.1016/j.adaj.2025.10.019 

2. Mishler O, Trembley C, Oates TW, et al. Dental providers' perceptions toward mental health screening at routine practices: a mixed-methods approach. BMC Oral Health. 2025;19;25(1):1208. doi:10.1186/s12903-025-06300-y 

3. Warren JJ, Levy SM, Kumar JV. An update on community water fluoridation, part 1. J Am Dent Assoc. 2026;157(4):334-343. doi:10.1016/j.adaj.2026.01.009 

4. Jennemann A. Get the facts: What states have considered fluoride bans? Updated May 23, 2025. WBALTV. https://www.wbaltv.com/article/what-states-have-considered-fluoride-bans/64855417  

5. Al Saffer A, Kolker JL, Guzman-Armstrong S, et al. Longitudinal effectiveness of silver diamine fluoride on caries lesions in adults: a retrospective study using a dental school database. J Am Dent Assoc. 2026;157(4):344-354. doi:10.1016/j.adaj.2025.11.010