Recently the federal government issued a recommendation to reduce the amount of fluoride in Americans’ drinking water. The decision sparked a renewal of the spirited debate surrounding fluoride that has raged for decades.
Indeed, fluoride is one of the most controversial issues in dentistry. There are many questions surrounding this mineral, which has long been used to protect teeth from decay. It is found not only in the public water supply in most U.S. towns, but also in mouthwash and toothpaste.
Over the years, we have received many questions about fluoride from patients at our Glendale, AZ-area offices, including:
A lot of people get very worked up over the issue of fluoride. They hear things from their friends, many of which are not true, that get them worried. It’s a topic full of misunderstandings and misperceptions.
Here’s our belief: The addition of fluoride to drinking water has been one of the smartest public health decisions ever made.
To explain why and to answer your lingering questions about fluoride, including whether fluoride is safe for kids, where it can be found, and what the benefits of fluoride are, read on.
It’s a mineral found in the Earth’s crust, which occurs naturally in soil, water, and other minerals such as fluorite. Fluoride can also be made in a laboratory. This is called synthesized fluoride, and it is what gets added to water, toothpaste and mouthwash.
Why does fluoride prevent tooth decay? It helps rebuild the enamel – the outer level of the tooth – which can be eaten away by bacteria. When enamel gets stronger, cavities are less likely to occur.
Fluoride has been added to the American water supply for more than half a century. Back in the 1930s, scientists discovered the link between decreased cavities in children and fluoride. In 1945, Grand Rapids, Mich., became the first town to add fluoride to its drinking water, and over the years, thousands of others followed.
Today, three-quarters of Americans have fluoride in their water supply, according to the Centers for Disease Control. People who have a private water supply do not have fluoride in their water. This is more common in rural parts of the country. As this chart shows, rural states have lower levels of fluoride in water supplies.
For a long time, the Department of Health and Human Services recommended a level of 0.7 to 1.12 milligrams of fluoride for every liter of water. As we mentioned, the HHS recently reduced that recommendation to 0.7, the first time it has adjusted its recommendation for fluoride levels in water since 1962.
Fluoride can be found in naturally in foods, seawater, soil, and in other minerals. In addition to the public water supply, it is added to mouthwash and toothpaste to help teeth develop stronger enamel. Dental offices such as ours outside of Phoenix, AZ, use fluoride treatments for patients to help guard against tooth decay.
The health benefits of fluoride include:
The American Medical Association, the World Health Organization, and the American Dental Association have all endorsed adding fluoride to the public water supply.
However, not everyone thinks fluoride works for teeth. Some do not think it’s a good idea.
The recent reduction in the HHS’s recommendation for fluoride in the water supply has sparked a lot of renewed speculation over the dangers of fluoride.
There have been many fluoride studies that have proven this mineral is safe not only for adults but also for children. Yet rumors persist that fluoride is toxic and harmful, in part because the public does not understand that fluoride levels in water, toothpaste, and mouthwash are very low.
Serious side effects such as acute fluoride toxicity, causing nausea and diarrhea, will occur when someone consumes 5 milligrams of fluoride for each kilogram of body weight, but the water supply does not have anywhere near that level of fluoride.
Opponents claim one of fluoride’s dangers is increasing the risk for other problems, including:
There is no credible research to back these claims, however. If there was, it would be absurd for the U.S. government to continue to advocate for inclusion of fluoride in water.
These false claims have been around for decades. Back in the 1950s, opponents claimed putting fluoride in the water supply was actually a fluoride hoax pulled by communists to try to bring down the United States. Other fluoride conspiracy theories include:
There has never been any credible evidence presented to support any of these ideas.
Over the years, people have filed lawsuits trying to get fluoride removed from the water supply, but no high-level courts have issued favorable rulings. This may be why the fluoride debate continues to flourish.
One proven side effect of an excessive amount of fluoride is fluorosis, a disorder that results in white marks developing on teeth. Fluorosis is a cosmetic condition that occurs when a child’s teeth are exposed to an excess of fluoride during the first eight years of their lives.
Severe cases of fluorosis can result in pits and darker stains forming on the teeth, occurring in about 1 percent of cases. Fluorosis is actually quite common, affecting a quarter of those ages 6-49 in the United States.
While fluorosis is caused by too much fluoride, it’s not necessarily from the water supply. Many kids drink mouthwash or swallow toothpaste when they are learning about dental hygiene; or a parent may not be aware that the drinking water in their house has fluoride and give their child a supplement. Still, the condition is not dangerous and is usually only noticeable to a dentist.
Because of the risk of fluorosis, it’s important for parents to understand a few basics about fluoride and dental care for kids. We’ll answer some of the questions we hear from parents most frequently in this section.
Many parents ask about fluoride for baby teeth. The recommendation on this from the ADA changed in 2014. Parents are now encouraged to use fluoride toothpaste to clean their baby’s teeth. Start out with a tiny sliver of toothpaste, about the size of a grain of rice, and use it to brush those early baby teeth.
Yes, fluoride toothpaste for toddlers is okay. Move up to a pea-sized dot of toothpaste once your child has turned 3, and remind your child not to swallow the toothpaste. Encourage them to rinse and give them lots of chances to spit the toothpaste as you brush.
Yes. Fluoride is not only safe, it can help guard against cavities. If you have ever been present when a child gets a cavity, you know it can be a difficult and scary experience. Fluoride helps prevent that from happening.
Yes. We recommend kids receive a fluoride treatment to help strengthen the enamel of their growing teeth and to guard against future tooth decay. This is especially important for kids who drink a lot of bottled water or who do not drink much tap water. They are not getting fluoride from the public supply, and so it’s vital they receive fluoride from another source.
Fluoride for adults can be helpful for those who do not have fluoride in their water supply or for those who drink a lot of bottled water. Talk to your dentist about your particular situation to get a recommendation on fluoride treatment.
Many parents want to get a better picture of how much fluoride their child gets in the water supply before getting a fluoride treatment. It’s always good to be fully informed. Contact your municipal water supply to get this information, as it varies from town to town. Then discuss with your dentist whether your child needs a fluoride treatment.
The vast majority of toothpaste sold in the United States have fluoride. Fluoride levels in toothpaste vary from brand to brand. You can find toothpaste made for babies and toddlers that does not have fluoride. However, the new recommendations urge use of fluoride toothpaste as soon as possible.
The ADA allows toothpaste to have up to 1,000 ppm per tube. If you see an ADA seal on the tube, you know the product falls under that level.
Yes. No studies have linked birth defects or miscarriage to fluoride.
Dentists can prescribe a fluoride tablet or drops to put in your child’s drink if your water supply is not fortified. For kids, dentists also can apply any of these three types of fluoride treatments:
Adults should use mouthwash and toothpaste with fluoride. Kids under the age of 6 should be monitored while they brush their teeth.
We’ve covered kids and fluoride and the great water fluoridation controversy, as well as the latest recommendations for fluoride for adults and children. Yet considering all the confusion over the years, you may still have questions about the safety of fluoride.
Here are the answers.
Yes. You can benefit from either a supplement or a treatment. Talk to your dentist about what solution is best for you.
No. People have claimed over the years that cancer can be caused by fluoride. This appears to be linked to the fact that fluoride can collect in growth plates where osteosarcoma, or a cancerous tumor in a bone, is likely to develop. That led to speculation that the fluoride could cause growth plate cells to grow rapidly, causing the cancer, but this has not been proven.
More than four dozen studies have examined a possible link between cancer and fluoride, and no equivocal evidence has been found.
There are certain groups who will benefit from fluoride treatment more than others, including:
A study came out in 2014 in the Lancet Neurology journal that argued fluoride should be classified as a neurotoxin and could increase the occurrence of autism. The study also linked fluoride and brain problems, saying the intake of the mineral could lower kids’ IQs by an average 7 points.
The study is so recent that there is not a lot of other research in the field to compare it to. While Lancet is a respected journal and one of the researchers hails from Harvard, this link between autism and fluoride has never been proven before. It would be premature to say the study is definitive.
Fluoride toothpaste is not harmful or dangerous as long as you use the toothpaste as intended. Do not eat or swallow the toothpaste, as this can increase the level of fluoride in your body above the optimal level and lead to higher risk of fluorosis.
Fluoride in water is good. It has many benefits, including:
The addition of fluoride to water is particularly helpful for those who cannot afford dental care and would not otherwise receive dental treatments.
No. This is an old wives’ tale. Toothpaste with fluoride has been linked to allergic reactions, however, that are often mistaken for acne. These red bumps pop up around the mouth. It does not necessarily mean that the person with the allergic reaction is reacting to fluoride, though. Often they are allergic to a flavoring in the toothpaste, such as mint or cinnamon.
Now that we have examined all the evidence for and against fluoride, from its effects on the human body to how it impacts tooth decay to where to find it, you can make your own decision on whether you believe fluoride is toxic.
The overwhelming evidence points to no.
Fluoride is a smart way to protect teeth for you and your family. Contact your dentist to discuss options for fluoride treatment or to determine whether you could benefit from a different toothpaste or mouthwash containing fluoride.