Fluoride and your Health
Fluoride, The good, the bad, and the ugly.
What is fluoride? Fluoride (F-) is an ion of the element fluorine. It is found naturally occurring in fresh water, the oceans, and soil. While it is not considered an essential nutrient, fluoride is often added to public drinking water to prevent and reverse tooth decay. In areas where there is already naturally occurring fluoride in water, the amount is adjusted to optimal levels set by the U.S. Department of Health and Human Services which is usually around 0.7 to 1.2 ppm (ppm = parts per million). Tooth decay is a common health problem that causes tooth pain, tooth loss, infection, and may cause bad breath. Fluoride is said to avert tooth decay by preventing the acid that is produced from bacteria in plaque from damaging teeth. Besides inhibiting tooth decay, fluoride may also re-mineralize a tooth's enamel.
- Fluoridation of drinking water
- Should I give fluoride to my child?
- Fluoride substitutes
- Removing fluoride from water
- More resources
Fluoridation of drinking water
In the 1930's dentists noticed that in certain parts of the United States some people had unusual stains on their teeth. The teeth with these stains (later called dental fluorosis, read more about that below) also appeared to be less prone to tooth decay. They discovered that the stains were there because of exposure to high levels (1 ppm of greater) of naturally occurring fluoride in their drinking water. In these areas with naturally fluoridated water people had lower incidences of cavities than areas where the drinking water had very low or no detectable levels of fluoride. Researchers sought a level of fluoride that would reduce the severity of dental fluorosis to no more than mild cases, but also have the added benefits of reduced tooth decay. Many areas began adding fluoride to public drinking water in 1945. Besides public drinking water, fluoride is now added to toothpaste, mouthwash, tablets, gels/foam, floss, and even vitamins. It can also be found in beverages and food that were prepared with fluoridated water.
The CDC reports that 66.2% of people in the United States receive fluoridated water through public water sources. Counties in each state add different levels of fluoride to the drinking water; these levels are usually around 1 ppm and are not to exceed 4 ppm. Some areas have very high levels of naturally occurring fluoride where the water is usually monitored to make sure the fluoride does not exceed levels of 4 ppm. Information on which counties add fluoride, and how much, to their drinking water can be found here: http://apps.nccd.cdc.gov/MWF/Index.asp.
Arguments FOR fluoride in drinking water
Fluoridation of drinking water has been hailed as one of the greatest achievements of public health by the CDC because it prevents tooth decay and tooth loss in children and adults despite socioeconomic factors and rates of dental care.(1) Many health, service, and professional organizations stand behind fluoridation as a safe and effective way to prevent tooth decay. Fluoride is relatively inexpensive and is reported as completely safe by the CDC. Fluoridation of public drinking water is about $0.50 per person per year in most communities. The American Dental Association says that fluoridation is a great investment; for every $1 spent on water fluoridation, $38 is saved on dental care.
While high exposure of fluoride may cause dental fluorosis, most cases are mild and barely visible; this is simply cosmetic and doesn't affect a tooth's function. Some of the earliest studies showed that water with fluoride reduced the total number of cavities in children's baby teeth by 60% and reduced tooth decay in permanent teeth by 35%.(2) A 2010 study found that adults who were born in a city with fluoridated water experienced less tooth loss as an adult.(3)
Fluoride levels added to water in a small amount copies the natural phenomena of naturally occurring levels in places around the world. Fortifying water with fluoride is often compared to fortifying salt with iodine or adding vitamin C to juice or milk. Most water filters do not remove fluoride because it is often seen as a desirable addition to drinking water. Many communities have voted in favor of adding fluoride to public drinking water.
A recent study examined whether or not there was a relationship between fluoride exposure and osteosarcoma (a cancer that starts in the bones) risk. Their analysis showed no significant association of bone fluoride levels and the risk of osteosarcoma.(4)
Arguments AGAINST fluoride in drinking water
Many recent studies on fluoride have suggested the need for further studies to test whether or not fluoridation of water is actually necessary, and whether or not it may cause underlying health problems. It may be a possibility of the bad outweighing the good. We can see what happens to our teeth when we consume too much fluoride, but we can't see with the naked eye what too much fluoride does to our bones and other parts of our bodies. There may be fluoride dangers that are not known.
Topical uses of fluoride (like in toothpaste) that you don't ingest, does prevent cavities and is said to be safe, but more and more studies are finding that ingesting a lot of fluoride may be harmful to our health. Fluoride has been said to cause Alzheimer's, hypothyroidism, arthritis, bone cancer, hip/joint problems, brain developmental problems in children and more. While we are unsure if these claims are 100% true, they are concerning and suggest that we should think twice about adding fluoride to our drinking water until more studies prove its absolute safety. The EPA also stated that excessive exposure of fluoride (over 4 ppm) over a lifetime may cause bone fractures, bone pain/tenderness, and bone disease.(5)
While dentists say that dental fluorosis is simply a cosmetic concern, some studies correlate dental fluorosis with other issues. For example, many areas in China have high levels of naturally occurring fluoride in their water; studies have shown that children who had dental fluorosis also had lower IQ scores than children who did not exhibit signs of dental fluorosis.(6) An American study that exposed animals to high levels of fluoride saw that fluoride accumulated in brain tissue possibly causing negative impacts on learning and memory.(7)
Data from the World Health Organization of fluoridated vs. unfluoridated countries from the years 1965-2005 show an overall trend in every country of a reduction in tooth decay. This suggests that water fluoridation is probably not responsible for the reduction of tooth decay.(8)
Others argue that the earlier studies administered on fluoride safety were conducted with the naturally occurring kind: calcium fluoride. Fluoride that is added to public drinking water is not calcium fluoride, it is fluorosilicic acid, sodium fluorosilicate, or sodium fluoride and are not from pharmaceutical grade sources. Instead these chemicals are by-products of fertilizer production and are often purchased from phosphate fertilizer companies. You can tell what type of fluoride is added to your public drinking water here: http://apps.nccd.cdc.gov/MWF/Index.asp.
Should I give fluoride to my child?
If your dentist advises you or you feel you should give fluoride to your child, it is a good idea to check the levels of fluoride that are added to your drinking water first. You can access the most recent Consumer Confidence Report from your utility company or check the link provided above. Some areas have high levels of naturally occurring fluoride so adding more fluoride in the form of toothpaste, tablets, or mouth wash are not necessary and may cause dental fluorosis. It is important to monitor your child's consumption of fluoride because too much might cause dental/enamel fluorosis in kids under the age of eight. High levels of fluoride during this time of tooth development may result in blotchy white areas or pits on the tooth's enamel. There are different degrees of dental fluorosis, severe cases may result in discoloration of larger areas of the tooth and may become a more noticeable brown color. Consider all sources of fluoride your child might consume such as drinking water, food, and juice. For example, white grape juice has been tested as having fluoride concentration levels of 2.13 ppm, this is higher than the level recommended by the CDC.(9)
Toothpaste with fluoride is not recommended by the ADA for children under the age of two. For older children only use a pea-sized amount and make sure they do not swallow the toothpaste. Mouth rinses containing fluoride should not be given to children under the age of six because the risk of them swallowing it and consuming too much fluoride is high. Swallowing fluoride at the amount of 5 mg/kg can be fatal and symptoms from fluoride toxicity can appear from doses as low as 0.2 mg/kg. Symptoms from fluoride poisoning are gastrointestinal pain, nausea, vomiting, and headaches. A 2004 study concluded that there is no advantage of using toothpaste with fluoride over gels, mouth wash, or varnish with fluoride.(10) If you do choose to give your child fluoride this schedule explains how much fluoride the ADA recommends for children based on their age: http://ebd.ada.org/contentdocs/6327_Fluoride_Chairside_Tool.pdf.
Various fluoride-free products for your children:
Brushing your teeth after every meal will help keep your breath fresh and reduce the risk of getting tooth decay.
Vitamin D: a study analyzing data from 1920 to 1980 showed an association between vitamin D and a 50 percent reduction in tooth decay in children.(11) You can increase your vitamin D level by getting at least thirty minutes of sunshine daily, cod liver oil, and other supplements.
Xylitol: one study reported that xylitol is capable of remineralizing enamel.(12) This increasingly popular product can be found in gum, toothpaste, and some foods.
If you are looking for a fluoride free mouthwash, then check out our article on homemade mouthwashes.
Removing fluoride from water
If the public drinking water in your area has fluoride added and you would like to remove it, you have a few options. Fluoride is removed through water by reverse osmosis filters and distillation. Keep in mind that most filters like brita and pur filters do not remove fluoride. On that same note, boiling or freezing water also does not remove fluoride. Be mindful of bottled water, unless it is stated on the bottle that the water is filtered through reverse osmosis, you have to assume that the water is from a municipal source and contains fluoride. Fluoride levels in bottled water are not regulated.
Here are some filters that remove fluoride in the water:
Do you support fluoridation of drinking water?
Most can agree that topical treatments of fluoride reduce tooth decay, so using fluoridated toothpaste and mouthwash is relatively safe as long as you don't swallow it and rinse your mouth after use. While too much of anything can cause health problems, fluoride is no exception. Because fluoride is added to the majority of American's drinking water it is crucial to monitor how much you are consuming. Fluoride is not only in our drinking water but it is also found in air pollution and on our food from pesticides. Not enough studies have been conducted to show that there is no risk with water fluoridation. These high levels may be dangerous and therefore excess fluoride should probably be avoided unless more solid research proves otherwise. The dangers of fluoride are real so research needs to continue.
We would love to hear your comments. Please post below if you have any information on fluoride or if you want to express your opinion on fluoride in tap water. Thanks!
To find the levels of fluoride in food and beverages:
More ways to avoid fluoride:
The American Dental Associations stance on fluoridation:
- Am J Public Health 100(10), 2010.
- Kim FM, Hayes C, Williams PL, et al. An assessment of bone fluoride and osteosarcoma. Journal of Dental Research 2011; 90(10):1171-1176.