Fluoride, a naturally occurring mineral, plays an integral role in dental health and has been widely incorporated into dental products and water supplies to prevent tooth decay.
In fact, health experts cite the use of fluoride in water as one of the greatest public health achievements of the 20th century, right along with vaccination. Yet, despite its proven benefits, people continue to debate its safety and efficacy.
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What Is Fluoride?
Fluoride is a mineral found naturally in soil, water and foods. Because the naturally occurring levels of fluoride are not enough to prevent tooth decay and cavities, community water systems have added fluoride to the local drinking water. Tap water is the primary source of fluoride for most Americans.
When you consume fluoride, your gut absorbs it, while your bones and teeth store the rest. This helps strengthen the outer layer of your teeth (known as tooth enamel), promotes remineralization and protects teeth from harmful bacteria that cause cavities. Any unabsorbed fluoride leaves your body when you urinate.
Fluoride is so effective in oral health that it has been shown to reduce tooth decay by at least 25%, according to the American Dental Association.
“For every dollar spent on fluoride, you will save $20 on dental issues,” says Dr. Michael Levine, associate professor in medical toxicology at UCLA.
Fluoride controversy
Controversy about fluoride has been around since the mineral was first added to the water supply in 1945.
Reminiscent of today’s conspiracy theories, in the 1960s, the John Birch Society raised the alarm, warning people that putting fluoride in water was a communist plot designed by the government to poison the population.
Scientific evidence shows that fluoride is safe and effective, but there have periodically been studies claiming to suggest that fluoride is dangerous. In 2014, fluoride was documented as a neurotoxin that could be hazardous to child development. In 2017, a small study suggested that exposure to fluoride before birth could affect a baby’s cognitive abilities.
But a majority of health experts echo the famous adage in medicine: “The dose makes the poison.” Many things in large doses can be harmful, but they can be beneficial at recommended smaller doses.
“Too much of anything, including fluoride, is usually not a good thing, but in moderation and in the proper amounts, fluoride is a good preventive medical health tool,” says Dr. Santina Wheat, a family medicine specialist at Northwestern Medicine.
Although there is some evidence that fluoride in large amounts can be harmful, the ADA, the American Academy of Pediatrics and the Centers for Disease Control and Prevention strongly recommend the benefits of its use in small doses for children and adults.
“Most studies opposing fluoridated water are based on concentrations of fluoride four or five times greater than the amount recommended here in the U.S.,” says Dr. Rhonda Stephens, a dental public health specialist and professor of the practice at the University of North Carolina’s Gillings School of Global Public Health. “But at recommended levels, there is no evidence of adverse health effects.”
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Uses for Fluoride
In the United States, the small amount of fluoride added to the drinking water is closely monitored and carefully balanced to help strengthen teeth and prevent decay.
In addition to water, fluoride is found in various products that are regulated by the Food and Drug Administration and are effective and safe when used as directed.
Fluoridated dental products include:
— Fluoridated toothpaste. Toothpaste is the most common fluoridated product in the U.S. It sticks to your teeth and increases the amount of fluoride in your saliva, helping to strengthen your tooth enamel.
— Fluoridated mouthwash. Fluoridated mouthwash used as directed also strengthens your tooth enamel and slows down the development of cavities by sticking to your teeth and saliva. Mouthwashes aren’t recommended for children, who may be more likely to swallow it.
— Fluoride varnish. A topical fluoride that is painted onto your teeth by a dental professional to prevent tooth decay. The treatment allows fluoride to remain on the surface of your teeth for a short time before gradually wearing off. It must be periodically applied.
— Fluoride gel and foam. If your dentist thinks you’re at high risk for tooth decay, they may want to strengthen your tooth enamel with a gel or foam. Sometimes a dentist will give you a prescription for use at home.
— Fluoride supplements. Fluoride tablets that require a prescription are chewed for one or two minutes before swallowing and are sometimes prescribed for adults and children at high risk for cavities. Supplements may also be recommended in areas where the water isn’t fluoridated.
— Fluoridated dental floss. Most flosses don’t contain fluoride, but some do to deliver fluoride to areas of the teeth that are hard to reach.
“Despite the increasing availability of other sources of fluoride, what some people fail to recognize or acknowledge is that everyone doesn’t have routine access to toothpaste, mouthwashes or a dentist, which means there is still a benefit and need for fluoridated water,” Stephens says.
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Children and Fluoride
Fluoride is important particularly for children’s dental health. Children from the ages of 6 months to 6 years are prone to tooth decay and need fluoride in limited amounts to help stave it off as teeth are forming, as well as when they emerge. Surveys show that children and teenagers who drink fluoridated water have fewer cavities than those who don’t.
The ADA, though, recommends that parents supervise their children’s fluoride intake to prevent fluorosis, a rare discoloration of the teeth that only affects the look of the teeth and can occur if a child is overly exposed to fluoride. To decrease the chances of children developing dental fluorosis, parents can do the following:
— Breastfeed infants. Breast milk is low in fluoride and does not get passed on to babies in significant levels.
— Use ready-to-feed formula. Ready-to-feed formula contains very little fluoride and doesn’t contribute in any significant way to the development of dental fluorosis.
— Use formula powder with unfluoridated water. Infant formula can be mixed with fluoride-free water. Water without fluoride is labeled as deionized, purified, demineralized and distilled.
— Limit the amount of toothpaste used. Children should only use a pea-sized amount of fluoridated toothpaste at each brushing, and parents should supervise brushing to make sure the toothpaste is spit out.
— Avoid flavored toothpaste. Children are more likely to swallow toothpaste if it’s flavored.
— Avoid mouthwashes. Children should not use fluoridated mouthwash, which they may be prone to swallowing.
— Avoid dietary supplements. Children under the age of 6 months should not be given dietary supplements that contain fluoride. Other children should be given them only if a dentist recommends them.
“If we were to stop adding fluoride to water systems, children, some of whom don’t have access to dental care, will have lost an important layer of health protection,” says Kellogg Schwab, a professor at Johns Hopkins Bloomberg School of Public Health.
Fluoride Risks
Because of the small amount of fluoride added to the water supply and over-the-counter products, it’s highly unlikely that you will be adversely affected by it.
The risks are minimal, but they do exist and in addition to fluorosis may include the following:
— Skeletal fluorosis. Although rare and unlikely to occur with the standard small amounts of fluoride added to water, skeletal fluorosis occurs when you’ve been exposed to an excess amount of fluoride over the years. It can cause hardening of the bone and joints. Hardened bones and joints lose elasticity and increase the risk for fractures.
— Thyroid problems. At very high levels, fluoride can cause thyroid problems. In particular, it can damage the parathyroid gland, which regulates your calcium level. While rare, when this happens, the secretion of parathyroid hormones becomes uncontrollable, depleting calcium in the bone and elevating the concentration of calcium in the blood. This makes you more susceptible to bone fractures.
— Fluoride poisoning. Again, this is rare, but acute high levels of exposure to fluoride can cause abdominal pain, excessive saliva, nausea and vomiting and serious muscle spasms. This doesn’t happen from drinking tap water. It occurs only when water is accidentally contaminated from an industrial fire or explosion.
Benefits of Fluoride for Adults
Adults who drink fluoridated water have fewer decayed and filled teeth and lose fewer teeth than those who don’t have access to fluoridated water.
Your doctor or dentist may recommend additional fluoride treatments for the following conditions:
— Dry mouth. Dry mouth is a side effect of some health conditions, such as dehydration and diabetes, and some medications, such as allergy medications and antihistamines. Because saliva helps wash away bacteria, slow production may make you more prone to oral health problems. Your doctor may suggest you get more fluoride through toothpaste, mouthwash or topical applications at your dentist’s office.
— Gum disease. Gum disease is an infection of the tissues that hold your gums in place. It’s usually caused by poor brushing or flossing habits that allow plaque to build up on your teeth, harden and increase your risk for tooth decay. Additional fluoride, sometimes applied to your teeth by a dentist, may help reverse gum disease.
— History of tooth decay. If you have a history of tooth decay, you may benefit from dental fluoride treatments.
— Crowns, bridges, braces and dentures. These dental procedures may increase your risk for cavities, especially around orthodontic brackets or where crowns meet your teeth. If you’ve had these dental procedures, your dentist may suggest fluoride treatments to strengthen your teeth.
Fluoride Levels in Water
In 2015, to address dental fluorosis concerns, the U.S. Public Health Service lowered the amount of fluoride recommended in drinking water from 0.7 to 1.2 milligrams per liter to 0.7 milligrams of fluoride per liter of water. That’s the equivalent of three drops in a 55-gallon barrel.
While the amount of added fluoride is a recommendation by the federal government, it’s not mandated. The decision to add fluoride to the public water supply is a local and municipal one. As of 2012, 75% of the U.S. population has fluoridated community water systems.
You can find out what the concentration of fluoride in your water is in the following ways:
— CDC. The CDC My Water’s Fluoridation site is a good source for information on fluoride in your state.
— Water bill. If your state has not reported to the CDC, you can check your water bill to see how much fluoride is in your tap water.
— Local water utility. Your local water utility can tell you how much fluoride is in your tap water.
The effectiveness and safety of your water supply is constantly being assessed and monitored by the U.S. Department of Health and Human Services and the Environmental Protection Agency, which sets standards for water, including reviewing the safety of fluoride in water systems.
Bottom Line
The addition of fluoride to water is one of the greatest public health achievements of the 20th century, right along with vaccines, fewer deaths from heart disease and stroke and recognition of tobacco as a health hazard.
Scientists say that when used at suggested doses, fluoride is safe, effective and economical. The annual cost of fluoridated water starts at about 50 cents per person and saves between $7 and $42 in dental costs.
While problems from drinking fluoridated water can occur, it would be almost impossible for those to come from the small amount of fluoride that’s added to your water source.
“When used at recommended doses, fluoridated water is a great preventive medical health tool equitably available to most of the population in the U.S. and when weighing the risks and benefits, the benefits clearly outweigh the risks,” Wheat says.
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Fluoride: Uses, Health Benefits and Risks originally appeared on usnews.com
