Fluoride: Who, What, When, Where, and How
Fluoride has been used for decades to reduce tooth decay in the US. Many people have questions about the benefits and risks of the use of fluoride – let’s address some of them now.
Who needs fluoride?
Everyone! It is necessary to prevent tooth decay and to help keep your teeth strong. Studies have clearly shown that getting enough fluoride reduces dental decay. Having dental decay will weaken your teeth and may lead to cavities, infection, tooth loss or other health problems.
The amount of fluoride needed for your dental health varies with your age, sex, and if you are pregnant or breastfeeding. Fluoride supplementation is especially important for those who have limited access to dental care, either by location or lack of insurance coverage.
Supplementation of the community water supply to provide optimal amounts of fluoride can reduce dental decay in adults and children. Recent estimates show that this reduces cavities by at least 25%. Although fluoride is available in other forms, such as dental products (toothpaste, mouth rinses), adding it to water has been found to be the most cost-effective option to provide to all people in the community.
What is fluoride?
Fluoride is a mineral that occurs in nature and is present in very small amounts in soil, untreated water, plants, and foods.
When do you need to use fluoride?
Getting enough fluoride is important during young childhood as teeth are forming in the gums and then throughout the older childhood, teen, and adult years to prevent cavities. The American Dental Association recommends fluoride supplementation beginning at 6 months of age.
Where can you get fluoride?
About 70% of communities in the US have added a certain amount of fluoride to the water supply to provide the recommended amount of fluoride for their location. If your community’s water supply is not treated, you may need to use additional sources of fluoride. Check to see the fluoride level in your community–you should also know that bottled water does not contain fluoride unless the product label specifically states it has been added.
If your community does not participate in water fluoridation, then you will need to find other sources of fluoride. They include:
- Dental products such as toothpaste, mouth rinses. Be careful with the amount used in children 2 – 6 years of age. For ages up to 3 years only use a smear the size of a grain of rice and for ages 3-6 years, only a pea-sized amount.
- Topical products (gels, varnishes) that are applied by dentists at least twice a year.
- Prescription products are currently used as a source for children given daily as drops or chewable tablets. However, the FDA has stated that it will begin the process to have these products removed from the market. This will limit options for providing a source of fluoride to children living in areas without community water fluoridation.
How do you know if fluoride is safe?
Fluoride supplementation within the recommended dose range is a safe and effective method to prevent tooth decay for children and adults. Supportive evidence of safety over several decades has been reported in clinical studies. But it is important for fluoride to be taken or used within the recommended range to avoid potential health risks. A condition known as dental fluorosis (white lines or spots of white or brown on the teeth) can occur when too much fluoride is received over time when the teeth are developing. Extremely high levels of fluoride can cause gastrointestinal symptoms such as nausea, vomiting, belly pain, and diarrhea. An overdose of fluoride is not possible from the amounts currently in water or fluoride enhanced toothpaste.
Several recent studies have suggested that lower IQs and GI problems occur with ingested fluoride. In the recent worldwide study evaluating the effect of fluoride in IQ, many experts were concerned about flaws in the research of the study. In addition, the dosages reviewed were not controlled and were much higher than the currently recommended amounts used in the US. And the studies conducted to review an association of gut microbiome (microbes that routinely live in our bodies) were inconclusive or conducted at high doses.
Some people promote the use of fluoride only as a topical application to the teeth, rather than a source in the water supply. But this limits exposure during tooth development and for those with limited dental access or poor dental hygiene habits.
Summary
It is important for children and adults to have sources of fluoride to support healthy oral hygiene. More than 70 years of evidence supports the safe and effective use of fluoride in community drinking water to prevent tooth decay. In fact, the CDC has stated that water fluoridation is one of the 10 best public health achievements of the 20th century.