According to the Centers for Disease Control and Prevention, fluoridated water is one of the best 10 public health achievements of the 20th century. Yet, the controversy over fluoride rages on in this country.
The question that we are addressing today is, “Is fluoride safe?”
A lot of people have opinions on the subject. But what does the scientific evidence show us?
This will likely come as no surprise to you, but there are many conspiracy theories and internet rumors out there that will tell you the opposite of what the science tells us. So it’s up to you which you believe.
I’m going to share with you what the best research on the topic shows us. And by the end of this article, you will hopefully have some better perspective on the world’s most controversial mineral.
Now, let’s get started!
First of All, I’ll Tell You About Fluoride
Fluorides are minerals that occur naturally on Earth. You will find fluoride in rocks, soil, water, and even the air.
And over the past 60 years, we have found that it’s a significant factor in preventing tooth decay.
We most often see fluorides in compounds that come from combining the element Fluorine with other substances. Sodium fluoride, stannous fluoride, and fluoride monofluorophosphate (MFP fluoride) are examples of those compounds.
The truth is:
All water contains some amount of fluoride.
In most places, the naturally occurring fluorides in the water aren’t enough to prevent tooth decay. Although, there are some places where the groundwater and springs have naturally very high levels of the mineral.
How fluorides help your teeth
When we eat sugary foods or carbohydrates like pasta, bacteria in our mouths produce acid which eats away at the minerals on the surface of your teeth. Not only does that make the teeth weaker, but it also dramatically increases the chances that you will develop cavities.
That’s where the fluoride comes in.
Fluorides actually help to rebuild and strengthen the surface or enamel of the teeth.
Fluoridating the water prevents tooth decay by providing consistent contact with low levels of fluoride. It keeps your teeth strong and solid.
Fluoride also stops cavities from forming. And believe it or not, it can even rebuild the tooth’s surface.
Community water fluoridation has adjusted the fluoride levels in the water to achieve optimal tooth decay prevention.
According to the Centers for Disease Control and Prevention, “community water fluoridation has been identified as the most cost-effective method of delivering fluoride to all, reducing tooth decay by 25% in children and adults.”
Exposure to fluoride
In addition to the water, we use fluorides in things like toothpaste, mouth rinses, dietary supplements, and dentists can apply it topically to your teeth.
When you consider that many foods and drinks also contain fluoride, it makes you wonder if we’re getting too much. Most adults don’t have to worry about that because they are not ingesting the toothpaste or mouthwash.
But it can be a concern for children.
They do tend to swallow the toothpaste. For that reason, you should only use a tiny amount of toothpaste with children under the age of six. When I say tiny, I’m talking about less than a small pea-size amount.
So, Tell Me the Controversy
The scientific research has been clear for more than 60 years. Fluoridating the water is safe.
But that hasn’t stopped wild conspiracy theories and internet rumors. Some people are against it because they don’t like the government forcing it on communities.
Exposure to too much fluoride can pose a problem. However, it’s a cosmetic problem with the teeth. There are no known health risks beyond that.
“People cannot differentiate between CDC and the American Dental Association and some quack outfit that’s trying to scare people,” said Myron Allukian Jr., DDS, MPH, president of the American Association for Community Dental Programs and a past president of APHA.
Conspiracy theories or science?
It’s true that some people oppose water fluoridation, just like some people are against vaccines or don’t believe in climate change. That doesn’t mean they’re right.
I tend to believe more in science than conspiracy theories. And the science says that water fluoridation is safe and effective. Unfortunately, we live in a time that a fake Facebook meme gets more attention than research.
On the flip side of that Facebook meme is numerous U.S. Surgeons General, and more than 100 health organizations who recognize the health benefits of water fluoridation for preventing dental decay, including the Centers for Disease Control and Prevention, the American Medical Association, the World Health Organization, the American Dental Association, and the American Academy of Pediatrics.
The Danger of Too Much Fluoride
Fluorides are like many things in life. A small amount is hugely beneficial, while too much is a problem.
The biggest issue with too much fluoride affects mainly children as their teeth are developing.
The research shows that when we expose kids to too much fluoride, they are more susceptible to getting something called fluorosis. Fluorosis is not life-threatening. But it is a cosmetic problem.
Fluorosis leaves white speckles on the teeth, and in some cases, it causes pitting or brown stains.
In the United States, we regulate water fluoridation, so fluorosis is very rare in children who are drinking the water.
But there’s one problem:
Children are also using way too much toothpaste. More importantly, they are swallowing too much toothpaste. When you combine that with the fluoridated water, you can see how a young child could get overexposed.
The Benefits of Fluoridated Water
- Fewer cavities
- Less severe cavities
- Less need for fillings or pulling teeth
- Prevents tooth decay
- Strengthens teeth at all ages
- It’s safe and effective
- Saves money
- It’s natural
None of those are small things.
We fluoridate the water for public health, much in the way that we add iodine to salt, or vitamin D to milk, or calcium to orange juice, or folic acid to bread.
But There Are Risks
As we just discussed, the research shows that low levels of fluoride in the drinking water are both safe and effective at preventing tooth decay.
However, there are some risks associated with exposure to very high levels of the mineral.
The most significant risk that too much fluoride poses is fluorosis.
According to the U.S. National Library of Medicine and the National Institutes of Health, moderate dental fluorosis occurs in one to two percent of the population exposed to one milligram per liter of fluoridated water.
When the fluoridation levels go up to two milligrams per liter, the percentage of the population that could be affected by fluorosis goes up to 10 percent.
And the news gets even worse when the levels go higher.
For populations exposed to fluoridation up to 4.1 milligrams per liter, moderate to severe fluorosis could affect up to 33 percent of the people.
As you can see, the problem gets significantly worse as the amount of fluoride goes up.
Less is more
Most communities now regulate the water fluoridation to no more than 0.7 milligrams per liter, which is considered safe.
But people can still run into problems if they are getting fluoride from other sources.
Fluorosis mainly affects children’s teeth. One reason for that is that kids tend to swallow too much toothpaste. You can significantly lower your child’s risk of fluorosis by giving them very tiny amounts of toothpaste when they brush their teeth.
The National Institutes of Health also says,
“There is no evidence of skeletal fluorosis among the general U.S. population exposed to drinking water fluoride concentrations lower than four mg/l. Radiographically detected osteosclerosis after chronic exposure to fluoride in drinking water at 8 mg/l was not associated with clinical symptoms.
Reports of crippling skeletal fluorosis associated with low concentrations of fluoride in drinking water in tropical countries have been attributed to other dietary factors. The available data suggest that some individuals may experience hypersensitivity to fluoride-containing agents. Further studies on hypersensitivity are required.”
But I Heard Fluoride Causes Cancer
Since water fluoridation first began, people have been asking this question. And it has been studied a lot.
According to the American Cancer Society, one study that has confused people came from the US National Toxicology Program (NTP) in 1990 which studied animals. The researchers found “uncertain” evidence of the potential for fluoridated water causing cancer in male rats.
After exposing them to an extremely high amount of fluoride, in the male rats, they found a higher than expected number of osteosarcoma cases, which is a very rare bone cancer.
However, they found no evidence of cancer links in the female rats or the male or female mice.
Here’s the problem:
Osteosarcoma in humans is extremely rare. In the United States, there are only around 400 cases diagnosed in children and teens each year. That makes it very difficult to do extensive studies.
What have scientific studies found?
In more than 50 population-based studies looking into any possible connections between fluoridated water and cancer, nearly all of them found no link.
The majority of studies into this subject have been retrospective, meaning that they looked back in time.
For example, they looked back at the cancer rates in communities both before and after water fluoridation. Some studies also looked at cancer rates in places that had lower levels of fluoride in the water compared to areas that had higher levels.
Here’s the truth:
There is no doubt that we need to continue researching this, but so far the scientific data shows no link between water fluoridation and cancer.
It’s worth recognizing that this is a difficult thing to study. Some things that we still don’t know include whether or not the type of fluoride makes a difference. We also need to know what exact level of fluoridation is too much.
In its review published in 1987, the International Agency for Research on Cancer (IARC), part of the World Health Organization, labeled fluorides as “non-classifiable as to their carcinogenicity [ability to cause cancer] in humans.”
While they noted that the studies “have shown no consistent tendency for people living in areas with high concentrations of fluoride in the water to have higher cancer rates than those living in areas with low concentrations,” they also noted that the evidence was inadequate to draw conclusions one way or the other.
In 2006, Harvard School of Public Health put out a questionable study that said they found a possible link between fluoridation and cancer. Harvard said that exposure to higher levels of fluoride in drinking water linked to a higher risk for boys, but not girls, for getting osteosarcoma.
But there was a problem with the data:
The researchers admitted that results from the second part of that study did not match what they found in the original study. Because of that, Harvard cautions about trying to interpret the results.
In 2011, Harvard put out another part of that study where they compared the fluoride levels of people with osteosarcoma, looking specifically at the fluoride in bones near the tumor and compared it to the levels in people with other types of bone tumors.
But the study found no difference between the fluoride levels in the two groups.
Other recent studies have looked at the rates of osteosarcoma in areas that have high levels of fluoridation compared to regions with lower levels. These studies looked at Great Britain, Ireland, and the United States.
However, none of those studies found an increased risk of osteosarcoma in areas that have fluoridated the water.
It’s Cool, Though, Fluoride Is Regulated
Over 70 percent of Americans have access to fluoridated water. Several government agencies regulate the level of fluoride found in community water.
In 1962, the United States Public Health Service recommended that public water supplies should contain between 0.7 and 1.2 milligrams of fluoride per liter to prevent tooth decay.
In 2015, they updated that recommendation and lowered it to the previous lower end level of 0.7 milligrams of fluoride per liter.
One of the reasons that they made that change was because more people are now getting fluoride from other sources than just the water, like toothpaste, for example.
The EPA has set a national limit for the maximum amount of fluoride allowed in the water of 4.0 milligrams per liter. They believe that anything above that puts people at risk for skeletal fluorosis, which makes the bones weaker. Many natural water sources have a level of around 0.2 milligrams per liter, although in some places it can be much higher.
And that’s not all:
The EPA has also set a secondary limit for children. To protect children under the age of nine from getting dental fluorosis, the EPA says that they should be getting no more than 2.0 milligrams of fluoride per liter.
Other ways we limit exposure
In addition to the national fluoridation standards, states can also regulate the levels and go lower.
Some people believe that they can avoid fluoride by drinking bottled water. But they’re wrong about that. Believe it or not, a lot of bottled water also contains fluoride.
Some of them contain a lot.
The U.S. Food and Drug Administration regulates the fluoride in bottled water. The fluoridation levels allowed vary depending on the climate where they sell the water.
For bottled water that does not add fluoride, it can have no more than 2.4 milligrams per liter in places with colder temperatures. For bottled water companies that do add fluoride to their product, the maximum amount allowed is 1.7 milligrams per liter in colder climates.
But don’t worry:
The FDA recommends that manufacturers not go above 0.7 milligrams per liter, which is the same recommendation given by the PHS.
Here’s What Happened When One City Removed Fluoride from Their Water
The controversy over whether or not we should fluoridate the water has been going on for a very long time. Some places have even gone as far as taking the fluoride out of the community drinking water.
Case in point:
For 50 years the Canadian city of Windsor fluoridated the water. Then in 2013, after facing public pressure, the city decided to end the water fluoridation.
Do you want to take a wild guess as to what happened next?
Yep. You guessed it.
By 2018 the number of children requiring urgent dental care and who had developed tooth decay increased in the city by a massive 51 percent.
UK dentist and writer on dental health matters Ollie Jupes said about this case,
“For decades, low-level public water fluoridation has proven to have a dramatic effect on the rates of tooth decay, particularly in children. Where fluoridation has been introduced, there is invariably a measurable difference in the rates of decay, compared to non-fluoridated areas.
“Decay rates in fluoridated areas can reduce by up to 25 percent. Removing fluoride from the water supply is madness – it’s a bit like withdrawing statins from a diabetic.”
So what happened?
After five years of watching more and more children developing tooth decay, and after being unable to find any adverse health risks associated with low levels of fluoridation, Windsor voted to put the fluoride back into the city’s water supply.
But even being faced with undeniable evidence, some delegates stood by their belief that they should not add fluoride to the water. One of them said that he didn’t support the measure to bring back the fluoridation because “I can’t vote to take away personal consent.”
Removing the fluoride and then adding it back in was an expensive experiment for the city.
But it was even worse for the residents.
One in four people living in Windsor had no dental insurance. Taking away water fluoridation put a huge cost onto the residents who ended up needing expensive dental work thanks to this foolish move.
If You’re Worried About Fluoride, Here’s How You Can Reduce Your Exposure
What we do know is that at low levels fluoride is both safe and effective at protecting your teeth. But there is a risk of fluorosis for people exposed to too much of the mineral.
Not only that:
The government regulates community water fluoridation to safe levels for the public. But the truth is, natural levels of fluoride in the water in some places goes far above four milligrams per liter.
That is too much.
Private wells, for example, wouldn’t be restricted by regulation. And some of them naturally contain too much fluoride.
Here’s what you can do
If you are concerned that your family has too much exposure to the mineral, there are a few things that you can do.
First of all, find out the exact level of fluoride in your water.
If you get your water from a public source, you can find out your level by contacting your local community water system. If you get your water from a private source, like a well, you can have your water tested by a reputable lab.
And here’s what you might not know:
Every water system is required by law to provide customers with an annual Consumer Confidence Report which will show you the exact levels of chemicals and other substances like fluoride found in your water.
For more general information about the safety of your drinking water, you can call the EPA’s Safe Drinking Water Hotline at 1-800-426-4791.
Another thing you can do if you’re worried about too much fluoride in the water is to switch to drinking bottled water.
But pay attention to the labels or contact the bottling company because most bottled water still contains some level of fluoride. Natural spring waters tend to have the least.
You can also buy filters that take the fluoridation out of the water, although they can be quite expensive.
The final thing that you can and should do is to do your best to ensure that your children aren’t swallowing too much toothpaste, which is a significant source of fluoride.
Remember people — pea size.
You can also buy low- or no-fluoride toothpaste and dental products.
The Bottom Line
Okay, let’s cut to the chase. The question is, “Is water fluoridation safe?”
To answer that question really depends on whether you believe science or conspiracy theories and internet rumors. If you go with science, then the answer is…
At low levels, water fluoridation is both safe and effective for protecting your teeth.
However, there is a sincere concern about being exposed to too much fluoride. It won’t kill you. But it could cause cosmetic problems with the teeth, especially in children.
So does that mean that you should prevent your children from consuming any fluoride at all?
The research has been clear on this. Without fluoride, you massively increase your risk of tooth decay and your children’s risk of tooth decay.
The bottom line is, at low levels, fluoridated water is hugely beneficial. Removing the fluoridation does far more harm than good. But with that said, you should also be cautious about too much exposure to high levels of fluoride.
So what do you think? We’d love to hear from you. Weigh in on the controversy in the comments section below and share with our readers how you feel about it.