In the 1990s, the CDC cited water fluoridation as one of the 10 greatest public health achievements of the 20th century (see footnote 1 for the CDC’s 10 greatest public health achievements).
Fluoride in water reduces tooth decay by more than 25% in both adults and children, according to the American Dental Association. Since this discovery, municipalities all over the U.S. and throughout the world have been adding fluoride to their community water.
As of 2018 (the most recent set of data available), about 73% of community water systems deliver fluoridated water to about 63% of Americans, according to the CDC’s National Water Fluoridation Statistics.
This article addresses two fundamental sets of questions that arise when people talk about fluoride. First, what does fluoride do, and is it safe? Second, where do you get fluoride naturally and supplementally?
First, some basics about fluoride.
What Does Fluoride Do?
Fluoride comes from fluorine (chemical symbol F), which is a naturally occurring mineral that’s found on our planet. Back in the early 1900s, scientists discovered a strong connection between fluoride and oral health, which led cities throughout the U.S. and the world to begin adding fluoride to their public water supplies.
Fun fact: What Midwestern city was the first to add fluoride to water in the United States? (See footnote 2 for the answer.)
Fluoride prevents tooth decay by making teeth resistant to demineralization, which is what happens when acids from food attack the surfaces of teeth. It also helps with remineralization, which is the technical term for repairing the tooth surfaces from demineralization damage. So, in short, fluoride protects, defends, and fortifies our teeth.
Where Do You Get Fluoride?
We get toothpaste through two primary methods: Topically through oral care products like toothpaste, oral rinses, and dental treatments; and orally through some foods but mostly through drinking water.
Community water supply
Most public water systems in the United States contain fluoride. If you want to know about your state’s water system, use the CDC’s “Find Water System Information” tool online. Choose your state, county, and municipality from the filters.
If you have a property that relies on well water, you can have your water tested to see what minerals it contains. The CDC recommends that drinking water should contain 0.7 milligrams per liter of water. Check with your local health department for testing your well water.
Homes that drink bottled water or use a water filtration system could be lacking fluoride. The ADA’s Fluoride Facts report says although there isn’t a lot of research about bottled water and tooth decay, the fact is that the vast majority of bottled waters do not contain fluoride. Or, if they do, they do not contain enough fluoride.
With some consumers opting for bottled water and water-filtration systems in their homes and businesses, are they missing out on the benefits of fluoride? The reasons for choosing bottled water are valid: It tastes better and, for some consumers, they want to avoid some minerals and chemicals in their drinking water.
If water quality or flavor is a concern in your home or business, and you are considering adding a filtration system, talk to the installer or manufacturer about options for preserving fluoride. Here is a summary of what the ADA says about water treatments and their impacts on fluoridated water:
● Reverse osmosis: Yes, reverse osmosis systems remove fluoride.
● Water softeners: No, most water softeners do not remove fluoride.
● Distillation process: Yes, water distillation can remove significant amounts of fluoride.
● Carbon water filters: Most do not remove fluoride, but some types of water filters do; always check with the manufacturer.
For consumers who drink bottled water or filtered water, there are lots of great options for ensuring they get enough fluoride to maintain and promote oral health.
Fluoride toothpaste and mouthwashes
Perhaps the number one consumer product that contains fluoride is toothpaste. Even some of the higher-end tooth-brightening products are enriched with fluoride[ which offers an added bonus of not only protecting your teeth but removing stains. Many makers of oral care products also include fluoride in mouthwashes and rinses.
Fluoride additives in toothpaste and oral rinses are safe and effective at preventing tooth decay and promoting remineralization. However, there are rumors and myths that have consumers, especially parents, scared about overdosing on fluoride.
Fluorosis is a condition that occurs when someone consumes too much fluoride. Parents should always observe their children when they brush their teeth to ensure they don’t use too much toothpaste or swallow it.
According to Medical News Today, children up to age 3 should use toothpaste that contains 1,000 parts per million (ppm) of fluoride, and children ages 3 to 5 should use a little more — 1,350 to 1,500 ppm. Of course, this is not intended to be medical advice; you should always seek advice from medical professionals, including your own pediatricians, dentists, and primary care physicians.
Fluoride treatments at the dentist
Some dentists recommend fluoride treatments that are applied topically, every few months. Dentist-applied fluoride treatments come in different forms — gels, pastes, foams, and varnishes — and they cost anywhere from $10 to $30 or more, depending on where you live. Poor oral hygiene is one of the most common reasons dentists might recommend a fluoride treatment, but there are many other indications, according to the ADA. Your dentist might recommend a fluoride treatment every few months if you have:
● Recessive gums and exposed dental roots
● Dry mouth
● Fillings, crowns, or restorations
● A history of alcohol or drug use or abuse
● An eating disorder or poor diet
● Received radiation therapy in the head or neck area
Foods that contain fluoride
According to the ADA, foods that contain the highest levels of fluoride are ocean fish and shellfish, thanks to the amount of fluoride that naturally occurs in ocean water. Other foods that contain fluoride include black tea, raisins, and some breakfast cereals including oatmeal.
Cooking food in fluoridated water can also increase the amounts of fluoride in your food. Parents who feed infant formula to their babies should defer to their pediatricians’ recommendations for the best water to use, as well as recommended fluoride levels.
For a complete list of foods with fluoride, visit the USDA’s National Fluoride Database of Selected Beverages and Foods.
In some areas where fluoride in water is not available and children are especially at risk for tooth decay, some dentists might prescribe fluoride supplements. These are available through a prescription at a pharmacy and should be taken only as recommended by your dentist or primary care physician.
Busting Myths About Fluoride
Let’s face it: The internet loves a good controversy, and fluoridated water is no exception. Most of the rumors about fluoride are addressed in the ADA’s Fluoridation Facts (Practical Guide Series), including the following:
● Fluoridated water is safe for infant formula (unless your pediatrician or dentist recommends otherwise).
● Fluoride is not a toxic substance.
● There is no association between cancer and drinking water that has been fluoridated at recommended levels.
● Fluoridated water does not cause osteosarcoma.
● There are no known adverse effects on the thyroid caused by drinking optimally fluoridated water.
● There is no scientific evidence to support that optimally fluoridated water leads to birth defects.
● Drinking fluoridated water does not increase one’s risk for cardiovascular diseases.
As the ADA recommends, trust only scientific research and do not trust rumors from social media or that have been shared with you that lack credible sources. Always talk to your medical and dental professionals if you have questions or concerns about your oral care.