Is Fluoride Poison? Fluoride Facts and Alternatives

You may have heard or read that fluoride is unsafe, toxic, or otherwise harmful, and in high doses it definitely CAN be. But that is also the case with almost anything, including even water. 

What is fluoride?

Fluoride is a naturally occurring mineral present in soil (and thus tea), air, some foods, and— water!

There is a massive collection of scientific evidence supporting that fluoride is one of the best things for preventing dental cavities and even reversing small cavities.

Community water fluoridation is recognized by the Centers for Disease Control and Prevention as one of ten public health achievements of the 20th century. Water fluoridation has greatly contributed to lowering the rate of cavities in the United States (US). It is a benefit we are fortunate to have access to as a result of scientific evidence and research that has also dramatically reduced the financial burden for families, individuals, and the health care system. Community water fluoridation programs have been estimated to provide nearly $6.5 BILLION dollars a year in net cost savings by preventing the need for treatments, including fillings, crowns, extractions, etc. as well as costs associated with loss of productivity and follow-up treatment.

HOW does fluoride prevent cavities?

Cavities form when the outer layer of a tooth loses minerals as a result of acid from bacteria in dental plaque breaking down the sugars we eat. Fluoride as previously mentioned is also a mineral, and it helps to prevent the loss of our teeth minerals, as well as restore them with a fluoride-containing mineral. Some of the hydroxyapatatite mineral in teeth is lost and replaced with fluorapatite. This fluoride-rich replacement mineral is even more resistant to acid attacks than the original tooth surface. To halt the formation of cavities or rebuild tooth surfaces, fluoride must be constantly present in low concentrations in saliva and plaque.

Concerns with Fluoride

Dental fluorosis-

This is a condition that results in discoloration of the teeth as a result of excessive fluoride consumption in young children. It is a valid but primarily cosmetic concern. That said, dental fluorosis can only occur during the first approximately eight years of life as the teeth are still forming under the gums, and it will not occur from having just any amount of fluoride. Consult with your dentist who can help regarding the proper amount of fluoride for your child. Eliminating fluoride altogether for children under eight is not recommended as this increases your child’s risk of developing cavities.

Skeletal fluorosis-

This is a disease involving painful damaged bones and joints due to excessive accumulation of fluoride. Most often cited cases of this are outside of the US, primarily in Asia and Africa where the ingested groundwater fluoride is going far beyond recommended levels, and where there are other exposures such as through inhaling fluoride gases. Cases in the US are very rare, and reports indicate they develop through abnormal use of fluoride such as through ingesting toothpaste, inhalant abuse, voriconazole treatment, or excessive tea consumption. 

Decreased IQ-

Some studies have documented children with elevated fluoride exposures having lower IQs. While this is worth additional research, it is important to note a few things. One, associations and correlations do not prove causation. For example, everyone I know who has ever died drank water. Every single one of them. But that does not prove that the water led to their demise. Two, multiple of these studies are from other countries. A number of conditions can vary when compared to the US. Three, again the level of fluoride is a crucial factor. In order to potentially warrant concern, causation at or below recommended levels would need to be consistently demonstrated. Finally, IQ is only one measure of cognition, and the amount of differences here are not likely to have any significant practical difference. Consider all of the doctors who use and advocate for fluoride who were intelligent enough to complete their rigorous educational programs to become doctors.

Demonstrated Benefits of Fluoride

During and prior to the 1930s most children and adults in the US were affected by cavities, and many suffered painful toothaches and premature loss of teeth, even as teenagers. In the 1930s, scientists made the pivotal finding that children who drank water with naturally high levels of fluoride had less cavities. But they didn’t just take that and run with it. Scientists performed extensive research into the levels, safety, and important factors for consideration, and it wasn’t until 1945 when the first city in the US, Grand Rapids, Michigan added fluoride to the city water system, providing residents with the benefit of fluoride.

By 2020 nearly 73% of the US served by community water systems had access to fluoridated water. The decline in cavities as a result has been indisputable and significant, thus the CDC naming community water fluoridation as 1 of 10 great public health achievements of the 20th century.

There has also been a significant amount of research into toothpastes containing fluoride, which has also demonstrated to be effective in preventing cavities. This is why all toothpastes with the American Dental Association (ADA) Seal of Acceptance must contain fluoride. Oral healthcare products earn the ADA Seal of Acceptance when they are able to submit data meeting the ADA’s specified requirements for both safety and efficacy. 

The fluoride concentration in water is much lower than that in toothpaste, hence why it can be swallowed safely in our water. Fluoride concentration is also lower in children’s toothpaste, who may be more at risk of accidentally swallowing, and the recommended amount to use is also less in small children.

Finally, your dentist may offer a 5% sodium fluoride varnish application. Fluoride varnish prolongs the contact time between fluoride and tooth surface, making it more resistant to cavities and even having the ability to stop and reverse early cavities. Multiple studies show a significant difference in decayed and filled tooth surfaces between test groups who receive fluoride varnish applications every 3 to 6 months and control groups who do not. Fluoride varnish has also been demonstrated to reduce tooth sensitivity.

Alternatives to Fluoride

Since fluoride is naturally present in water and many foods, it is questionable whether true allergy to fluoride exists. A true allergy is a damaging immune response and will typically involve one or more of the following: hives, rash, itching, swelling, or shortness of breath. Due to the well-demonstrated significant oral health benefits of fluoride, it is important to rule out other possibilities before ruling out fluoride. 

Hydroxyapatite-

You may have seen toothpaste with this ingredient in those advertising fluoride-free. Hydroxyapatite is also a naturally occurring mineral, and it actually makes up the main mineral part of teeth and bones. One study showed that 10% hydroxyapatite achieved comparable efficacy with 500 ppm Fluoride in preventing demineralization and remineralizing early cavities. But some of the toothpastes containing Hydroxyapatite may have a lower percentage than that 10%. Davids will not even share their percentage, stating that, “We do not disclose % as this is proprietary information to our formulation”. Although it could be an effective alternative, clinical data for products with hydroxyapatite is much more limited, and toothpastes containing Hydroxyapatite or nano-hydroxyapatite are generally more expensive than those containing fluoride. 

Xylitol-

Xylitol is a sugar alcohol that is found naturally in some plants. Xylitol contains some cavity preventing properties as it has been shown to reduce the level of cavity-causing bacteria in the plaque and saliva. However, it has primarily been studied as an adjunct to fluoride, and in chewing gum and candy forms.

I recommend xylitol as an adjunct to my patients with dry mouth because of this. Bacteria thrive in a dry environment, so if you suffer from dry mouth it is important to find ways to keep the mouth less dry and stimulate saliva, such as with chewing gum, sprays, and melts. But, if you chew gum with regular sugar or suck on sugary lozenges and so forth, this can certainly have the opposite effect and further promote cavities. This is what makes xylitol a great supplement for this. Xylitol can cause gastrointestinal upset in some people. In order to say that xylitol could be a potential effective replacement for fluoride, further research would need to be conducted to investigate xylitol alone versus fluoride alone, rather than xylitol as an adjunct.

Personal Risk for Cavities

There are a number of factors that affect an individual’s risk of developing cavities, from oral hygiene habits, to diet, to the makeup of your mouth’s bacteria. This is why no one factor or thing controls whether or not you develop cavities. Hence why some people who never use fluoridated toothpaste or receive fluoride treatments may not develop cavities and why some people who brush twice daily still may. But we do know what can significantly lower your risk, and fluoride is a safe, cost-effective, scientifically proven way of doing that. 

See a full guide on fluoridation facts and common fluoride FAQs at:
https://www.ada.org/en/resources/community-initiatives/fluoride-in-water/fluoridation-facts

ABOUT THE AUTHOR

Dr. Kelsey B.P. Garza is a General Dentist and the owner of Darling Dentistry in Bulverde, TX. She is delighted to be able to provide patients in and around Bulverde and Spring Branch with an elevated experience to the dentist through quality, compassionate, and ethical care with special attention to providing a more relaxing environment and helping patients overcome dental anxiety and fear. She is an active member of the Academy of General Dentistry, American Dental Association, American Association of Women Dentists, Texas Dental Association, San Antonio District Dental Society, and the Bulverde - Spring Branch Area Chamber of Commerce. She is an advocate of preventive methods such as fluoride to save patients invasive and expensive treatment. She is accepting new patients. If you have any questions or concerns or would like to schedule an appointment, click the Schedule Now button to reserve your spot through our online scheduling, or reach out to 830.357.7177 or care@darlingdentistry.com.

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Amaechi BT, AbdulAzees PA, Alshareif DO, Shehata MA, Lima PPCS, Abdollahi A, Kalkhorani PS, Evans V. Comparative efficacy of a hydroxyapatite and a fluoride toothpaste for prevention and remineralization of dental caries in children. BDJ Open. 2019 Dec 9;5:18. doi: 10.1038/s41405-019-0026-8. PMID: 31839988; PMCID: PMC6901576.
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