Aside from vaccinations, there is no public health issue more controversial than fluoride. Fluoride has been added to most public water supplies in the United States for the past 70 years and many of our patients, particularly parents, worry about overexposure when fluoride is in the water we drink, the toothpaste we brush with twice a day, and in the fluoride treatments we get at the dentist.
Here at Ryan Senft, DDS, we adhere to the American Dental Association’s position on fluoride: that it is a safe, effective means of preventing tooth decay in children and adults. That being said, let’s go over some common concerns our patients have about fluoride.
Myth or Fact: Fluoride Is Toxic
Fact. With a caveat: yes, fluoride is toxic, but so are most things in excess.
It’s easy to scare people by labeling things toxic, but just about everything is toxic if the dosage is high enough. According to the World Health Organization, exposure to excess fluoride is a public health concern, but water fluoridation programs are not a cause and the contribution of fluoride-containing dental products to overall fluoride intake is minimal.
When adverse reactions to fluoride overexposure, such as skeletal fluorosis, occur, they are nearly always in areas with naturally high fluoride levels in groundwater, like parts of East Africa and China. The risk of skeletal fluorosis increases when fluoride levels are 6 milligrams per liter or above; the US Department of Health and Human Services recommends that municipalities maintain a level of 0.7 milligrams per liter, well below the amount that would prove harmful.
The best way to protect against fluoride toxicity in children is to keep their toothpaste and mouth rinses out of reach–several hundred cases of fluoride toxicity each year involve children eating a large amount of toothpaste or drinking fluoride mouth rinses while unsupervised.
Myth or Fact: Fluoride Damages Teeth Instead of Protecting Them
Myth. Or at least a myth with a little bit of fact thrown into the mix.
Dental fluorosis occurs when children are exposed to too much fluoride; the result is that their adult teeth come in with white spots. These white spots are cosmetic and often barely noticeable.
Cavities are far more damaging to teeth than fluorosis, so the benefits of fluoride outweigh the risk of fluorosis. The American Dental Association calls fluoride ‘nature’s cavity fighter’ because of its ability to strengthen enamel and even reverse early signs of tooth decay.
Myth or Fact: Children Should Not Use Fluoride Toothpaste
Myth. There was a time when the American Dental Association recommended that children under 3 brush their teeth with water instead of toothpaste to protect them against swallowing too much fluoride.
After further research, the ADA reversed this recommendation and instead recommends that children under 3 use an amount of toothpaste equal to the size of a grain of rice, which offers the protection of fluoride without the potential risk of swallowing an excess amount. Always supervise your children while they brush their teeth and don’t leave them with their toothpaste unattended.
Myth or Fact: Fluoride Causes Low IQ in Children
Fact. This is another fact that has been distorted by opponents of municipal water fluoridation programs. A study published in Environmental Health Perspectives suggests that prenatal exposure to fluoride can lower children’s IQ scores.
While that may be true, the study was done in Mexico, where naturally occurring fluoride levels are higher in community water and fluoride is also added to salt. The ADA stands by its position that water fluoridation programs in the United States are safe and effective and has concluded that this research is not applicable to the US.