Having worked in the dental field for over three decades, I have recently observed over the last few years that more people are concerned about the safety of fluoride. Although there is scientific evidence that fluoride is deemed safe to strengthen teeth, as well as slow down the rate of decay in baby teeth and adult teeth, every once in awhile there is a patient or a parent of a young patient that objects to a topical fluoride treatment because they have either heard or read that fluoride is toxic. I attribute this issue to the age of technology and the accessibility to the world wide web. With social media and easy access to Google searches at our fingertips, most anyone can seek information, whether true or false, on just about any topic of concern. In my dental office, most patients, or parents of our young patients will allow the clinician to apply topical fluoride after a teeth cleaning with out any hesitation. But if they do object, the dentist always reassures them that fluoride in small doses is completely safe and beneficial, and it is only toxic if large doses are ingested. Being a Registered Dental Assistant, the issue of fluoride safety interests me because I feel it is important to have firsthand knowledge about the safety of fluoride so that I can assure my patients and people I know who are concerned about fluoride toxicity that it is safe, and have the research and knowledge to back it up.
The history of how fluoride was discovered is quite fascinating. In 1901, a new dental school graduate Frederick McKay decided to open a dental practice in Colorado Springs, Colorado. He was perplexed as to why many of his patients born and raised in that area had severe brown staining on their teeth. He sought to find out why with the assistance of renown dental researcher Dr. G.V. Black. Between the two of them, they discovered that the drinking water in Colorado Springs had a high amount of natural fluoride, which was attributed to the brown staining they called “mottling”. What they discovered was that these people plagued with mottling of the teeth had an incredible resistance to dental caries, which is dental decay or commonly known as cavities. Fluoride became well-known as “natures cavity fighter” with “careful observations and dedicated research.” The technical term for this brown staining or mottling is referred to fluorosis. This is one of the side-effects that occurs when a child has ingested an excessive amount of fluoride while the adult teeth were forming under the gums (Fluoride, Dental Caries, and Safety).
Kris Dill, RDA, giving a young patient a fluoride treatment
Meghanne Kruizenga D.D.S., M.S.D., Pediatric Dental Specialist
Reading the history of how fluoride was discovered helped me to understand how this natural supplement aids in preventing cavities. In my research on fluoride safety, and also discussing this topic with one of the doctors I work with, pediatric dental specialist Meghanne Kruizenga D.D.S., M.S.D., I was overwhelmed with the amount of information both supporting the claim that fluoride is safe, as well as discovering a lot of information claiming that fluoride is toxic to humans, animals and the environment. I have found more information supporting the former claim that fluoride is safe, as long as it is in small amounts. There is seventy years of research to back up this claim (CDC).
One such statement is from the review council of the American Academy of Pediatric Dentistry:
“The American Academy of Pediatric Dentistry (AAPD), affirming that fluoride is a safe and effective adjunct (an added supplement) in reducing the risk of caries and reversing enamel demineralization, encourages public health officials, health care providers, and parents/caregivers to optimize fluoride exposure” (www.aapd.org).
Fluoride is recommended by the American Dental Association (ADA), American Academy of Pediatric Dentistry (AAPD), the Centers for Disease Control and Prevention (CDC) as well as many other government organizations. The AAPD strongly recommends early intervention for prevention of “Early Childhood Caries” (ECC) as young as 12 months of age, or six months after the first tooth erupts. Also, the other benefit of fluoride for a child is drinking fluoridated water while the adult teeth are forming. There is evidence that fluoride strengthens the permanent teeth, aiding in the prevention of future cavities. The only risk reported is mild fluorosis (AAPD). From my personal experience of working in a dental office, as well as what Dr. Kruizenga has observed in her 10 years of practicing dentistry, it is very rare to see cases of fluorosis, at least in the Inland Empire region of Southern California.
What about the potential risks of fluoride? As mentioned before, the most common risk is fluorosis. Unfortunately, there have been four reported deaths since 1978, but there has been a dramatic decline in deaths stemming from the ingestion of the fluoride compound in the U.S. compared with the first half of the 20th century. The four fatalities resulted from ingesting large quantities of dental products with added fluoride. Three of those fatalities were young children that accidently ingested a toxic amount of fluoride, possibly swallowed a tube of fluoride toothpaste. The “probable toxic dose” of fluoride has been set at 5 milligrams kg/f body weight (the kilogram-force is a metric unit of force. http://www.aqua-calc). There is a concern in the rise of reported exposure to fluoride cases according to the annual reports of the American Association of Poison Control Centers. Over 3700 persons have been treated in health care facilities for exposure to fluoride during this period, and there have been 133 cases for which the medical outcomes were classified as moderate or major.” Those statistics are a legitimate reason for concern. However, in spite of the reported adverse effects of chronic ingestion of fluoride, based on a study conducted in the early 1990s, the NY State Department of Health, the U.S. Public Health and Safety, and the National Cancer Institute concluded that there is no evidence of risk in the U.S. of adverse effects for the chronic intake that is associated with drinking water containing up to the level of 4 ppm (parts per million) of fluoride, other than dental fluorosis. Adjustments were made to how much fluoride is added to drinking water to keep it safe (Acute and Chronic Fluoride Toxicity). But there are many people who arguably disagree with these type of reports.
One such person who believes that fluoride is toxic is Richard Sauerheber. He is the author of a very extensive article in the Journal of Environmental and Public Health in 2013, and he claims that “ingested industrial fluoride” is toxic and there is a permanent negative physiological reaction from adding a fluoride compound to drinking water in the United States.
“The toxicity of fluoride is determined by environmental conditions and the positive cations (chemical reaction) present. At a pH typical of gastric [fluids], fluoride is largely protonated (a fundamental chemical reaction) as hydrofluoric acid HF. Industrial fluoride ingested from treated water enters saliva at levels too low to affect dental caries. Blood levels during lifelong consumption can harm heart, bone, brain, and even developing teeth enamel.”
He claims industrial fluoride is harmful and causes adverse effects in humans because the pH in fluoride causes a chemical reaction when fluoridated drinking water is ingested. He stated that fluoride is “not a normal constituent of the mammalian bloodstream, it has no nutritive value, or physiologic function but has been believed by some to be useful for teeth based on an initial correlation with natural calcium fluoride in drinking water.” Many of these studies were conducted on rats, according to one of his cites from the Journal of Medical and Allied Sciences. However, he did admit that “dental officials report in CDC fluoridation literature that fluoride ion is identical in natural and industrial compounds.” But he added, “it is difficult to accurately measure the toxic effects of natural fluoride in water.” (Physiological Conditions Affect Toxicity of Ingested Industrial Fluoride). Many of Sauerheber’s resources are dated from the 1960s and 70s, some are from the early 2000s. Due to public awareness, this prompted several changes to be made over the last several decades of how much fluoride is added to drinking water, as well as to over-the-counter dental products as a result of reported illnesses and deaths.
There are numerous reports on the pro’s and con’s of fluoride safety. Alfredo Morabia, MD, PhD gives another perspective in favor of community water fluoridation, (CWF) with two separate articles published in the American Journal of Public Health (AJPH) in 2015. He addressed both sides of the argument. The process of CWF is done by feeding a fluoride compound into the water supply, usually one milligram per liter. Since millions of people who consume CWF are exposed to some level of fluoridated water, it raises a concern about the long-term risks that may occur. It is becoming a growing popular belief of many that fluoridation is not safe for children’s health, and those individuals “look for every weakness in epidemiological studies (the study and analysis of the patterns, causes, and effects of health and disease conditions in defined populations) contradicting their views to denigrate the evidence.” Basically, those who oppose community fluoridated water are constantly looking for any information to justify their assumptions about fluoride toxicity. There is an ongoing debate between the advocates for CWF and the anti-CWF and their misleading information. Another argument against CWF is the accusation that it causes a lower IQ, according to studies done in New Zealand. However, the studies were deemed inconclusive, having “methodological limitations” and the reference group “was not pure”, according to Dr. Morabia. In the second article, that three claims are made by a historian who “revisited the conditions from the 1950s: stating “(1) scientists and dentists are not in agreement in supporting CWF, (2) early concerns about the toxicity of fluoride were put aside, and (3) little money was spent on fluoridation research after the 1950s, and it was poor quality.” However, that argument was debunked by Jay Friedman, D.D.S., M.P.H. stating that “nothing could be further from the truth” (AJPH). He affirmed that there has been continual monitoring for the safety of CWF since the beginning. Another concern mentioned was about the environmental effects of CWF, “sometimes backed up by studies on rats.” Morabia discredited that claim as well, stating that “there was no evidence based on population studies in humans that support their claims.”
But this will continue to be a controversial subject of both those in favor of CWF and those against it (Community Water Fluoridation: Open Discussions Strengthen Public Health). The only potential risk to drinking CWF is a fluorosis, which is now rare since the fluoride levels have been adjusted.
The bottom line is this, although many people have heard or read that fluoride is toxic and not safe, research gives evidence that it is safe for consumption, and for use in the dental office and in dental products. Proper adjustments have been made in the amount of fluoride added to community drinking water, and as long as precautionary measures are taken in preventing too much fluoride being accidently ingested, it is completely safe. The dental profession has adjusted their recommendations for the use of fluoride based on current research. The results of scientific research have “focused on improving the efficacy of fluoride therapies thus reducing dental caries and lowering the amount of fluoride required for efficacy” (Focus on Fluorides: Update on the Use of Fluoride for the Prevention of Dental Caries). There are so many positive benefits to fluoride. When ingested systemically in our drinking water, it strengthens the enamel of permanent teeth while they are still forming under the gums in young children prior to eruption, making it less likely to be prone to decay. It benefits adult teeth as well, strengthen the enamel thus aiding in the prevention of tooth decay, as long as a healthy diet, good home care and regular dental check-ups are implemented. Topical fluoride is beneficial in strengthening tooth structure in primary (baby teeth) and helps prevent early childhood caries (decay), as well as continue to strengthen the permanent adult teeth. It also helps reduce sensitivity in teeth that have root exposure at the gum line. Topical fluoride is available in many different forms such as in toothpaste, mouth rinses, gels, and fluoride varnish that is applied in a dental office with a dental cleaning. According to the National Cancer Institute (NCI), “optimal fluoridation of drinking water does not pose a detectable cancer risk to humans” (NCI 2016). This critical information counters any “unfounded fears” and provides sufficient research that it is safe to drink community fluoridated water.
Fluoride is arguably a safe intervention in preventing dental decay, and has aided in maintaining healthy teeth effectively for the past 70 years (CDC). Based on research and personal experience of working in the dental field for over thirty years, I am convinced that fluoride is completely safe, and there is nothing to be concerned about, as long as it is used wisely. I stand behind the many organizations such as the ADA, AAPD, CDC, AMA, World Health Association, U.S. Department of Health and Human Services, along with more than 125 national and international organizations that advocate the health benefits of fluoridated drinking water and topical fluoride in the prevention of dental decay (Fluoride, Dental Caries and Safety). For more information, go to http://www.ada.org/goto/fluoride.
Carey, C. M. (2014). Focus on Fluorides: Update on the Use of Fluoride for the Prevention of Dental Caries. The Journal of Evidence-Based Dental Practice, 14 Suppl, 95–102. http://doi.org/10.1016/j.jebdp.2014.02.004. Accessed 2 July 2017.
CDC Image. i.ytimg.com/vi/JGrZn7xw8A4/maxresdefault.jpg. Accessed 9 July 2017.
Debating Fluoride Image. dur-duweb.newscyclecloud.com/storyimage/DU/20170318/NEWS01/170319587/AR/0/AR-170319587.jpg?maxw=1290&ts=1490036026 . Accessed 9 July 2017.
“Department of Health and Human Services.” Department of Health and Human Services, Centers for Disease Control, 30 Jan. 2017, http://www.cdc.gov/fluoridation/pdf/cdc-statement.pdf. Accessed 9 July 2017.
“Fluoridation Facts.” American Dental Association, 2005, http://www.ada.org/~/media/ADA/Member%20Center/FIles/fluoridation_facts.ashx. Accessed 9 July 2017.
Fluoride-Is it Safe? Image. http://www.joannebancroftdds.com/wp-content/uploads/2016/04/fluoride-is-it-safe.jpg. Accessed 9 July 2017.
I don’t Always Drink Water, But When I do, It has Fluoride Image. s-media-cache-ak0.pinimg.com/736x/b7/4d/f3/b74df35e44802b3d91d9402308b4936b–original-memes-i-dont-always.jpg. Accessed 9 July 2017.
Is Fluoride Good or Bad Image. http://www.gordon-dental.com/wp-content/uploads/2017/02/Fluoride.jpg. Accessed 9 July 2017.
Is Fluoride Safe? Image. fearlessparent.org/wp-content/uploads/2013/11/is-fluoride-safe.jpg. Accessed 9 July 2017.
Messina, Matthew J. “Fluoride, Dental Caries, and Safety.” Ebscohost.com, Generations, vol. 40, no. 3, 2016, http://www.ebscohost.com/login.aspx?direct=true&db=a9h&AN=119134599&site=ehost-live. Accessed 2 July 2017.
Mineral or Menace Image. http://www.media.factmyth.com/2016/03/fluoride-is-bad-for-you.jpeg. Accessed 10 July 2017
Morabia, Alfredo. “Community Water Fluoridation: Open Discussions Strengthen Public Health.” Ebscohost.com, American Journal of Public Health, 106(2), 209-210. doi:10.2105/AJPH.2015.303012, 2016. Accessed 2 July 2017.
“Policies on Early Childhood Caries (ECC): Classifications.” American Acadamy Pediatric Dentistry, Review Council, 2014, http://www.aapd.org/media/Policies_Guidelines/P_ECCClassifications1.pdf. Accessed 9 July 2017.
“Policies on Use of Fluoride.” American Acadamy Pediatric Dentistry, Review Council, 2014, http://www.aapd.org/media/Policies_Guidelines/P_FluorideUse1.pdf 2014. Accessed 9 July 2017.
Sauerheber, Richard “Physiologic Conditions Affect Toxicity of Ingested Industrial Fluoride.” Journal of Environmental and Public Health, 6 June 2013, doi.org/10.1155/2013/439490. Accessed 2 July 2017.
Side-by-Side photo of teeth exposed and not exposed to fluoride. openparachute.files.wordpress.com/2013/11/connett-1-1.jpg. Accessed 9 July 2017.
Strong Tooth Image. http://www.geachdental.com/wp-content/uploads/2015/09/fluoride.jpg. Accessed 9 July 2017.
Whitford, G.M. “Acute and Chronic Fluoride Toxicity.” Journal of Dental Research, http://www.journals.sagepub.com/doi/abs/10.1177/00220345920710051901. Accessed 2 July 2017.
“What is kilogram-Force (Unit).” What is a force unit “kilogram-Force” (Kgf), http://www.aqua-calc.com/what-is/force/kilogram-force. Accessed 9 July 2017.
Willie Wonka-Tell Me Again How Fluoride is Toxic?s-media-cache-ak0.pinimg.com/736x/37/8d/e5/378de59b09c9e4d0cf50f348eb3abf31.jpg. Accessed 9 July 2017.
Two Personal Images Included of Kris Dill and Dr. Meghanne Kruzenga 9 July 2017