I read a recent article about an ongoing debate in Great Britain: whether or not to include fluoride in the water supply. In the United States, we began adding tiny amounts of this naturally occurring substance to the water supplies over 60 years ago. In fact, as much as 75% of the drinking water in the US is artificially fluoridated, and the purpose is to improve the health of our teeth. I was wondering what the research shows about the need for additional fluoride in our diet, and if there are any risks posed by fluoridation of our water supplies. I asked Revolution Health dental expert, Dr. Andres Garcia, what he thought about this issue. Here are his thoughts:
Dr. Val: Is there compelling evidence that adding fluoride to our water system is beneficial for teeth?
Dr. Garcia: Numerous studies by the ADA have shown that a decrease in cavity exposures of 20-40% can be expected when water is fluoridated in communities. In 1999, the CDC listed fluoride as one of the ten great public health achievements of the 20th century. The current goal by the USPHS (U.S. Department of Health and Human Services) is to have 75% of the drinking water in the U.S. fluoridated to optimum levels by 2010.
Dr. Val: how do people get the benefits from fluoridated water exactly?
Dr. Garcia:You get the benefits from drinking fluoridated water in two ways, systemically and topically. Systemically, small children ingest fluoride as the teeth are forming. The fluoride is incorporated into the enamel and causes the enamel to be stronger and more resistant to decay. After the teeth have erupted, fluoride has a topical action. Fluoride from toothpaste, water, or other sources bathe the teeth, and the fluoride ions reverse tooth damage from decay and harden the enamel to resist further decay. The optimum fluoride intake is a combination of ingestion of fluoride before the teeth erupt and subsequent topical application after eruption.
Dr. Val: Is there any risk associated with too much fluoride?
Dr. Garcia: Fluoride toxicity can occur if people are exposed to high concentrations of the substance over long periods of time, though the water supply is closely monitored to ensure that the concentrations are well within acceptable limits. Fluoride toxicity is called “fluorosis.” If toxic amounts of fluoride are ingested when a child is young, the teeth will be weakened when they form. (This is counter intuitive because small amounts of fluoride strengthen the teeth, but large amounts weaken the teeth.) When the teeth erupt into the mouth, the enamel is very thin and breaks easily. The teeth are also prone to cavities. They will have a brown “mottled” appearance. Bones are also susceptible to fluorosis. Excess fluoride is stored in the bone, and the bones can be brittle and more prone to fractures.
Dr. Val: So if small amounts of fluoride are good for us, why are the British so hesitant to add it to their water supplies?
Dr. Garcia: Many European countries, such as Britain, have been slow to adopt fluoride supplementation due to high levels of other natural sources providing an adequate amount of fluoride in the diet. Tea has been shown to contain from 1ppm to 6.5ppm fluoride concentration. In the U.S., the recommended concentration of fluoride is 1.0-1.2ppm/day as recommended by the USPHS. So regular tea drinkers get enough fluoride naturally. There is also strong anti-fluoride opposition in the public with fears of “forced immunization” and possible adverse health side effects.
Dr. Val: Should people living in areas where the water supply is not fluoridated take additional steps to get more fluoride?
Dr. Garcia: Areas that lack fluoridated drinking water should seek other sources for optimal fluoride intake. The best way is to contact your dentist or pediatrician. Supplements in the form of pills or topical gels can be prescribed to supplement a lack of fluoride. Care must be taken to avoid over supplementation. If the community receives its drinking water from an underground source, they may already be ingesting a higher level of fluoride than is necessary. Toothpaste is also a good source of fluoride. Care must be used in infants as they swallow the toothpaste unknowingly.
Dr. Val: What about those additional fluoride treatments that I had as a child? Are those really necessary?
Dr. Garica: Fluoride should only be used in individuals at high risk for cavities. Kids with braces, a high caries rate, adults with xerostomia, these are ideal candidates for fluoride use. I have all patients learn about fluoride and they make a choice for themselves. I personally will not use anything stronger than an OTC toothpaste for myself and family. Fluoride is a known toxic substance that irreversibly binds to the hard tissues of the body. I am wary of the long term effects of any non essential diet supplement. It is equal to taking antibiotics constantly to stave off a possible infection. Good oral hygiene will keep an individual cavity free. Only in rare cases is someone genetically predisposed to cavities. It is usually a consequence of diet (refined foods) and poor oral hygiene that causes the decay.
For more information, check out Revolution Health’s Dental Health Center
.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.