Public drinking water in the United States has been treated with fluoride for 70 years. This is widely recognized by public health organizations as one of the top acheivements in public health over the past century. But, why is fluoride added to the water we drink? The idea is that fluoridated water prevents dental caries (cavities) and keeps teeth strong. Mulitple organizations, such as the American Dental Association, American Academy of Pediatrics, US Public Health Service, and World Health Organization promote fluoridation of water because cavities are still one of the most common diseases of childhood today.
What is fluoride? Fluoride consists of a group of compounds containing the element fluorine. It is a naturally occurring element found in water, air, rocks, and soil throughout the world. The benefits of fluoride in water were discovered in the 1940s when scientists noticed that populations that drink water containing naturally elevated levels of fluorine have less cavities. This is because fluoride reduces the growth and establishment of bacteria in the mouth, which can harm tooth enamel.
What are dental caries? Dental caries are most commonly called cavities. This is the break down of tooth enamel, which is the outermost, protective layer of the tooth. According to the CDC “This acid eats away minerals from the tooth’s surface, making the tooth weaker and increasing the chance of developing cavities.” Severe and untreated cavities can cause further infection, such as cellulitis and require hospitalization for adequate treatment. The prevalence of dental caries is so large that the NIH actually tracts statistics regarding the prevalence and severity by age group! Images of dental caries can be found through the California Dental Association
What are the risks for fluoridated water? The first risk most people associate with fluoride is the possibility of toxicity. The ingestion of a high level of any element can have adverse effects on a person’s health. According to a study titled Fluoride Toxicity, toxic levels of fluoride can “provoke chronic joints-pain, ligaments-calcification, osteosclerosis.” The list extensively lists complications with bone structure/function and alterations to te levels of other minerals in the body. At very high levels, there are even neurological risks. The American Dental Association website has multiple resources regarding evidence that fails to support a correlation between fluoridated water and neurological consequences such as lowered IQs. However, it appears that the most common risk is dental fluorosis. This is damage to the enamel of developing teeth in children before the tooth breaks through the gums. For most people affected by this condition, the effect is largely cosmetic and does not have negative health outcomes.
What can be done to reduce your toxicity risk? First off, the amount of fluoride in our water is relatively low compared to the minimum toxicity level. Potential fluoride toxicity from oral medicaments: A review notes that “the minimum optimal dose likely to cause toxicity and requiring therapeutic intervention has been set at 5 mg/kg of body weight.” this is well below the current level of fluoride in water which is 0.7 to 1.2 ppm. For those of you concerned for dental fluorosis, Newsweek notes that the levels of fluoride in our water have been decreasing nationally since 2015.
The National Cancer Institute notes that a study in 1990 showed a link between osteosarcomas (bone cancers) in rats given water containing high fluoride levels over a prolonged period of time. However, it is important to note that the results of this study have yet to be replicated, even through a meta analysis of 50 human subject studies. Further studies and reviews evaluating the link between fluoridated water and bone cancer over the past 40 years have yet to create any sort of correlation between the two.
Why don’t we just use fluoridated toothpaste? While fluoride is found in many dental hygiene products such as toothpaste, mouth rinses, and dietary supplements, it can also be found in your diet. Foods such as fruits, vegetables, chicken, infant cereals, ready to drink juices, and canned goods contain some levels of fluoride. Livestrong recommends things such as tea and baked potatoes as sources of this mineral. So, why is fluoride still added to our drinking water? Fluorinated water is the most cost effective means to ensure that the public maintains optimal fluoride levels to maintain healthy teeth. Additionally, although there are other fluoride supplements available to the public, studies still show that communities that drink fluoridated water still have a up to 35% less cavities in their children than communities that do not drink fluoridated water.
So, cheers to some sparkling water and healthy teeth! Drink up!