At the Dentist
Fluoride Pros and Cons: Is Fluoride Safe?
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The use of fluoride is controversial—it's a known toxin, but we've also been told it's essential for healthy teeth. Fluoride can sometimes be beneficial, but with safer alternatives available, it's just not worth the risk.
by Dr. Burhenne
Now, at this point, you might be asking the same question I did over 30 years ago, which is: How did this stuff get in our water?
Fluoride has always been a controversial topic in the world of
dentistry, and as a dentist, I’m going to make a bold statement that may
surprise you:
I don’t think you need fluoride.
That’s
right—contrary to what the CDC, American Dental Association and Academy
of Pediatrics say, fluoride is not the miracle of dental health it was
sold to be. (1, 2, 3, 4)
On
occasion, I’ve had patients who benefited greatly from topical fluoride
application (more on that later). However, on the whole, most people
don’t truly need it—especially when it’s ingested via the water supply.
Due
to recent advances in dental technology, there’s a better option on the
market that not only works better, but is also non-toxic (and way less
controversial).
I raised three daughters without ingestion of
fluoride. That was something I decided back in 1988 when I bought our
first water filter. I should also add that each of my daughters grew up
without a single cavity.
While many people believe fluoride is perfectly safe and that the water fluoridation controversy
has been settled, that’s not the case. And while uncovering the truth
about fluoride can be difficult, I’m going to help you unpack the facts.
What is Fluoride?
There
are actually many different types of compounds known as fluoride. For
example, calcium fluoride is found in well water and soil all over the
world in varying degrees, with people who drink from wells in Texas
being exposed to higher-than-average levels. Seawater also contains this
compound. (5)
Sodium fluoride, on the other hand, is the compound that was originally added to drinking water.
Unlike
calcium fluoride, sodium fluoride is greatly absorbed by your body and
is not naturally-occurring (read: it’s synthetic). Before it became
known as the miracle of modern dentistry, sodium fluoride was just good
ol’ industrial toxic waste.
The third kind of fluoride is most
concerning to me, as it makes up 90 percent of today’s fluoridated water
supply in the US. It’s called hydrofluorosilicic acid (HFS or FSA) and is also industrial waste.
Why
is it so bad? HFS contains arsenic (a known carcinogen) and leeches
lead (also a carcinogen) as it travels through pipes more than other
types of fluoride. (6, 7, 8, 9)
Is Fluoride Safe?
Sodium fluoride, found in toothpaste, can have beneficial effects when used topically. Used in prescription-strength toothpastes, it can support remineralization of teeth and make it possible to heal cavities. At least, that was the profession’s thinking for the past several decades.
But
in order to get the fluoride into the teeth, prescription strength
toothpastes are formulated to be acidic. The acid breaks down the tooth
so that the amount of fluoride that enters your tooth is greater.
I’m
not a fan of any product that breaks down enamel, but as I mentioned,
these topical applications can be beneficial. (However, there is a
better option for remineralizing teeth, which I’ll discuss later.)
Unfortunately, fluoride in water isn’t really helpful for preventing cavities and swallowing this chemical causes much more harm than good, as it travels through your bloodstream and to all parts of your body.
For example, fluoride can pass into the brain or the placenta to a fetus when ingested. (10, 11)
And since you only get rid of about 50 percent of the fluoride you
consume (through urination), the other 50 percent sticks around via
bioaccumulation anywhere your body stores calcium, like the inside of
your teeth, bones, and cartilage. (12) The chemical can also build up in the pineal gland that regulates sleep. (13)
In
animals, fluoride accumulation in the brain alters neurotransmitter
levels including epinephrine, histamine, serotonin, glutamate,
norepinephrine, acetylcholine, and dopamine. (14)
Notably, this happens to animal subjects when the amount of fluoride in
its blood is similar to that of a human who is ingesting it regularly .
Considering
the above facts, it makes you wonder why we’re still adding this
chemical to water, especially because there’s no concrete proof that
ingested fluoride will even reduce the cavity rate.
History of Fluoride Use
Fluoride
for the teeth was an unexpected discovery made by Frederick McKay, a
dentist who spent time in Colorado. In 1901, he stumbled across the fact
that the cases of “Colorado Brown Stain” in the many children in
Colorado Springs seemed to relate to the strength of the children’s’
teeth, even discolored as they were.
McKay found that fluoride
supports the process of remineralization but could also lead to mottled
teeth, now known as dental fluorosis. Colorado Springs had a great deal
of naturally occurring fluoride in the ground and well water that led to
this conclusion. (15)
Then,
in 1945, studies in various US cities were conducted between
fluoridated and unfluoridated communities. The CDC claims a big victory
from these experiments: Apparently, fluoride reduced dental caries
(cavities) by 50-70 percent over the course of 15 years, leading to an
official recommendation in 1962 to add fluoride to public drinking
water. (16)
However,
none of that data referenced in those studies is actually available. In
fact, it’s unclear whether the studies were ever completed or
well-documented.
The evidence we do have shows us that cavity
formation has actually declined equally between communities with and
without this compound in their water, which leads me to believe that it
wasn’t about the water. (17)
Even
when the use of fluoride to reduce cavities has been studied, the
quality of research leaves much to be desired and typically shows that
if cavity rates decrease, it’s by an incredibly small margin. (18, 19, 20)
Yes,
cavity rates have declined since the introduction of fluoride in the
water supply. However, rates have also declined at nearly identical
rates in “control” countries with no public water fluoridation
whatsoever. (21)
The Dangers of Fluoride
According
to a review from the University of California in San Diego, industrial
fluoride is completely soluble—unlike calcium fluoride that occurs in
nature. The review also supports my belief that, not only is ingesting
this chemical unhelpful for cavities, it’s also dangerous as it
accumulates in the body.
The review states, “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.” (22)
It’s
nearly impossible to track an individual’s fluoride consumption because
it comes from so many sources. In addition to tap water, fluoride is
found in foods, like dill pickles; carbonated drinks; bottled fruit
juice; canned tomato products; spinach; dental products including
toothpaste, mouthwash, gels, varnish, and supplements; the pesticides
cryolite and sulfuryl fluoride; teflon pans; and medications such as
flecainide, niflumic acid, voriconazole, cipro, and anesthetics. (23, 24, 25, 26, 27)
After all, fluoridated water is used to make boxed foods, bottled drinks, and even to water plants!
Now that we know that fluoride is practically everywhere, let’s take a look at some of the specific ways it can cause harm.
1. Fluorosis
Fluorosis
is, perhaps, the least shocking but also the most ironic danger. Dental
fluorosis is the condition of mottled teeth (appearing as small, white
or brown spots on the teeth) that was first defined by Dr. McKay. The
CDC reports that dental fluorosis rates have been rising in the last
30-40 years, likely due to the increase in fluoride sources. (28)
Fluorosis is the only widely acknowledged issue from fluoride exposure—at least according to all governmental bodies. (29)
It is thought to impact less than a quarter of people worldwide and
typically doesn’t stay on permanent adult teeth, but many adults find
that their permanent teeth also show signs of fluorosis.
In countries with very high levels of calcium fluoride in the water,
people can develop a severe form of this condition called crippling
skeletal fluorosis, which causes bone to become rigid and brittle. (30)
So why do I consider even mild fluorosis to be a major problem?
These discolorations are not
just a cosmetic issue. They are indicative of excessive fluoride
ingestion, a dangerous practice that is connected to many more severe
problems. Plus, areas affected by fluorosis are more prone to developing
cavities—and this can happen in areas of the mouth that are difficult
to access, clean, and maintain.
2. Cancer
The
research in this area is somewhat inconsistent; however, it seems that
fluoride ingestion may impact cancer incidence and/or death from cancer.
(31, 32, 33, 34)
Additionally, a bone cancer called osteosarcoma may happen more often
in fluoridated communities, but there are conflicting results. (35, 36, 37, 38)
This,
at least, should convince you of why I encourage making a decision
based on the lesser of two evils. Is the hope of preventing one or two
cavities enough to risk a higher chance of cancer?
3. Brain/Central Nervous System Damage
Concerns
about the impact of fluoride on the brain began in the 1990s in the
infamous Mullenix study, which found that both prenatal and postnatal
exposure to the chemical led to deficits in cognition and/or attention. (39)
Various human studies, including some conducted by Harvard scientists,
suggest that significant fluoridated water exposure is associated with
up to a 7-point drop in IQ scores. (40, 41, 42, 43)
Because
it might cause you to absorb more aluminum—which likely plays a role in
brain degradation—fluoride could be one possible reason instances of
Alzheimer’s disease continue to increase. (44, 45, 46, 47)
We also know that fluoride may affect circadian rhythms and sleep, as
well as a number of neurotransmitter levels. (13, 14) These impacts
have not been studied but could have incredibly far-reaching effects for
not only brain health, but overall health.
4. Various Disease Risks
Fluoride
might increase risk for a number of diseases and health conditions in
addition to those listed above. Those with studied correlations include:
Is Fluoride in Toothpaste Bad?
Fluoride
in over-the-counter toothpaste is pretty useless, primarily because
there’s not enough of it in the toothpaste to help your teeth
remineralize.
That said, there is enough of the chemical in
store-bought toothpastes to be dangerous if swallowed regularly, which
is why I recommend using a fluoride-free toothpaste with children.
In the past, I’ve recommended prescription-strength fluoride toothpaste
of 5000 ppm to certain patients. However, now that a better option is
available, I no longer see any reason to recommend fluoride use.
Alternatives to Fluoride-Containing Toothpaste (And When to Use Them)
Many
people simply don’t need a toothpaste that remineralizes cavities. You
can do much more to reverse cavities naturally simply by adjusting your
diet and following better dental hygiene, like mouth taping at night, tongue scraping, and rinsing your mouth after eating acidic or sugary foods.
For patients who do need extra support remineralizing, I now
recommend toothpaste containing nano-hydroxyapatite particles. It is
much more effective in healing decalcification on the teeth, and with
none of the associated dangers.
The particles in
nano-hydroxyapatite toothpastes are actually tiny, nano-sized bone
fragments that your teeth can incorporate to strengthen enamel and
remineralize the surface. They outperform fluoride when compared side by
side, and the best part is that they’re completely non-toxic. (53, 54) Swallowing this toothpaste is essentially like drinking some extra bone broth—and far from requiring a call to Poison Control.
My preferred nano-hydroxyapatite toothpaste is Boka’s Ela Mint Toothpaste.
Patients I recommend this toothpaste to fit into a few classifications:
- The kid with braces who’s having a hard time keeping plaque off his teeth.
- The young person with a carbohydrate- and sugar-rich diet who’s trying to stop developing so many cavities.
- The patient on radiation therapy for cancer treatment. When the mouth, head, and neck are exposed to radiation, saliva glands will atrophy and stop producing moisture. Without saliva, the decay rate goes up drastically.
- The elderly person with dry mouth, receding gums, and root decay. These conditions often occur when older patients are exposed to certain medications that carry these side effects. These conditions can then be exacerbated by declining dental hygiene.
- The patient with ultra-sensitive teeth. For some people, just walking outside in the winter can cause severe tooth pain. The roots and/or neck of the teeth are typically exposed in these patients, and their teeth desperately need additional calcification. In cases like these, a prescription-strength fluoride toothpaste can help to decrease the pain caused by external stimuli.
- The patient who has a habit of mouth-breathing. Surprisingly, people who breathe through their mouths instead of their nose have a higher rate of tooth decay. In addition to using nano-hydroxyapatite toothpaste, this can be treated naturally by mouth taping at night.
- The person with chronic allergies. When your nose is stuffed up because of chronic allergies, your body may be forced to breathe through the mouth, increasing your risk for cavities.
Additionally, there are several natural toothpastes that I recommend for my average patient without cavities. Dr. Bronner’s Peppermint Toothpaste
is a great, non-toxic option with a refreshing taste. It also foams
less than the average toothpaste, which helps you brush longer.
You might also want to try one of my DIY toothpaste recipes:
- Homemade Toothpaste (this is the one I use every day!)
- Charcoal Whitening Toothpaste
- Probiotic Toothpaste
- Kid’s Toothpaste
- Turmeric Teeth Whitening Paste
But allow me to make an important point:
Brushing and flossing
aren’t the best, or even most effective, methods of keeping teeth
healthy. Treating dry mouth, diet, followed by brushing and flossing, are the most important elements to keeping teeth cavity-free and naturally reversing any smaller, existing cavities.
Genetics
even play a part, which is why some people will simply be more prone to
tooth decay than others, making it all the more important to follow the
best practices overall.
Brushing serves to reorganize and remove the bacteria in your oral microbiome,
and you doesn’t need fluoride to do that. The actual toothpaste you
use, in my experience, is a very small part of the equation.
And, again, I definitely
don’t recommend fluoridated toothpastes to children who aren’t old
enough to fully control their swallowing. I used to draw this line
around the age of eight.
Young children may unintentionally
swallow way too much toothpaste and experience serious negative side
effects, from fluorosis to toxic poisoning. After all, there’s a reason
that even over-the-counter toothpastes with fluoride contain a poison
warning!
What is Fluoride Varnish and Who Should Use It?
Fluoride
varnish is the gel-like treatment used by your dentists or dental
hygienist after your teeth have been cleaned. The problem with varnishes
is that they have extremely high levels of fluoride which can then be
absorbed into your bloodstream and distributed throughout the body.
My suggestion? When you go to the dentist, tell them to skip this treatment altogether.
Are Fluoride Treatments at the Dentist Safe for Kids?
At
the end of a child’s teeth cleaning, the dentist or hygienist will
typically apply a fluoride varnish, then suction any additional liquid
and advise the child to avoid eating or drinking for at least 30
minutes.
Because of the concentration of fluoride in these dental
treatments, eating or drinking (and even swallowing saliva) has a risk
of exposing your child to higher-than-necessary amounts of the chemical.
Many
dentists will use this varnish on 3- or 4- year olds, but I don’t trust
that children at that age will avoid swallowing it. That’s why I used
to tell parents to wait until their child is 8-10 years old before
allowing this post-cleaning treatment.
Now, I recommend
nano-hydroxyapatite toothpaste for children who need to remineralize
cavities—there’s no danger of swallowing, so even younger children can
use it safely.
Do Babies and Toddlers Need Fluoride Water?
I don’t ever think that babies or toddlers need
exposure to fluoridated water. Because their little bones are still
growing, the fluoride from the water will be incorporated into bones and
throughout the rest of the body, where it can cause numerous problems.
These kids are also at a higher risk of dental fluorosis, which can be
permanent.
Instead, focus on the right foods for your child and avoid baby bottle tooth decay
by not bottle-feeding your child as they fall asleep, especially with
formula that contains decay-promoting ingredients, such as high fructose
corn syrup.
Don’t I Need Fluoride to Prevent Tooth Decay?
The
reason babies and toddlers don’t need fluoridated water is the same
reason that teenagers, adults, and even the elderly don’t need
fluoridated water: It’s not the key to preventing or reversing tooth
decay.
Cavities and oral disease occur because of a lack of proper hygiene
and diet as well as mouth breathing and some genetic components. Many
families don’t need any sort of remineralizing toothpaste, so I advise
those who do on a case-by-case basis.
Families that primarily eat
meats, vegetables, and fruits, and drink plenty of water instead of
fruit juice and sodas, rarely have cavities. They have very low
bacterial activity because they’re eating foods that heal cavities naturally and prevent tooth decay.
(Which also means, of course, that they’re avoiding the foods that directly cause tooth decay.)
How to Get Fluoride Out of Your Life
It’s virtually impossible to avoid all fluoride, but you can go a long way in reducing your exposure or detox the amount that you’ve already bioaccumulated.
First, try focusing on a more alkaline diet—the more acidic your urine, the less fluoride you’re able to get rid of. (53)
You might also benefit from drinking tamarind tea, increasing the
amount of high-selenium foods you eat, and exercising regularly. All of
these activities will cause your body to excrete more fluoride. (54, 55, 56)
Other ways to greatly decrease your fluoride consumption include:
Filtering Your Water—Filters
including reverse osmosis, deionizers, and activated alumina will
reduce the amount of fluoride in your tap water. Be aware of exactly the
type of filter you’re using: activated carbon filters or other common
types likely don’t get rid of this particular toxin.
Drinking Distilled Water—There
are important minerals in water that are removed by distillation, but
you can drink distilled water to avoid fluoride. If you’re getting
minerals through vegetables, bottled mineral water, or supplements,
distilled water is a great option. I generally recommend water with a pH
of 7 or higher for cavity prevention.
Using Bottled Water—The FDA requires that bottled water with fluoride must be labeled that way. Most brands don’t contain any at all.
Eliminating Processed Foods—Many processed, boxed foods
have more fluoride than you might expect because they’re made using
water that’s been fluoridated. Getting rid of as many processed foods as
you can has the double whammy of both reducing fluoride consumption and supporting a healthier oral environment.
Buying Organic—Because
of the fluoride-based pesticides used on many non-organic vegetables,
organic options will often have less of the chemical.
Final Thoughts on Fluoride
I know it might be surprising for a dentist to say, but I stick to my guns here: People just don’t need fluoride.
While
I used to recommend it to certain patients, the development of
nano-hydroxyapatite toothpaste has completely eliminated the need for
even prescription-strength toothpastes and varnishes.
This toxin
was introduced into public water supplies throughout the second half of
the 20th century and is currently present in almost 75 percent of public
water in the US. However, there is little to no research supporting its
purported ability to prevent cavities when ingested.
Additionally,
consuming fluoride via tap water and other sources leads to many
dangers, including fluorosis, cancer, brain/central nervous system
damage, and various disease risks.
Ultimately, we’ve missed the
real discussion of the root cause of cavities when we put the focus on
using fluoride. To truly prevent and reverse cavities, the best
practices you can follow are:
- Prevent dry mouth. Try mouth taping at night to help you stop mouth breathing, and and have a conversation with your physician about any medications that could be causing dry mouth.
- Eat a diet rich in plants, grass-fed proteins, grass-fed dairy, nuts, seeds, and healthy fats. When you “cheat” with something high in acid, refined carbohydrates, or sugar, spend only a brief time consuming it, rinse your mouth, then brush 30-45 minutes later to neutralize the impact of it to your teeth.
- Incorporate good dental hygiene, such as brushing teeth the right way, tongue scraping, flossing, and getting regular cleanings at the dentist.
- Remember that genetics and epigenetics (the changeable “on-off switch” of your DNA) play a part in dental health. Research shows that epigenetics can be positively influenced by healthy dietary and lifestyle habits—a benefit you can experience not only for yourself, but that you can even pass to your offspring.
That’s what we’re all about here at AsktheDentist.com: not only
having the right conversations about dental and oral health, but
sometimes changing the conversation.
Fluoride is a poison. Fluoride was poison yesterday. Fluoride is poison today. Fluoride will be poison tomorrow. Some people are beginning to wake up to the poisons our government are putting in our food, air and water to name a few. Fluoride is the most obvious and a great way to start lowering our toxic load. When in doubt get it out.
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