Jan 302017
 

Short Answer: It is mostly safe in very small quantities and you should use it, but only in topical form (not swallowed). Say NO to fluoridated drinking water.

Long Answer: I don’t think I could take on a more contentious dental question than this one. There are two opposing views on this subject ranging from “fluoride is poison” to “fluoride is one of the greatest public health achievements in the 20th century (Source: cdc.gov).”. Both sides are extremely passionate about their point of view.

SUMMARY

The American Dental Association (ADA) has been a vocal proponent of fluoridating drinking water for over 40 years and today, over 70% of the U.S. population is served by fluoridated water. [source].  The ADA is certain that fluoride supplied by drinking water and toothpaste lowers the chance of developing tooth decay and that it is perfectly safe.

Opponents simply feel that fluoride is a poison, even at very low concentrations.  They equate fluoride to lead, arsenic and other harmful materials.  They attribute the use of fluoride with things ranging from Alzheimer’s disease and Attention Deficit Disorder to irritable bowel syndrome, joint pain and cancer.

The trouble lies in the fact that non-biased information is hard to come by, and most sources are either strongly for or strongly against fluoride. I have some mixed feelings on the topic myself, and it would be disingenuous to claim I have the right answer – but I do think I have a reasonable, middle-of-the-road answer.

There is no debating the fact that fluoride is poison, but it’s equally important to put that statement into perspective:  Everything is potentially poison at a high enough dose and fluoride is no exception.  Take Vitamin D for example, which has been credited with strengthening bones, reducing the risk of certain cancers and many other important beneficial purposes.  It is so widely supported, that most store-bought milk and breakfast cereals are fortified with it.  Yet, at too high a dose, Vitamin D can cause your heart to beat irregularly, damages your kidneys and even increases your risk of cancer [source]. At a high enough dose, Vitamin D will kill you.  But then again, just about anything at a high enough dose, including plain water, will kill you too.  So the point is this: like Vitamin D, fluoride is toxic at the right dose.  The difference in opinion often comes from what constitutes a “toxic” dose.  While the ADA feels that 0.7-1.2 parts per million in drinking water is perfectly fine, holistic sources feel that no amount is safe.  So who is right?

DISCUSSION OF FACTS

Let’s start by discussing the supposed advantage of fluoride:  When minerals like calcium and phosphate leech out of your teeth in acidic conditions, the resulting softness is known as a cavity (caries).  Acidic conditions are usually caused by a specific strain of bacteria that digests sugar in your mouth and converts it into acid. But studies show that when fluoride is present, it helps tooth structure take back some of that lost calcium and phosphate. It actually forms a new material called fluoroapatite.  Unlike the original calcium and phosphate ions, fluoroapatite leeches out of the tooth in significantly more acidic conditions (pH 4.5) than just calcium and phosphate do normally.  In fact, it takes an environment that is about TEN TIMES more acidic to cause fluoroapatite to leech out than just normal calcium and phosphate ions. Bottom line: It takes a lot more acid for a cavity to form, thus, fluoride makes the tooth resistant to cavities.

It is hard to debate the science behind fluoride and the beneficial effects it has on a tooth’s resistance to tooth decay.  At the same time, the potential toxicity it possesses cannot be dismissed.

ASSUMPTIONS

Before drawing conclusions, it’s important to make some assumptions:

  1. Let’s assume that fluoride is potentially toxic even at low concentrations. This is because you cannot scientifically prove that fluoride is completely safe at any dose.
  2. Since I have found little to no scientific evidence supporting the idea that fluoride is absorbed readily through the inside of your mouth, let’s also assume any fluoride placed in your mouth that is then rinsed out thoroughly will have a negligible impact on the blood level of fluoride in the body. If you want to argue that an undetectable amount of fluoride does get absorbed, then I address that in point #5.
  3. Let’s assume that the cavity-fighting effect of fluoride occurs when it contacts the teeth directly in the mouth, not when it is secreted by saliva or when it is circulating in the blood. We know this to be true from other scientific articles I agree with.
  4. Let’s assume you believe, as I do, that ridding your life of fluoride would likely increase your chances of getting a cavity. Most studies agree with this point so we will take it at face value.
  5. Lastly, we assume it is impossible to live a completely 100% fluoride-free life, because fluoride is found in almost everything from rain water to tea, vegetables, fruits, meats, milk and eggs. It is everywhere. Do a little research and you will see. Here is a nice start.

One final assumption I have to make is that most people want to keep their teeth healthy and want to have cavities properly fixed.  But doing so involves many chemicals that are equally or more toxic to the body.  It is common to use materials that contain bisphenol A, mercury, strong acid gels and other toxins when repairing tooth decay.  So if one were to get more cavities and need more fillings as a result of using less fluoride, would they not be ironically exposing themselves to different unwanted chemicals over the long-term?  And since fillings often don’t last a lifetime and need replacement and repair, this could be a potentially serious concern for fluoride-free advocates.  On the other hand, some believe chronic low level fluoride exposure could lead to potential health implications. So which is worse?  We have already assumed that no meaningful amount of fluoride is absorbed through the mouth and that the positive effects of fluoride happen locally in the mouth, not systemically when it is swallowed.  So there is no need to ingest it. I believe the bulk of the problem is solved when you limit fluoride exposure to just your mouth and for a short time.

CONCLUSION

Perhaps the pro-fluoride crowd is 100% correct and there are absolutely no adverse health implications to chronic low levels of fluoride.  Or, perhaps they are wrong and this won’t be revealed for another two decades?  My logic guides me to not risk it if I can easily help it – and I can.  I have chosen to use reverse osmosis filtration in my house to remove fluoride (among other things) but I do use fluoridated toothpaste. After brushing with it once a day using a pea-sized portion and for two minutes, I thoroughly rinse my mouth out with water.  I continue to rinse until I don’t taste any of the toothpaste flavors.  In this way, I get the benefits of fluoride with minimal risk.

As for municipal water fluoridation, this is a contentious issue.  My world view largely dictates a more libertarian approach, whereby, I prefer to empower people with knowledge and let them make informed decisions.  I am personally not in favor of forcing anyone to ingest anything in the name of public health.

Perhaps fluoride is indeed one of the “greatest public health achievements of the 20th century”, but my personal issue with water fluoridation is that one has to actively take measures to remove it if they disagree. Adding iodine to salt has been a very important step in reducing iodine deficiency, something that leads to a host of terrible and preventable health problems.  Nevertheless, when I go to the grocery store, I can still choose between iodized and non-iodized salt.  When I drink from a public water fountain, I do not get that choice.

The pro-fluoride movement also feels strongly that they are helping the “under-served” and “poor” who cannot afford the best dental care or aren’t as empowered with knowledge that prevents tooth decay. I personally find that a bit simplistic and borderline patronizing. Just because someone is poor doesn’t mean they are not intelligent enough to make an informed decision. But if they are poor then they are much less likely to afford a filtration system which rids their tap water of fluoride. In other words, the poorest in our population are being forcibly medicated while the well-off can opt out more easily.

FINAL POINTS

♦ I think fluoride that only touches your teeth and the insides of your mouth is probably safe. Doing so will decrease your risk of getting cavities, which is good.

♦ I recommend brushing your teeth with a very small amount of fluoridated toothpaste at least once a day and rinsing it out completely afterwards.

♦ Do not expect to live a 100% fluoride-free life. You are living in a dream world if you do.

♦ I strongly disagree with medicating the population by fluoridating tap water and also causing the masses to actually ingest this medication (fluoride is only useful when it touches the teeth). I find it disingenuous to use the argument that the poor don’t know enough to make their own decision.

♦ Filter out fluoride from your water if you can and don’t ingest fluoride if you can help it.

Care to comment? Concerns? Questions? Give me your thoughts below.

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  One Response to “Q: Is fluoride safe and should my family use it?”

  1. I enjoyed reading this.

    Yair

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