By Amal Noureldin
Driving through downtown Dallas, you might see a striking banner hanging at the U-turn bridge, near the Walnut Hill exit on Central Expressway (US 75): “Stop Fluoridation!” Below it, other banners demand action and warn of supposed dangers.
It’s not the first time fluoride has been at the center of public debate.
Since 1951, fluoride has been added to community water supplies in many countries to prevent tooth decay. Fluoridation started as an observation, then an idea that ended as a scientific revolution 50 years later.
Fluoridation is the controlled careful addition of a precise amount of fluoride to community water systems to enhance dental health, ensuring it remains safe without causing systemic health side effects.
The practice has been hailed as one of the “10 greatest public health achievements of the 20th century.”
But with Robert F. Kennedy Jr., a vocal opponent of fluoridation of water supplies, being tapped by President-elect Donald Trump to lead the Department of Health and Human Services, this progress is under threat.
I am a clinical professor specializing in caries management, with over 30 years of experience in preventing and treating early decay. In my view, it is crucial to rely on evidence-based practices and research that have consistently shown fluoride to be a cornerstone of dental health, benefiting millions without adverse effects.
Fluoride in the water supply
Fluoride is a naturally occurring mineral found in water, soil and even certain foods. Its role in oral health was first recognized in the early 20th century when researchers observed lower rates of tooth decay in communities with naturally high levels of fluoride in their water.
In 1945, Grand Rapids, Michigan, became the first city in the world to intentionally fluoridate its water supply. This decision came after thorough discussions with Dr. H. Trendley Dean, head of the dental hygiene unit at the National Institutes of Health at the time, and other public health organizations. The Michigan Department of Health approved adding fluoride to the public water supply the following year.
The city was chosen due to its low natural fluoride levels, a large population of school-age children, and proximity to Muskegon, which served as a control city. After 11 years, the results were remarkable: Cavity rates among children in Grand Rapids born after fluoridation began dropped by over 60%. This scientific breakthrough transformed dental care, turning tooth decay into a preventable condition for the first time in history.
By 2008, over 72% of the U.S. population – over 200 million Americans – using public water systems had access to fluoridated water.
This scientific breakthrough transformed dental care, turning tooth decay into a preventable condition for the first time in history.
Fluoride is naturally present in most water sources, but typically at concentrations too low to prevent tooth decay. By adjusting the fluoride level to the recommended 0.7 milligrams per liter, equivalent to about three drops in a 55-gallon barrel, it becomes sufficient to strengthen tooth enamel.
Dr. Martha Alvarez
Benefits of fluoride for tooth health
The science is simple: Fluoride strengthens tooth enamel, the protective outer layer of teeth, by promoting remineralization. It also makes teeth more resistant to the acids produced by bacteria in the mouth. This helps prevent cavities, a problem that remains widespread even in modern societies.
Fluoridated water has been extensively studied, and its benefits are well documented. According to the Centers for Disease Control and Prevention, water fluoridation reduces cavities by about 25% across all age groups. It’s a public health measure that works passively – every sip of water helps protect your teeth, without requiring you to change your behavior.
This is especially important for vulnerable populations. Low-income communities often face barriers to accessing dental care or fluoride products like toothpaste. By fluoridating water, communities provide a safety net, ensuring that everyone benefits regardless of their circumstances.
Economically, it’s a smart investment. Research shows that for every dollar spent on fluoridation, communities save about US$20 in dental treatment costs. These savings come from fewer fillings, extractions and emergency visits – expenses that disproportionately affect low-income communities.
Opposition to fluoridation
Despite its benefits, water fluoridation is not without controversy. Opponents often argue that it infringes on personal choice – after all, most people don’t get to opt out of drinking community water. Others raise concerns about potential health risks, such as fluorosis, bone issues or thyroid problems.
Fluorosis, a condition caused by excessive fluoride exposure during childhood, is often cited as a reason for alarm. However, in most cases, it manifests as mild white spots on teeth and is not harmful. Severe fluorosis is rare in areas with regulated fluoride levels.
What about other health risks? Decades of research, including large-scale reviews by expert panels from around the world as well as the World Health Organization, have found no credible evidence linking fluoridation to serious health problems when fluoride levels are kept within recommended limits. In fact, the fluoride concentration in drinking water is carefully monitored to balance safety and effectiveness.
The CDC oversees the monitoring of fluoride levels in community water systems across the United States. Meanwhile, the Environmental Protection Agency establishes a safety standard of 2 milligrams per liter to prevent mild or moderate dental fluorosis.
Still, the debate continues, fueled by misinformation and mistrust in public health initiatives.
It’s important to separate legitimate concerns from unfounded claims and rely on the overwhelming body of evidence supporting fluoridation’s safety.
Fluoride alternatives
For those who prefer to avoid fluoride, there are alternatives to consider. But they come with challenges.
Fluoride-free toothpaste is one option, but it is less effective at preventing cavities compared with fluoride-containing products. Calcium-based treatments, like hydroxyapatite toothpaste, are gaining popularity as a fluoride alternative, though research on their effectiveness is still limited.
Diet plays a crucial role too. Cutting back on sugary snacks and drinks can significantly reduce the risk of cavities. Incorporating foods like crunchy vegetables, cheese and yogurt into your diet can help promote oral health by stimulating saliva production and providing essential nutrients that strengthen tooth enamel.
However, these lifestyle changes require consistent effort and education – something not all people or communities have access to.
Community programs like dental sealant initiatives can also help, especially for children. Sealants are thin coatings applied to the chewing surfaces of teeth, preventing decay in high-risk areas. While effective, these programs are more resource-intensive and can’t replicate the broad, passive benefits of water fluoridation.
Ultimately, alternatives exist, but they place a greater burden on people and might not address the needs of the most vulnerable populations.
Should fluoridation be a personal choice?
The argument that water fluoridation takes away personal choice is one of the most persuasive stances against its use. Why not leave fluoride in toothpaste and mouthwash, giving people the freedom to use it or not, some argue.
This perspective is understandable, but it overlooks the broader goals of public health. Fluoridation is like adding iodine to salt or vitamin D to milk. These are measures that prevent widespread health issues in a simple, cost-effective way. Such interventions aren’t about imposing choices; they’re about providing a baseline of protection for everyone.
Without fluoridated water, low-income communities would bear the brunt of increased dental disease. Children, in particular, would suffer more cavities, leading to pain, missed school days and costly treatments. Public health policies aim to prevent these outcomes while balancing individual freedoms with collective well-being.
For those who wish to avoid fluoride, alternatives like bottled or filtered water are available. At the same time, policymakers should continue to ensure that fluoridation levels are safe and effective, addressing concerns transparently to build trust.
As debates about fluoride continue, the main question is how to best protect everyone’s oral health. While removing fluoride might appeal to those valuing personal choice, it risks undoing decades of progress against tooth decay.
Whether through fluoridation or other methods, oral health remains a public health priority. Addressing it requires thoughtful, evidence-based solutions that ensure equity, safety and community well-being.
Amal Noureldin is Clinical Professor of Cariology, Prevention and Restorative Dentistry at Texas A&M University.
Concerned says
My siblings and I had fluoridated water and have good teeth, My husband and his siblings did not and have very unhealthy teeth.
DaleL says
Here is my testimonial. I grew up in a time before fluoridation. I had many cavities as a child. My two children grew up drinking well water that contained 0.9 milligrams per liter of fluoride according to a water sample that I had tested. My children had only a couple of cavities while growing up.
Amal Noureldin mentions iodine in salt and vitamin D in milk as other examples of community health measures. Beginning in the 1920s until it was banned in 1996, lead was added to automotive gasoline to improve combustion. It is still used in aviation gasoline. A recent study has found that the lead in gasoline is tied to over 150 million excess cases of mental health disorders. The rise in car ownership after WWII, especially in the 1960s roughly corresponds with the rise of fluoridation in public water systems. Similarly, the MMR vaccine was licensed in 1969. The organophosphate insecticides (Malathion, etc.) were developed in the 1950s. They have been accused of affecting the development of children’s mental abilities.
Could it be that the anti-fluoridation and anti-vaccine crowd are directing their crusades at the wrong substances. Vaccines and fluoridation have been studied to death. There is no link (ZERO) with either fluoridation or vaccines to mental health disorders in children. Lead and organophosphate insecticides have also been well studied. Lead exposure is very BAD; there is no safe level of exposure. Organophosphate insecticides might be bad. (The indoor use of these insecticides is now banned.)
Drinking water should be fluoridated and lead should be removed from aviation gasoline.
Pogo says
@DaleL
I would add:
As stated
https://www.google.com/search?q=lead+in+hunting
Dave says
Very interesting. As a head and neck cancer patient and having received 30 high dose ( 60 gy’s) of radiation on my neck area. Back in 2018 my oncologist and my dentist both noted, I would have to use fluoride trays for the rest of my life , each day. So what is it, fluoride good or bad and for whom.
Pierre Tristam says
Dave, you and me both. I go through the fluoride-in-trays ritual nightly. It’s either that or we risk losing a lot more.
Dave says
So very true Pierre. The danger of doing without, for me radiation therapy caused severe dry mouth (xerostomia), which significantly increases the risk of tooth decay. Without the fluoride and for me, quarterly dental visits, I could encounter tooth decay. Or worst, loose my bone structure in my jaw holding my teeth. I’ll trust my dentist and my oncologist rather than Robert F. Kennedy Jr. .
Laurel says
Compelling argument, but I’m not buying it. I like government protecting people, but I don’t like it acting like my daddy. Believe me, I’m no fan of RFK Jr., either.
I grew up in Florida, and its florinated, public water. Of course I survived (!) but even though my mom took me kicking and screaming to the dentist on a regular basis, I had plenty of fillings to suffer through. As a kid, I brushed two to three times a day. Still do. Floss too.
It’s a moot point these days. Our daughter and granddaughter have sealants on their teeth with great success. I think between them they have had one cavity. So, swallowing excessive amounts of fluoride daily seems like a bad idea. We have an RO system for drinking water. I’ve been against adding fluoride for decades.
Jim says
I thought this statement by the writer tells us all what the real problem is:
“I am a clinical professor specializing in caries management, with over 30 years of experience in preventing and treating early decay. In my view, it is crucial to rely on evidence-based practices and research that have consistently shown fluoride to be a cornerstone of dental health, benefiting millions without adverse effects.”
Is this country, we no longer believe in “evidence-based practices and research” – on anything. We just went through a pandemic where many people – with absolutely no data to support their claims – encouraged people not to get vaccinated but depend on unproven and mostly disproven “cures” like ivermectin (horse tranquilizer). And this type lunacy was embraced by a significant portion of Americans.
I’ve seen no reliable medical studies showing adding fluoride to water causes medical issues other than what the author comments on in this article. Those issues that are reported are relatively mild and correctable. So, to me, what the issue really comes down to is the current position that we shouldn’t have to do anything we don’t want to even if it’s good for us. We no longer believe in getting vaccinated for the good of society. More and more parents are refusing to get their kids vaccinated. And, in time, this is going to lead to a recurrence of all the diseases that most of us thought were long gone from this world. So let’s stop fluoridation of our water supplies and be free! So what if cavity rates go up. That’s someone else’s problem, not mine.
I’ve spent my whole life believing in science and facts. My training in my working career was to make fact-based decisions. Yet, here in my twilight years, I have to watch this country devolve into a third world order “civilization” where we all do what we want and the hell with everyone else.
I think the absolute worst part of this “new” America is that – should another pandemic occur – our federal and state medical services will not work towards reliable vaccines for all of us but recommend “cures” based on little to no scientific support. It’s not going to be much solace when that happens other than we can all die knowing we were “free”!
KC says
I’m 53 years old. When I was a small child my city had fluoride enhanced water. We later moved to a city that did not and I remember my pediatrician telling my parents that we needed fluoride supplements because of that. I took fluoride supplements through college.
I have never had a cavity, over three decades after stopping the fluoride. It definitely makes a difference.
Laurel says
Okay, I started thinking more about it, and came up with the idea that fluoride must somehow be mined, therefore, creating a profit for someone after extracting and selling. A quick search found that fluoride is a toxic waste product of phosphate mining and chemical fertilizer processing. I know that fluoride has no connection to the purification of drinking water, but is an efficient way to get rid of a waste product.
https://origins.osu.edu/article/tox
I’m not sure, Pierre, why you would need nightly treatment, as I have found that as I got older, cavities have become non-existent. Maybe because, as a kid I brushed often, but also loved candy and its high sugar content. That love of sugar has long disappeared from my pallet. But your program is between you and your health care provider. Accidentally swallowing it, along with drinking it in daily, may lead to more questions.
The problem I have here, with some of the commenters, is that this is lumped in with anti-vaxers. I think that is an unfair labeling, and more of political side taking. RFK Jr., like a broken clock, can be right twice a day. However, he should not be in control of America’s health.
Laurel says
Don’t know why, but the link to Ohio State University’s article is somehow different each time I try it. When searching from scratch, a consistent, long article on the subject comes up. Forget the link.
There are many, many articles supported by the ADA promoting the use of fluoride, but I remain unconvinced. After all, the ADA thought, for decades, that filling our mouths with fillings that contained mercury was a good idea, until they decided it wasn’t. The articles also also repeatedly mention fluoride as naturally occurring, which is true as it occurs in many of our foods, such as tea, but there are many naturally occurring chemical elements that are potentially toxic to humans. I’m not saying the amount of fluoride in our water is toxic, I don’t know, I’m saying it is unnecessary, and I prefer to make it my choice.
The fact of the matter is, the fluoride in our water systems is a waste byproduct in the making of chemical fertilizer, mined phosphorus, here in Florida, and shipped around the country expressly for adding to municipal water systems.
Another fact is, I have ingested fluoride in the Broward County water system for decades, and experienced a nightmare of continuing dental problems. It did not help me. I have all but two wisdom teeth, and two teeth that failed. Why? Because I have repeatedly poured thousands of dollars in tooth repair.
All these wondrous claims of miraculous results of fluoride use seem to fail to mention the real culprit: sugar. Sugar is a seriously big business! It is added to nearly every processed product you can think of. Sugar has a very, very large lobby. Sugar causes tooth decay. Sugar causes diabetes. Sugar causes monumental problems, but it is better for profit to add chemicals to *save* our teeth, and help us lose weight.
Enjoy your fluoride, I’ll use my RO water system, and hope for a decrease in unnecessary additives.
DaleL says
The correct link is: https://origins.osu.edu/article/toxic-treatment-fluorides-transformation-industrial-waste-public-health-miracle
It is a very good article on the history of the discovery that fluoride was important in preventing cavities. Here is a highlight from the story:
“During the 1930s, Dean, McKay, and colleagues from the PHS and various university dental schools set about trying to demonstrate fluoride’s connection to both dental fluorosis and reduced rates of caries.”
As a result they set about conducting a comparison trials in Michigan. In the trial, Grand Rapids had fluoridated water and Muskegon did not.
“By 1950, the trial in Grand Rapids was yielding very positive results. In fact, officials in Muskegon grew increasingly agitated. From their perspective, the town’s ongoing status as the control city meant their citizens’ dental health was being sacrificed on the altar of Dean’s scientific cautiousness. They would indeed begin fluoridation in 1951, thus severely compromising Dean’s 15-year study in the eyes of fluoridation skeptics.”
As to my children, as I wrote, it just so happened that our well water naturally had nearly the ideal level of fluoride. 12 percent of Americans, mostly rural rely on well water for drinking. Very few have their water tested for fluoride. Almost all of the water from these wells contains naturally occurring fluoride. Yet I do not hear anything about the “horror” of these people drinking natural fluoride.
Common sense health measures include: pasteurization of milk, vitamin D in milk, childhood vaccinations, and fluoridation of drinking water.
Laurel says
DaleL: Thank you for the link, it is appreciated.
My personal stand on the subject is that I believe fluoride, applied directly to the teeth, such as in toothpaste or prescribed applications, is logical. I do not like the government promoting the ingestion of fluoride through our digestive system with no say on the ingester’s part. I am not aware of just how much daily ingestion of fluoride is required for general health.
Like the ending summary of the article stated, the Florida’s phosphate, fertilizer companies would have to find a different disposal of the waste byproduct if not poured into our drinking water supplies.
JOSEPH HEMPFLING says
THE SAME ARGUMENT THAT TOLD US SMOKING CIGARETTES MADE US SEXY. FLUORIDE IS A KNOWN TOXIN WITH
DANGEROUS EFFECTS AND AS SO MANY THINGS LIKE THE MOST RECENT “SCAM-DEMIC”AND SHOULD HAVE NEVER BEEN PUT IN OUR WATER SUPPLY ONCE AGAIN SHOWING YOU THE POWER OF BIG BUSINESS. AND NOW
IS THE TIME DESPITE ALL THE CONTRARY MADE-UP ARGUMENTS TO BAN IT ONCE AND FOR ALL.
OR AT LEAST REQUIRE “INFORMED CONSENT” IF YOU CHOOSE TO POISON YOURSELF. READ THE LITERATURE
IT IS ALL THERE AND HAS BEEN FOR SOME TIME.