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June 2022

Calming Fluoride Concerns

Water fluoridation is considered one of the greatest public health successes of the past century. Its effect on dental cavity prevention has been significant, with up to 35% fewer cavities occurring in children living in communities with water fluoridation compared to those living without. Despite this, there continue to be concerns about the potential negative effects of fluoride. What are the concerns? How can you help address them with patients?

Questions about excess exposure might come up, particularly in children. It’s true that consuming too much fluoride can lead to health problems, including skeletal fluorosis, tooth discoloration, and potential thyroid issues. While these are legitimate concerns, explain that these negative effects only occur when fluoride is regularly consumed at high doses, long-term. Children 8 years and older should stay below 10 mg of elemental fluoride daily. Younger children should limit intake further – no more than 2.2 mg daily for kids 4-8 years old.

Fluoride is primarily obtained from water and toothpaste, where it is present in only small amounts. Community water fluoridation is limited to 0.7 mg per liter. Most toothpastes contain about 1.3 mg of fluoride in a quarter teaspoon. While some residual fluoride may be consumed while toothbrushing, the majority should be spit out. To avoid excess exposure in young kids, encourage parents to help them brush their teeth. Only allow them to use a pea-sized amount when brushing just in case they swallow some.

In addition to community water fluoridation, bottled water also often contains added fluoride. This has been a source of controversy for some time. The FDA recently lowered the amount that can be added to bottled water to 0.7 mg per liter (from the previous range of 0.8 to 1.7 mg per liter) to match approved levels in community water. This new rule goes into effect on June 21, 2022.

Overall, tell patients not to worry. Health organizations including the American Dental Association (ADA) stand by the benefits of fluoride – it’s much more likely to improve health than cause harm. As long as toothpaste is used properly, excess exposure shouldn’t be a concern, even in areas with fluoridated water. If tooth staining is a concern, instruct patients to look for products containing sodium fluoride rather than stannous fluoride. Additionally, some communities in the US do not fluoridate community water. If you live in one of these areas, it’s even more important to use toothpaste that contains fluoride. To learn more about the benefits of fluoride, check out our recently updated monograph.

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The information in this brief report is intended for informational purposes only, and is meant to help users better understand health concerns. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions. Copyright © 2022 Natural Medicines Inc. Commercial distribution or reproduction prohibited. Natural Medicines is the leading provider of high-quality, evidence-based, clinically-relevant information on natural medicine, dietary supplements, herbs, vitamins, minerals, functional foods, diets, complementary practices, CAM modalities, exercises and medical conditions. Monograph sections include interactions with herbs, drugs, foods and labs, contraindications, depletions, dosing, toxicology, adverse effects, pregnancy and lactation data, synonyms, safety and effectiveness.