Fluoride is currently added to the drinking water of about 2/3 of the people in the US. The objective of the addition is to protect your teeth from harmful bacteria. The fluoride works by creating a protective coating on your teeth which helps to prevent tooth decay.
Still, fluoridation of water has become controversial. From what I can see, both sides are exaggerating the effects. Proponents of fluoridation claim much greater benefits than are justified by the current data. Opponents are exaggerating the risks. The purpose of this to present the facts, or at least my reading of the facts, and let the reader decide.
Water is fluoridated to reduce the incidence of dental caries (cavities). Caries arise when bacteria in your mouth attack your teeth and start eating your insides. The fluoride protects you from that. A tiny amount (1 ppm) of fluorine is added to the water. The fluorine hardens your teeth and protects you from the bacteria.
Some people say that fluoridation does not work, but in fact there have been hundreds of studies which document fluorides positive effects. As of 1998 the evidence was that fluoridation did reduce cavities. For example Selwitz RH, Nowjack-Raymer RE, Kingman A, and Driscoll WS, J Public Health Dent 1998 Winter;58(1):28-35 compared the incidence of dental caries in towns in Wisconsin with and without fluorinated water. The people in towns with fluoridated water had 30% fewer cavities than the people in towns without fluorinated water.
One of the confusing features with fluoridation is that benefit of fluoridation has decreased over the years. For example, a 1965 study showed a factor of 5 difference in caries rates after fluoridation. However now people are seeing smaller effects in the west. For example Selwitz RH, Nowjack-Raymer RE, Kingman A, and Driscoll WS J Public Health Dent 1998 Winter;58(1):28-35 only saw a 30% change in caries rates in 1997.
Kunzel W, Fischer T Caries Res 1997;31(3):166-73 compared the incidence of dental caries in two towns in Germany, one with fluoridated water one without fluoridation. Up until 1987 the people who lived in places with unfluoridated water showed much higher incidences of dental caries. But then in 1985, the German government started offering free dental sealants to people in both towns. Also people started using tarter control toothpastes. In the period from 1990 to 1998, there was very little difference in the caries rates in the towns with fluoridated water and those without fluoridation. Further there was a decrease in decay rates even in people who did not get sealants applied.
What is going on? Well, the bacteria are dying. This is a normal thing. The bacteria which cause tooth decay are contagious. When I was little everyone got vaccinations for small pox, polio, diphtheria and other contagious diseases. But then after a large, worldwide effort, the bacteria died so the effect of vaccinations decreased. The same thing is happening with the bacteria which cause tooth decay. The widespread use of dental sealants, toothpastes with tarter control and fluorine and other public health measures have killed most of bacteria which cause tooth decay. The declining bacteria population has produced a decrease in decay rates even in people with poor oral hygiene.
If we would have a concerted worldwide assault on tooth decay, we could wipe out the bacteria. But politically that is unlikely to happen in the near future. That is where fluoridation comes in. Fluoridation prevents cavities in people who do not brush their teeth after every meal. The bacteria are dying, or at least evolving to no longer attack your teeth. Fluoridation is part of the reason that we are winning the war with the bacteria.
British studies have examined the impact for the social economic class on the benefits of fluoridation. For example, Jones CM, Taylor GO, Whittle JG, Evans D, and Trotter DP BMJ 1997 Aug 30;315(7107):514-7 found that fluoridation had a major effect on the tooth decay rates in poor neighborhoods, but little effect in more affluent areas.
My reading of the literature is that if you brush your teeth with a tarter control toothpaste after every meal, get semiannual dental cleanings and exams and have your teeth sealed, then you do not need fluorinated water. All of the other measures are enough. However, if you do not brush after every meal and take all of the other measures, then fluoridation will help you.
Further, even people who take all of the measures above are helped indirectly by fluoridation. Fluoridation has lead to a decrease in the population of the bacteria which lead to fluoridation. If we stop fluoridating water nationwide, then bacteria will make a comeback, and everyone’s health will suffer. And not just their oral health. The bacteria have been linked to heart disease.
There is one side effect of drinking fluoridated water: fluorosis. If babies get too much fluorine, then small crystals of calcium fluoride can form on the babies teeth. Later that area can stain because the calcium fluoride is porous. Fortunately, while fluorosis is unsightly, it does not damage your teeth.
There are no other documented health risks from fluoridationIn the popular press people often suggest other health risks associated with fluoridation. There was one “study” in Australia which suggested that fluoridation causes osteoporosis. It is now recognized however, that the one study was heavily flawed; other more recent studies have found that instead fluoridation reduces osteoporosis by hardening peoples bones.
There are no other well documented health risks from fluoridated water contrary to what it says elsewhere on the net.
That does not mean that we should not look for side effects. Maybe one will develop.
My opinion is that having fluoridated water is like take a one a day vitamin. If you eat perfectly, then you do not eat vitamins. But I am human, so I take one a day vitamins to be sure.
I do not like bacteria eating out my insides and want to do anything to kill them. Drinking fluoridated water offers some protection from the bacteria, so I am for it. With continued fluoridation we will eventually wipe out the bacteria which cause tooth decay (and some forms of heart disease) just like we wiped out the bacteria which causes smallpox, polio, etc. At that point it will be OK to stop fluoridating water. However, we need fluoridation to tame the bacteria which cause tooth decay.
Let me say it again: I do not like bacteria eating out my insides and want to do anything to kill them. How do you feel about bacteria eating you?
The American Dental Association is strongly in favor of fluoridation Click here to read their statement.
Read and opposing view from the ” Health Action Network Society, Alberta Chapter, Council’s Operations and Environment Committee “Click here to read their statement.