Fluoride: A Key to Healthy Smiles and Public Health
Fluoride has been a cornerstone of dental health for over a century and today remains an important tool for maintaining oral health. Fluoride makes your teeth more resistant to decay, helps rebuild weakened tooth enamel, and slows down the progression of active cavities.
Here is a quick look at fluoride and how it has helped reduce dental cavities and improved oral health worldwide.
In 1901 Dr. Frederick McKay, a dentist in Colorado Springs, made an important discovery: fluoride played a crucial role in protecting teeth from cavities. His findings sparked decades of research, including studies by Dr. H. Trendley Dean at the National Institutes of Health (NIH), whose research focused on the optimal level of fluoride for preventing cavities without causing fluorosis (a condition that can cause white or brown spots on teeth).
Dr. Dean’s work identified that 1 part per million (ppm) of fluoride, or 1 mg/liter, was the ideal level for preventing tooth decay while minimizing the risk of fluorosis. His examination of fluoride levels in a variety of communities showed that fluoride was an effective and safe tool for improving oral health.
Current Uses of Fluoride for Oral Health
Today, you can ingest fluoride in a variety of ways—including in toothpaste, certain foods, and water. Topical fluoride treatments, such as gels and varnishes, help strengthen teeth by promoting remineralization—the process by which enamel repairs itself after acid attacks. These treatments are often applied at dental visits, with recommendations based on a person’s cavities risk. For moderate-risk individuals, fluoride treatments are recommended every 6 months; for high-risk individuals, every 3-6 months.
Fluoride’s effectiveness in preventing cavities has been most notable in communities that have added fluoride to their public water supplies. Community water fluoridation (CWF) works by forming a mineral called fluorapatite in both primary and permanent teeth during their development, which makes them more resistant to acid attacks from bacteria and food. By adding fluoride to public water supplies, communities have seen a significant reduction in tooth decay among their populations. Studies in Newburgh-Kingston, NY (1950) and Grand Rapids, MI (1960), for example, showed that CWF resulted in a 30-60% reduction in cavities. Because CWF impacts everyone in the community, water fluoridation remains a cost-effective way to protect public health, particularly for those without regular access to dental care.
The Safety of Fluoride
Fluoridation of public water supplies has been extensively studied for over 50 years, and research consistently shows that it is a safe way to reduce tooth decay across all age groups. The fluoride used in drinking water is carefully regulated and meets rigorous safety standards, including NSF/ANSI/CAN 60 product certification. This certification is granted by the National Sanitation Foundation (NSF), an independent organization that tests and audits public health products.
Despite its proven success, the use of fluoride continues to face scrutiny. Recent reviews, including those from Cochrane, have raised questions about the strength of evidence supporting its effectiveness in preventing cavities. In 2024 a California court ruling suggested that fluoride might contribute to reduced IQ levels in children. However, this claim has been widely disputed by many studies—including ones conducted in Sweden, New Zealand, and Harvard University—which found no significant link between fluoride exposure and lower IQ or neurobehavioral disorders.
Most health experts believe that the benefits of fluoride for dental health far outweigh any concerns, especially considering that fluoride concentrations in drinking water (0.7-1.2 ppm) are well within safe limits. In fact, the Centers for Disease Control and Prevention (CDC) has named CWF one of the top 10 public health achievements of the 20th century. For more information regarding the American Dental Association’s position on fluoride, please follow this link: https://jada.ada.org/article/S0002-8177(24)00567-1/fulltext?dgcid=raven_jbs_etoc_email.
In New York State, public water systems that add fluoride to increase naturally occurring fluoride levels are required by law to ensure concentrations meet the optimal level of 0.7 mg/L. The federal Safe Drinking Water Act (SDWA) and state Public Health Law set water quality standards for drinking water, and the maximum allowable concentration for fluoride is 2.2 mg/L, well above the levels typically used for fluoridation. For more information regarding the Monroe County Water Authority fluoridation, please visit their website at https://www.mcwa.com/my-water/water-quality/my-water-fluoride-in-your-drinking-water/.
Fluoride’s Lasting Impact
Fluoride has been a key factor in reducing cavities and improving oral health, leading to a decrease in the need for extensive dental treatments. By 2014 nearly 66% of the U.S. population had access to CWF, which has helped lower cavity rates significantly, particularly among children.
Fluoride’s contribution to public health is undeniable, and its impact on preventing tooth decay will continue to shape dental care for generations to come.
For communities, families, and individuals, fluoride remains a safe, inexpensive, and effective tool to help maintain healthy smiles—now and in the future.
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Fluoride Fact: Fluoride is found in nature in soil, water, and foods, and it is safe at the optimal levels used in community water fluoridation.
REFERENCES
Alessa, N., Bidyasagar, Bal S. C., Beegum, F., Ali Habibullah, M., Farhan, M., Almuntashri, A. A., & Babaji, P. (February 2024). Assessment of antibacterial effectiveness of SDF and fluoride varnish agents for application in pediatric dentistry. Journal of Pharmacy and Bioallied Sciences, 16(Suppl. 1), S720-S723. https://doi.org/10.4103/jpbs.jpbs_963_23
Allukian, M., Jr., Carter-Pokras, O. D., Gooch, B. F., Horowitz, A. M., et al. (June 2018). Science, politics, and communication: the case of community water fluoridation in the US. Annals of Epidemiology, 28(6). 401-410. https://doi.org/10.1016/j.annepidem.2017.05.014
American Dental Association. Press Release, October 4, 2024.
American Dental Association Council on Scientific Affairs. (2006). Professionally applied topical fluoride: evidence-based clinical recommendations. Journal of the American Dental Association, 137(8), 1151-1159. https://jada.ada.org/article/S0002-8177(14)64961-8/fulltext
Ast, D. B., Finn, S. B., & McCaffrey, I. (June 1950). The Newburgh-Kingston caries fluorine study. American Journal of Public Health, 40, 716-724. https://doi.org/10.2105/AJPH.40.6.716
Wright, J. T. (December 2024). Courting water fluoridation. Journal of the American Dental Association, 155(12), 993-994. https://doi.org/10.1016/j.adaj.2024.10.003