Fluoride Research Analysis

Q: Why did governments decide to fluoridate water?

In the mid-20th century, governments introduced community water fluoridation as a strategy to address the widespread issue of dental decay, which posed a major public health challenge.[11] Observational research at the time showed that communities with naturally high fluoride levels in their water had significantly lower rates of tooth decay (dental cavities) than communities with lower levels,[12][13][14] and subsequent experimental research confirmed the beneficial effects of water fluoridation for reducing cavities and improving dental health.[9] This evidence supported community water fluoridation as a cost-effective measure for improving dental health across entire populations in both adults and children, offering widespread benefits regardless of an individual's income level or access to dental care.

Q: Should community water be fluoridated?

The question of whether community water should be fluoridated is a topic of debate. Evidence suggests that fluoridation can reduce tooth decay in children by up to 35%, but much of the supporting research predates the widespread use of fluoride toothpaste, and there is insufficient evidence to determine the effects of removing fluoridation.

Q: Does fluoride impact neurological development in children?

Excessive fluoride exposure may be associated with poorer cognition in children, particularly in areas with naturally high fluoride levels, whereas community fluoridation in the U.S. and Canada occurs at levels that are not concerning. However, studies show no significant effect on IQ from typical community fluoride levels, and findings are limited by confounding factors.

Q: Why are certain geographical areas more prone to fluoride toxicity?

Certain geographical areas are more prone to fluoride toxicity due to naturally high fluoride levels in groundwater, which often result from geothermal and volcanic activity that releases fluoride from rocks. Regions in India, China, and potentially Central Africa are particularly at risk because high fluoride exposure can go undetected due to the lack of taste, odor, or color in fluoride-contaminated water.

Q: How do fluoride varnishes work?

Fluoride varnish is a highly concentrated fluoride treatment applied to the surface of the teeth by dental professionals using a brush, cotton tip, or syringe-like applicator, typically 2 to 4 times per year in individuals who are at high risk of caries (dental cavities).[15][16] Fluoride varnishes form a temporary coating on the teeth that allows fluoride to be slowly released and absorbed into the enamel over time. This process helps reduce enamel demineralization (mineral loss) and promotes remineralization, repairing early tooth damage.[16] More specifically, during an acid attack (in which bacteria in plaque produce acids from sugars), fluoride moves with the acid from plaque into the tooth enamel, where it reduces mineral loss by decreasing the solubility of the enamel, increasing calcium and phosphate availability, and inhibiting the diffusion of acid into the enamel. As the pH normalizes after the acid attack, fluoride combines with calcium and phosphate in the saliva to rebuild and strengthen the enamel by forming fluorapatite, a mineral that is more resistant to future acid damage.[17] This dual action — reducing mineral loss and enhancing mineral gain — makes fluoride a powerful tool for preventing dental caries.

Marina Shkayeva

Fluoride

•Last Updated: December 17, 2024

Fluoride is a mineral found in bones and teeth. Fluoride is often used to strengthen enamel and prevent cavities. Small amounts of fluoride are added to public water supplies in some countries, a process known as water fluoridation.

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Fluoride is most often used for

Marina Shkayeva, PharmD

•

Antonis Damianou, MSc

Nick Milazzo, MSc, MPH

•

Katie Jantz, RPh, MSc

Last Updated:December 17, 2024

Dosage Information
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Frequently asked questions
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What is fluoride?

Fluoride is the ionic form of fluorine and is found in soil, rocks, water, and food; approximately 99% of fluoride in the body is associated with bones and teeth. Although it helps prevent tooth decay, excessive fluoride can harm tooth enamel, and its essentiality as a mineral is debated, which has led to varying fluoridation practices in different countries.

Why did governments decide to fluoridate water?

What are fluoride’s main benefits?

Fluoride is primarily known for its ability to stop and reverse tooth decay by integrating into the tooth enamel, inhibiting demineralization, promoting remineralization, and blocking plaque-forming bacteria. Additionally, it contributes to bone formation and has been used to prevent osteoporosis.

Should community water be fluoridated?

What are fluoride’s main drawbacks?

Excessive fluoride intake can lead to dental and skeletal fluorosis, which is characterized by mottled enamel and increased bone density, respectively, along with potential cardiac complications. Additionally, high fluoride exposure may negatively affect children's neurological development, though further research is needed.

Does fluoride impact neurological development in children?

Why are certain geographical areas more prone to fluoride toxicity?

How does fluoride work?

Fluoride is absorbed by the small intestine and can bind with apatite in bones and teeth to form fluorapatite, and it is excreted by the kidneys. In dental products, fluoride enhances tooth remineralization, resists demineralization, and inhibits plaque-forming bacteria, and professional applications provide extended protection when the mouth is acidic.

How do fluoride varnishes work?

What are other names for Fluoride?

Note that Fluoride is also known as:

Acidulated Phosphate Fluoride
Amine Fluoride
Silver Diamine Fluoride
Sodium Fluoride
Sodium Monofluorophosphate
Stannous Fluoride

Dosage information

Fluoride is consumed from foods, fluoridated water, toothpaste, and some dietary supplements. Apart from some teas, most foods do not contain a substantial amount of fluoride. There is no dietary reference intake (DRI) for fluoride, but adults consume less than about 0.5 mg daily. The maximum safe daily dose of fluoride is 4 mg in adult men and 3 mg in women.^[1] In Europe, a number of combination mineral supplements for bone health containing 0.95 mg of fluoride per dose have been on the market for 40 years without reported side effects.^[1]

In community drinking water, the concentration of fluoride to prevent tooth decay ranges between 0.5 and 1.1 mg/L. The US Public Health Service recommends a fluoride concentration of 0.7 mg/L, and the US Environmental Protection Agency set the maximum level as 4 mg/L. The World Health Organization (WHO) guideline recommends 1.5 mg/L fluoride in the drinking water.^[2]

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