Fluoride Pros and Cons: Is Fluoride Safe?

Fluoride has always been a controversial topic in the world of dentistry, and as a dentist, I’m going to make a bold statement that may surprise you:

I don’t think you don’t need fluoride.

That’s right—contrary to what the CDC, American Dental Association and Academy of Pediatrics say, fluoride is not the miracle of dental health it was sold to be. (1, 2, 3, 4)

On occasion, I’ve had patients who benefited greatly from topical fluoride application (more on that later). However, on the whole, most people don’t truly need it—especially when it’s ingested via the water supply.

Due to recent advances in dental technology, there’s a better option on the market that not only works better, but is also non-toxic (and way less controversial).

I raised three daughters without ingestion of fluoride. That was something I decided back in 1988 when I bought our first water filter. I should also add that each of my daughters grew up without a single cavity.

While many people believe fluoride is perfectly safe and that the water fluoridation controversy has been settled, that’s not the case. And while uncovering the truth about fluoride can be difficult, I’m going to help you unpack the facts.

What is Fluoride?

There are actually many different types of compounds known as fluoride. For example, calcium fluoride is found in well water and soil all over the world in varying degrees, with people who drink from wells in Texas being exposed to higher-than-average levels. Seawater also contains this compound. (5)

Sodium fluoride, on the other hand, is the compound that was originally added to drinking water.

Unlike calcium fluoride, sodium fluoride is greatly absorbed by your body and is not naturally-occurring (read: it’s synthetic). Before it became known as the miracle of modern dentistry, sodium fluoride was just good ol’ industrial toxic waste.

The third kind of fluoride is most concerning to me, as it makes up 90 percent of today’s fluoridated water supply in the US. It’s called hydrofluorosilicic acid (HFS or FSA) and is also industrial waste.

Why is it so bad? HFS contains arsenic (a known carcinogen) and leeches lead (also a carcinogen) as it travels through pipes more than other types of fluoride. (6, 7, 8, 9)

Is Fluoride Safe?

Sodium fluoride, found in toothpaste, can have beneficial effects when used topically. Used in prescription-strength toothpastes, it can support remineralization of teeth and make it possible to heal cavities. At least, that was the profession’s thinking for the past several decades.

But in order to get the  fluoride into the teeth, prescription strength toothpastes are formulated to be acidic. The acid breaks down the tooth so that the amount of fluoride that enters your tooth is greater.

I’m not a fan of any product that breaks down enamel, but as I mentioned, these topical applications can be beneficial. (However, there is a better option for remineralizing teeth, which I’ll discuss later.)

Unfortunately, fluoride in water isn’t really helpful for preventing cavities and swallowing this chemical causes much more harm than good, as it travels through your bloodstream and to all parts of your body.

For example, fluoride can pass into the brain or the placenta to a fetus when ingested. (10, 11) And since you only get rid of about 50 percent of the fluoride you consume (through urination), the other 50 percent sticks around via bioaccumulation anywhere your body stores calcium, like the inside of your teeth, bones, and cartilage. (12) The chemical can also build up in the pineal gland that regulates sleep. (13)

In animals, fluoride accumulation in the brain alters neurotransmitter levels including epinephrine, histamine, serotonin, glutamate, norepinephrine, acetylcholine, and dopamine. (14) Notably, this happens to animal subjects when the amount of fluoride in its blood is similar to that of a human who is ingesting it  regularly .

Considering the above facts, it makes you wonder why we’re still adding this chemical to water, especially because there’s no concrete proof that ingested fluoride will even reduce the cavity rate.

Now, at this point, you might be asking the same question I did over 30 years ago, which is: How did this stuff get in our water?

History of Fluoride Use

Fluoride for the teeth was an unexpected discovery made by Frederick McKay, a dentist who spent time in Colorado. In 1901, he stumbled across the fact that the cases of “Colorado Brown Stain” in the many children in Colorado Springs seemed to relate to the strength of the children’s’ teeth, even discolored as they were.

McKay found that fluoride supports the process of remineralization but could also lead to mottled teeth, now known as dental fluorosis. Colorado Springs had a great deal of naturally occurring fluoride in the ground and well water that led to this conclusion. (15)

Then, in 1945, studies in various US cities were conducted between fluoridated and unfluoridated communities. The CDC claims a big victory from these experiments: Apparently, fluoride reduced dental caries (cavities) by 50-70 percent over the course of 15 years, leading to an official recommendation in 1962 to add fluoride to public drinking water. (16)

However, none of that data referenced in those studies is actually available. In fact, it’s unclear whether the studies were ever completed or well-documented.

The evidence we do have shows us that cavity formation has actually declined equally between communities with and without this compound in their water, which leads me to believe that it wasn’t about the water. (17)

Even when the use of fluoride to reduce cavities has been studied, the quality of research leaves much to be desired and typically shows that if cavity rates decrease, it’s by an incredibly small margin. (18, 19, 20)

Yes, cavity rates have declined since the introduction of fluoride in the water supply. However, rates have also declined at nearly identical rates in “control” countries with no public water fluoridation whatsoever. (21)

The Dangers of Fluoride

According to a review from the University of California in San Diego, industrial fluoride is completely soluble—unlike calcium fluoride that occurs in nature. The review also supports my belief that, not only is ingesting this chemical unhelpful for cavities, it’s also dangerous as it accumulates in the body.

The review states, “Industrial fluoride ingested from treated water enters saliva at levels too low to affect dental caries. Blood levels during lifelong consumption can harm heart, bone, brain, and even developing teeth enamel.” (22)

It’s nearly impossible to track an individual’s fluoride consumption because it comes from so many sources. In addition to tap water, fluoride is found in foods, like dill pickles; carbonated drinks; bottled fruit juice; canned tomato products; spinach; dental products including toothpaste, mouthwash, gels, varnish, and supplements; the pesticides cryolite and sulfuryl fluoride; teflon pans; and medications such as flecainide, niflumic acid, voriconazole, cipro, and anesthetics. (23, 24, 25, 26, 27)

After all, fluoridated water is used to make boxed foods, bottled drinks, and even to water plants!

Now that we know that fluoride is practically everywhere, let’s take a look at some of the specific ways it can cause harm.

1. Fluorosis

Fluorosis is, perhaps, the least shocking but also the most ironic danger. Dental fluorosis is the condition of mottled teeth (appearing as small, white or brown spots on the teeth) that was first defined by Dr. McKay. The CDC reports that dental fluorosis rates have been rising in the last 30-40 years, likely due to the increase in fluoride sources. (28)

Fluorosis is the only widely acknowledged issue from fluoride exposure—at least according to all governmental bodies. (29) It is thought to impact less than a quarter of people worldwide and typically doesn’t stay on permanent adult teeth, but many adults find that their permanent teeth also show signs of fluorosis.

In countries with very high levels of calcium fluoride in the water, people can develop a severe form of this condition called crippling skeletal fluorosis, which causes bone to become rigid and brittle. (30)

So why do I consider even mild fluorosis to be a major problem?

These discolorations are not just a cosmetic issue. They are indicative of excessive fluoride ingestion, a dangerous practice that is connected to many more severe problems. Plus, areas affected by fluorosis are more prone to developing cavities—and this can happen in areas of the mouth that are difficult to access, clean, and maintain.

2. Cancer

The research in this area is somewhat inconsistent; however, it seems that fluoride ingestion may impact cancer incidence and/or death from cancer. (31, 32, 33, 34) Additionally, a bone cancer called osteosarcoma may happen more often in fluoridated communities, but there are conflicting results. (35, 36, 37, 38)

This, at least, should convince you of why I encourage making a decision based on the lesser of two evils. Is the hope of preventing one or two cavities enough to risk a higher chance of cancer?

3. Brain/Central Nervous System Damage

Concerns about the impact of fluoride on the brain began in the 1990s in the infamous Mullenix study, which found that both prenatal and postnatal exposure to the chemical led to deficits in cognition and/or attention. (39) Various human studies, including some conducted by Harvard scientists, suggest that significant fluoridated water exposure is associated with up to a 7-point drop in IQ scores. (40, 41, 42, 43)

Because it might cause you to absorb more aluminum—which likely plays a role in brain degradation—fluoride could be one possible reason instances of Alzheimer’s disease continue to increase. (44, 45, 46, 47)

We also know that fluoride may affect circadian rhythms and sleep, as well as a number of neurotransmitter levels. (13, 14) These impacts have not been studied but could have incredibly far-reaching effects for not only brain health, but overall health.

4. Various Disease Risks

Fluoride might increase risk for a number of diseases and health conditions in addition to those listed above. Those with studied correlations include:

• Bone fractures (48, 49)
• Diabetes (50)
• Early puberty (51)
• Hypothyroidism (52)

Is Fluoride in Toothpaste Bad?

Fluoride in over-the-counter toothpaste is pretty useless, primarily because there’s not enough of it in the toothpaste to help your teeth remineralize.

That said, there is enough of the chemical in store-bought toothpastes to be dangerous if swallowed regularly, which is why I recommend using a fluoride-free toothpaste with children.

In the past, I’ve recommended prescription-strength fluoride toothpaste of 5000 ppm to certain patients. However, now that a better option is available, I no longer see any reason to recommend fluoride use.

Alternatives to Fluoride-Containing Toothpaste (And When to Use Them)

Many people simply don’t need a toothpaste that remineralizes cavities. You can do much more to reverse cavities naturally simply by adjusting your diet and following better dental hygiene, like mouth taping at night, tongue scraping, and rinsing your mouth after eating acidic or sugary foods.

For patients who do need extra support remineralizing, I now recommend toothpaste containing nano-hydroxyapatite particles. It is much more effective in healing decalcification on the teeth, and with none of the associated dangers.

The particles in nano-hydroxyapatite toothpastes are actually tiny, nano-sized bone fragments that your teeth can incorporate to strengthen enamel and remineralize the surface. They outperform fluoride when compared side by side, and the best part is that they’re completely non-toxic. (53, 54) Swallowing this toothpaste is essentially like drinking some extra bone broth—and far from requiring a call to Poison Control.

My preferred nano-hydroxyapatite toothpaste is Boka’s Ela Mint Toothpaste.

Patients I recommend this toothpaste to fit into a few classifications:

• The kid with braces who’s having a hard time keeping plaque off his teeth.
• The young person with a carbohydrate- and sugar-rich diet who’s trying to stop developing so many cavities.
• The patient on radiation therapy for cancer treatment. When the mouth, head, and neck are exposed to radiation, saliva glands will atrophy and stop producing moisture. Without saliva, the decay rate goes up drastically.
• The elderly person with dry mouth, receding gums, and root decay. These conditions often occur when older patients are exposed to certain medications that carry these side effects. These conditions can then be exacerbated by declining dental hygiene.
• The patient with ultra-sensitive teeth. For some people, just walking outside in the winter can cause severe tooth pain. The roots and/or neck of the teeth are typically exposed in these patients, and their teeth desperately need additional calcification. In cases like these, a prescription-strength fluoride toothpaste can help to decrease the pain caused by external stimuli.
• The patient who has a habit of mouth-breathing. Surprisingly, people who breathe through their mouths instead of their nose have a higher rate of tooth decay. In addition to using nano-hydroxyapatite toothpaste, this can be treated naturally by mouth taping at night.
• The person with chronic allergies. When your nose is stuffed up because of chronic allergies, your body may be forced to breathe through the mouth, increasing your risk for cavities.

Additionally, there are several natural toothpastes that I recommend for my average patient without cavities. Dr. Bronner’s Peppermint Toothpaste is a great, non-toxic option with a refreshing taste. It also foams less than the average toothpaste, which helps you brush longer.

You might also want to try one of my DIY toothpaste recipes:

• Homemade Toothpaste (this is the one I use every day!)
• Charcoal Whitening Toothpaste
• Probiotic Toothpaste
• Kid’s Toothpaste
• Turmeric Teeth Whitening Paste

But allow me to make an important point:

Brushing and flossing aren’t the best, or even most effective, methods of keeping teeth healthy. Treating dry mouth, diet, followed by brushing and flossing, are the most important elements to keeping teeth cavity-free and naturally reversing any smaller, existing cavities.

Genetics even play a part, which is why some people will simply be more prone to tooth decay than others, making it all the more important to follow the best practices overall.

Brushing serves to reorganize and remove the bacteria in your oral microbiome, and you doesn’t need fluoride to do that. The actual toothpaste you use, in my experience, is a very small part of the equation.

And, again, I definitely don’t recommend fluoridated toothpastes to children who aren’t old enough to fully control their swallowing. I used to draw this line around the age of eight.

Young children may unintentionally swallow way too much toothpaste and experience serious negative side effects, from fluorosis to toxic poisoning. After all, there’s a reason that even over-the-counter toothpastes with fluoride contain a poison warning!

What is Fluoride Varnish and Who Should Use It?

Fluoride varnish is the gel-like treatment used by your dentists or dental hygienist after your teeth have been cleaned. The problem with varnishes is that they have extremely high levels of fluoride which can then be absorbed into your bloodstream and distributed throughout the body.

My suggestion? When you go to the dentist, tell them to skip this treatment altogether.

Are Fluoride Treatments at the Dentist Safe for Kids?

At the end of a child’s teeth cleaning, the dentist or hygienist will typically apply a fluoride varnish, then suction any additional liquid and advise the child to avoid eating or drinking for at least 30 minutes.

Because of the concentration of fluoride in these dental treatments, eating or drinking (and even swallowing saliva) has a risk of exposing your child to higher-than-necessary amounts of the chemical.

Many dentists will use this varnish on 3- or 4- year olds, but I don’t trust that children at that age will avoid swallowing  it. That’s why I used to tell parents to wait until their child is 8-10 years old before allowing this post-cleaning treatment.

Now, I recommend nano-hydroxyapatite toothpaste for children who need to remineralize cavities—there’s no danger of swallowing, so even younger children can use it safely.

Do Babies and Toddlers Need Fluoride Water?

I don’t ever think that babies or toddlers need exposure to fluoridated water. Because their little bones are still growing, the fluoride from the water will be incorporated into bones and throughout the rest of the body, where it can cause numerous problems. These kids are also at a higher risk of dental fluorosis, which can be permanent.

Instead, focus on the right foods for your child and avoid baby bottle tooth decay by not bottle-feeding your child as they fall asleep, especially with formula that contains decay-promoting ingredients, such as high fructose corn syrup.

Don’t I Need Fluoride to Prevent Tooth Decay?

The reason babies and toddlers don’t need fluoridated water is the same reason that teenagers, adults, and even the elderly don’t need fluoridated water: It’s not the key to preventing or reversing tooth decay.

Cavities and oral disease occur because of a lack of proper hygiene and diet as well as mouth breathing and some genetic components. Many families don’t need any sort of remineralizing toothpaste, so I advise those who do on a case-by-case basis.

Families that primarily eat meats, vegetables, and fruits, and drink plenty of water instead of fruit juice and sodas, rarely have cavities. They have very low bacterial activity because they’re eating foods that heal cavities naturally and prevent tooth decay.

(Which also means, of course, that they’re avoiding the foods that directly cause tooth decay.)

How to Get Fluoride Out of Your Life

It’s virtually impossible to avoid all fluoride, but you can go a long way in reducing your exposure or detox the amount that you’ve already bioaccumulated.

First, try focusing on a more alkaline diet—the more acidic your urine, the less fluoride you’re able to get rid of. (53) You might also benefit from drinking tamarind tea, increasing the amount of high-selenium foods you eat, and exercising regularly. All of these activities will cause your body to excrete more fluoride. (54, 55, 56)

Other ways to greatly decrease your fluoride consumption include:

Filtering Your Water—Filters including reverse osmosis, deionizers, and activated alumina will reduce the amount of fluoride in your tap water. Be aware of exactly the type of filter you’re using: activated carbon filters or other common types likely don’t get rid of this particular toxin.

Drinking Distilled Water—There are important minerals in water that are removed by distillation, but you can drink distilled water to avoid fluoride. If you’re getting minerals through vegetables, bottled mineral water, or supplements, distilled water is a great option. I generally recommend water with a pH of 7 or higher for cavity prevention.

Using Bottled Water—The FDA requires that bottled water with fluoride must be labeled that way. Most brands don’t contain any at all.

Eliminating Processed Foods—Many processed, boxed foods have more fluoride than you might expect because they’re made using water that’s been fluoridated. Getting rid of as many processed foods as you can has the double whammy of both reducing fluoride consumption and supporting a healthier oral environment.

Buying Organic—Because of the fluoride-based pesticides used on many non-organic vegetables, organic options will often have less of the chemical.

Final Thoughts on Fluoride

I know it might be surprising for a dentist to say, but I stick to my guns here: People just don’t need fluoride.

While I used to recommend it to certain patients, the development of nano-hydroxyapatite toothpaste has completely eliminated the need for even prescription-strength toothpastes and varnishes.

This toxin was introduced into public water supplies throughout the second half of the 20th century and is currently present in almost 75 percent of public water in the US. However, there is little to no research supporting its purported ability to prevent cavities when ingested.

Additionally, consuming fluoride via tap water and other sources leads to many dangers, including fluorosis, cancer, brain/central nervous system damage, and various disease risks.

Ultimately, we’ve missed the real discussion of the root cause of cavities when we put the focus on using fluoride. To truly prevent and reverse cavities, the best practices you can follow are:

1. Prevent dry mouth. Try mouth taping at night to help you stop mouth breathing, and and have a conversation with your physician about any medications that could be causing dry mouth.
2. Eat a diet rich in plants, grass-fed proteins, grass-fed dairy, nuts, seeds, and healthy fats. When you “cheat” with something high in acid, refined carbohydrates, or sugar, spend only a brief time consuming it, rinse your mouth, then brush 30-45 minutes later to neutralize the impact of it to your teeth.
3. Incorporate good dental hygiene, such as brushing teeth the right way, tongue scraping, flossing, and getting regular cleanings at the dentist.
4. Remember that genetics and epigenetics (the changeable “on-off switch” of your DNA) play a part in dental health. Research shows that epigenetics can be positively influenced by healthy dietary and lifestyle habits—a benefit you can experience not only for yourself, but that you can even pass to your offspring.

That’s what we’re all about here at AsktheDentist.com: not only having the right conversations about dental and oral health, but sometimes changing the conversation.

read next: The Only All-Natural Teeth Whitening Methods I Recommend

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