Fluoride - What You Need to Know

Isn't it hard to figure out how bad fluoride is for you?   We hear horror stories about how sick it can make us, but we also hear that our teeth need it!   

I recently reviewed the current evidence about fluoride on behalf of a young patient who is struggling with his dental health.  Here is what I found, and I have to say, I was surprised!


Why Fluoride is Added to Drinking Water

Here is a summary, from the Centers for Disease Control and Prevention, of how a lot of drinking water came to be treated with fluoride, and it says "...laboratory and epidemiologic research suggests that fluoride prevents dental caries [cavities] predominately after eruption of the tooth into the mouth..."


Evidence That Fluoridated Water Helps With Dental Health 

Evidence does show that the fluoridation of water is associated with better dental health, but the evidence also shows that dental health has improved in areas that don't have fluoridated water.   This 2001 study from British Columbia found "The prevalence of caries [cavities] (assessed in 5,927 children, grades 2, 3, 8, 9) decreased over time in the fluoridation-ended community while remaining unchanged in the fluoridated community."   Translation - dental health improved when water stopped being fluoridated!


Too Much Fluoride!

One of the concerns is something called dental fluorosis, which is the deposition of excess fluoride into the enamel of the tooth, causing visible white or brown spots or streaks.  There is also concern regarding fluorosis in general (meaning too much fluoride in the body).   Dental fluorosis is often thought to indicate general fluorosis. 
  

Is There Proof That Fluoride is Bad For Me?

Part of the problem with fluoride is that we know that it can be bad for you, but we're not always sure of how and at what level of exposure.   Take this review from The Lancet (a very well-respected journal) which says:

"Neurodevelopmental disabilities, including autism, attention-deficit hyperactivity disorder, dyslexia, and other cognitive impairments, affect millions of children worldwide, and some diagnoses seem to be increasing in frequency. Industrial chemicals that injure the developing brain are among the known causes for this rise in prevalence. In 2006, we did a systematic review and identified five industrial chemicals as developmental neurotoxicants: lead, methylmercury, polychlorinated biphenyls, arsenic, and toluene. Since 2006... studies have documented six additional developmental neurotoxicants—manganese, fluoride, chlorpyrifos, dichlorodiphenyltrichloroethane, tetrachloroethylene, and the polybrominated diphenyl ethers...To control the pandemic of developmental neurotoxicity, we propose a global prevention strategy. Untested chemicals should not be presumed to be safe to brain development, and chemicals in existing use and all new chemicals must therefore be tested for developmental neurotoxicity."

Scientists do go looking for a connection between elevated fluoride levels and negative health effects.  We know that very high levels of fluoride damage our neurological system.   This study found a correlation between higher fluoride levels and lower IQ scores, but it mostly reviewed studies coming out of rural areas in China with high levels of fluoride exposure.  Overall, there isn't a lot of good evidence out there yet that fluoride, in the concentrations that Canadians are exposed to, is detrimental to our health.  Bear in mind, it is considered unethical to expose children to high levels of fluoride, which makes it pretty hard to study!

Much of the research regarding fluorosis is coming out of India, where water has more fluoride added than Canada.   Studies like this one found that fluoridated water does increase blood and urine fluoride levels, and negatively affects thyroid function. 

In 2006 the National Research Council published the book "Fluoride in Drinking Water" which raised a lot of concerns about the known health risks of high levels of fluoride and called for A LOT more research about the health risks of long-term exposure to lower levels of fluoride (excerpts here). 


The Movement Against Fluoride Use

Here is a link to a post from Mercola about fluoride, coming out strongly against fluoride use.   I find the Mercola website to be alarmist, but I also really respect the fact that it includes references.  If you find something they claim unbelievable or shocking, click on the reference and learn the details.    


Fluoride Use Recommendations

The Centers for Disease Control and Prevention recommends that children younger than 2 years of age not use fluoridated toothpaste, and that children younger than 8 years of age not be exposed to drinking water that contains more than 2 mg/L of fluoride.   [The Indian children in the study previously mentioned were exposed to between 0.98 to 5.5 mg/L of fluoride in their drinking water.] Health Canada recommended in 2007 that drinking water contain no more than 1.5 mg/L of fluoride.

There is a group of world-renowned scientists, called The Cochrane Collaboration, that is well respected for taking a hard look at the evidence and releasing recommendations that are just based on the facts.   Here is what they have had to say about fluoride use in children:

"A statistically significant reduction in fluorosis was found if brushing of a child's teeth with fluoride toothpaste commenced after the age of 12 months."  "The evidence for its use between the age of 12 and 24 months is equivocal. If the risk of fluorosis is of concern, the fluoride level of toothpaste for young children (under 6 years of age) is recommended to be lower than 1000 parts per million (ppm)." (review here)

"Topical fluorides (mouthrinses, gels, or varnishes) used in addition to fluoride toothpaste achieve a modest reduction in caries compared to toothpaste used alone."  (review here)

" There is a need for complete reporting of side effects and acceptability data in fluoride mouthrinse trials."  (review here)

"This review confirms the benefits of using fluoride toothpaste in preventing caries [cavities] in children and adolescents when compared to placebo, but only significantly for fluoride concentrations of 1000 ppm and above... The decision of what fluoride levels to use for children under 6 years should be balanced with the risk of fluorosis."  (review here)

Note - 1000 ppm fluoride concentration seems to be the level at which children will experience the most benefit AND the most risk.  


Is My Water Fluoridated?

Wondering if your water is fluoridated?   Here is a nice summary put out by Canadian Dental Association regarding the state of fluoridation in Canada.   It says that, as of 2007, 45.1% of the Canadian population has fluoridated water (Ontario's percentage is higher).  Some communities have decided to stop fluoridating their water based on health concerns, including Kirkland Lake.   


The Doctor's Opinion

After spending hours and hours reviewing all this evidence, I have come to the conclusion that fluoride exposure from anything other than natural food and water sources (especially above 1000 ppm) is only worth the risk:

• after 12 months of age
• through the use of topical products
• if problems are being experienced with dental health.    

Dental health, as an issue, reminds me of osteoporosis.  Our society has become fixated upon the idea that osteoporosis is a condition caused entirely by calcium deficiency, even though other cultures with less dietary calcium than us don't suffer from osteoporosis, and we know it's related to numerous other nutrient deficiencies (vitamin K1, vitamin K2, trace minerals, vitamin D3, magnesium, etc.) and other health imbalances (general acidity, lack of exercise, poor digestion, etc.).  

Similarly, fluoride is only a small part of the picture with regards to dental health.    A naturopathic doctor can help you look at other factors that affect your dental health, including diet, digestion of nutrients necessary for dental health, bacterial levels, and many other factors.  


 [Image courtesy of Ambro at FreeDigitalPhotos.net]