Illustration by Justine Wong

Fluoride: Is It Legit?

In our “Is It Legit?” series, we weigh in on trendy topics in oral wellness, flossing fiction from fact so that you know what to trust your mouth with.

By Dr. Marc Schlenoff

There’s a lot of chatter around fluoride and its place in toothpaste and our public water: do we need it to strengthen teeth? Is it actually safe to use? The simple answer: though it isn’t the only way to strengthen teeth, fluoride is a safe and effective way to do just that. And there’s over 70 years of research to back it up.

Fluoride prevents cavities

Before we go deeper, let’s establish what fluoride is. Fluoride is a mineral that naturally occurs in our teeth, helping to strengthen the enamel that protects them from decay. Fluoride is incorporated into the mineral matrix that comprises the actual enamel, making it a key component in the preservation of your teeth.

You may be surprised to learn that at least 74.4% of the U.S. population has fluoride in their public water. Why? A study in the 1930’s examined the correlation between tooth decay and water with naturally-occurring fluoride. It found that communities with more fluoride had stronger teeth and therefore had less susceptibility to tooth decay. Because of these findings, cities around the United States started to put fluoride in public water in 1945. And the results have been astounding: fluoride in water has prevented at least 25% of cavities in children and adults.

If you’re interested to see if your public water has fluoride, the CDC website provides a resource for people living in participating states here. If you’re in the 25.6% of places that don’t have it in their water, it may be more important to make sure fluoride is incorporated in your dental care routine.

Fluoride works in two ways

The first is through ingesting it as a baby or child, as your teeth are forming. This is where having it in water becomes a factor: people born in NYC, for instance, initially have very strong teeth compared to people in areas with no fluoride in the water at all. In areas with water that doesn’t have fluoride, children can take vitamins with fluoride as a way to incorporate it into developing teeth, building the foundation to have strong teeth as an adult. (If your water has fluoride, this isn’t necessary.)

Fluoride also works topically, once the tooth is fully formed. Fluoride toothpastes and mouthwashes work by filling in the pores that exist in your teeth’s enamel with fluoride, thereby strengthening it against acidic or sweet foods, which can damage your teeth. A highly concentrated fluoride toothpaste can also be useful to lessen the sensitivity of teeth as we age.

It is important to note, however, that while it can be important to use fluoride as an adult, the most crucial time for fluoride is the first 5 to 6 years of your life. After that, assuming you have good dental hygiene, using fluoride is more about maintenance.

There is no evidence that suggests fluoride causes autism or cancer

Now that we’ve established what fluoride is and what it does, let’s talk about the elephant in the room: the claims that fluoride can lead to autism, a lowered IQ, and a myriad of other conditions like cancer.

There is very little credible research to support these claims. While an excess of anything can have harmful ramifications, at the recommended dosages, the worst that can happen with fluoride is that your teeth may develop white spots (or a few brown spots)—for example, if you take fluoride supplements as a child and also drink fluoridated water. As fluoride has become more prevalent in things like toothpaste and mouthwash, the U.S. has lowered the amount of fluoride put in water to ensure people are not getting harmful amounts.

The verdict: fluoride is legit

Fluoride in our water is one of the most helpful public health initiatives ever undertaken in the United States. The CDC named it one of the top ten public health achievements of the 20th century. Fluoride is a practical, safe, and effective way for us to strengthen our teeth from childhood into adulthood.

That said, there are other, fluoride-free ways to remineralize teeth for routine maintenance. One involves a mineral called hydroxyapatite. This mineral is what most of our tooth enamel is made of. Adding it to toothpaste has been shown to protect teeth in a way that’s comparable to fluoride. So if you still have concerns about fluoride, for any reason, look for a toothpaste with hydroxyapatite.

Smile strong.

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Dr. Marc Schlenoff

Dr. Schlenoff is Tend’s Head of Clinical Development. He has three decades of experience as a dentist and a clinical instructor at Aesthetic Advantage, the nation’s most prestigious aesthetic dentistry program. Before joining Tend, he was a Program Director at Columbia University School of Dental Medicine.