Possible consequences for dental health when water fluoridation is discontinued: a breakdown of tooth enamel due to increased tooth decay and cavities.
In a striking turn of events, Utah became the trailblazer in March, becoming the initial US state to opt out of adding fluoride to public drinking water. Not one to follow the pack, Florida soon joined the bandwagon, with Health Secretary Robert F Kennedy Jr urging the Centers for Disease Control and Prevention (CDC) to cease their nationwide endorsement of fluoridation.
As the anti-water fluoridation sentiment swells in the US, scientists are alarmed at the prospect of a sharp spike in tooth decay, potentially hitting poorer communities the hardest and tallying up an astronomical cost for states. With Nebraska, Kentucky, and Louisiana contemplating similar moves, the speed at which this shift will impact Americans is a topic of much debate.
The Fluctuating Role of Fluoride
First discovered in fresh water in the 1940s, fluoride was hailed as an effective means to help prevent tooth decay when it was added to community drinking water with controlled amounts. The CDC lauded community water fluoridation as one of the 20th century's most monumental public health achievements in 1999.
Lately, concerns have arisen about the accumulation of fluoride in sources such as food, milk, and dental products like toothpaste and mouthwash. The National Toxicology Program (NTP) released a report in 2021, scrutinizing published scientific studies on the links between fluoride and neurodevelopment and cognition. The findings suggested that excessive fluoride exposure, defined as drinking water containing more than 1.5 milligrams of fluoride per liter, was associated with lower IQ in children. However, the NTP admitted that insufficient data existed to determine if the recommended, low fluoride levels of 0.7 mg/L negatively impact children's cognitive development.
The case for Caution
Vida Zohoori, a public health and nutrition professor at the UK's Teesside University, disputes the studies' findings, stating that they offer insufficient data for drawing conclusions. She argues that these studies often focus on regions where fluoride concentrations surpass US standards, making them irrelevant to a 0.7mg/L community water fluoridation program. Moreover, many of these studies fail to control for vital variables like exposure to iodine or lead, poor nutrition, and socioeconomic status, all factors that can independently affect child cognitive development.
Despite these concerns, the evidence supporting adding safe amounts of fluoride to drinking water remains robust. A systematic Cochrane review from 2015 (updated in 2024) suggests that the removal of fluoride from public water supplies would result in a substantial increase in childhood tooth decay, also known as Early Childhood Caries (ECC). This oral ailment impacts children aged one to five, as well as the permanent teeth of 6-12-year-olds which are highly susceptible to decay.
The Unavoidable Cost
Dr James Bekker, associate professor at the University of Utah School of Dentistry and a pediatric dentistry specialist, underscores that there are no scientifically substantiated studies indicating detrimental effects of fluoride if added in safe doses. He asserts that fluoride in toothpaste provides topical protection during brushing, while small traces in drinking water and supplements offer continuous systemic exposure, strengthening tooth enamel and making it more resistant to acids.
According to the CDC, water fluoridation reduces tooth decay by approximately 25% in children and adults. Schoolchildren living in communities where water is fluoridated, on average, have 2.25 fewer decayed teeth than their non-fluoridated counterparts. With the recent ban in Utah, Bekker anticipates seeing the full impact in about five years. In Calgary, Canada, the effects materialized even sooner, as dental decay in children skyrocketed just three years after fluoride was removed from their drinking water.
A Shared Sentiment
63% of the US population currently receives fluoridated water. However, most countries opt not to add fluoride to their drinking water, with reasons ranging from its natural occurrence in drinking water to safety concerns and the belief in personal choice regarding ingestion. In the UK, only 10% of people receive purposefully fluoridated water, with natural fluoride occurring in most drinking water in England and Wales.
The recent ban in Utah has raised concerns about the public's understanding of fluoride and its potential consequences. In light of this, the Utah Oral Health Coalition is planning to launch the Your Smile Matters campaign to promote oral hygiene. With the cost of untreated tooth decay reaching an estimated $9.8 billion over the next five years, it's evident that the stakes are high, and the debate on fluoride continues to drive lively discussions across the globe.
Sources:
- [1] National Toxicology Program (NTP) Review of Fluoride and Cognitive and Neurodevelopmental Effects in Rats
- [2] Cochrane Review on Water Fluoridation for Preventing Tooth Decay
- [3] American Dental Association (ADA) on Community Water Fluoridation
- [4] CDC's Division of Oral Health
- [5] Safe Drinking Water Act Requirements for Fluoride Contaminant Monitoring in Drinking Water
Insights:
- The removal of fluoride from public drinking water is a controversial issue, with proponents citing its health benefits and opponents voicing concerns over potential risks and delivery methods.
- Scientific evidence supports the safety and effectiveness of community water fluoridation at recommended levels for preventing tooth decay.
- PricewaterhouseCoopers estimates that removing fluoride from U.S. community water systems could cost approximately $9.8 billion over the next five years, due to an increase in dental decay (JAMA Health Forum, May 2021).
- While the primary debate revolves around dental health and tooth decay, some studies suggest potential risks associated with high fluoride exposure and cognitive development. However, these studies focus on regions with naturally occurring fluoride levels exceeding US standards.
- More countries apart from the U.S. have reservations about adding fluoride to their drinking water due to concerns over safety, health effects, and personal choice.
- Despite the concerns about excessive fluoride exposure and its potential impact on cognitive development, the evidence supporting the addition of safe amounts of fluoride to drinking water remains robust, as it significantly reduces tooth decay in children and adults.
- As the debate on fluoride continues to drive lively discussions across the globe, there is a growing need for further research into the neurodevelopmental effects of fluoride, particularly in regions where fluoride concentrations surpass US standards.
- The science of health-and-wellness acknowledges the role of fluoride as an effective means to help prevent tooth decay, especially when added to community drinking water in controlled amounts, a practice that has been hailed as one of the 20th century's most significant public health achievements.
