Dental Health

Do we need fluoride?


In the 1950s, dentists believed that fluoride was a “nutrient” (a vitamin or mineral necessary for good health). In the case of fluoride, dentists believed ingesting fluoride during childhood was necessary for the development of strong, healthy teeth, and that a “fluoride deficiency” would cause cavities, just like a deficiency of vitamin C can cause scurvy. This belief is mistaken.

It is now known that fluoride is not a nutrient and that the fluoride content of a tooth has little bearing on whether that tooth will develop a cavity. People can have perfect teeth, therefore, without consuming fluoridated water or using fluoride toothpaste.

Rob rendered

Dental researchers overwhelmingly agree that fluoride’s main benefit to teeth comes from topical application, not ingestion.

Isn’t fluoride good for our teeth?

Not when swallowed.

In the 1950s, when fluoride was believed to be a “nutrient,” dentists believed fluoride needed to be swallowed to be most effective at preventing cavities. That is why fluoride was added to things that people swallow: water and prescription pills (fluoride supplements).

Today, however, dental researchers overwhelmingly agree that fluoride’s main benefit to teeth (whatever that may be) comes from topical application, not ingestion. Even if one believes that fluoride is good for teeth, therefore, there is no need to swallow it.

In addition, recent studies from the United States have found little practical or statistical difference in tooth decay rates among children living in fluoridated versus non-fluoridated areas. That difference is 0.6 of 1 tooth surface – 1 out of 128 tooth surfaces. Put another way, that’s less than 0.5% of total tooth surface area.

In addition, data compiled by the World Health Organization (WHO) show tooth decay rates have declined just as rapidly in non-fluoridated western countries as they have in fluoridated western countries.

Is fluoridating tap water the best way to protect teeth?


Although fluoridation of water was initially approved on the premise that swallowing fluoride is the most effective way to strengthen teeth, most dental researchers now concede that fluoride’s primary benefit comes from direct topical contact with the teeth, not from ingestion. There is no need to swallow fluoride to prevent tooth decay, whether in water or tablet form.

“By delivering medication through the drinking water supply there is no way of controlling the individual dose that people receive. Put another way, would you ever trust a Doctor who, without examining you or looking at your personal medical circumstances, gave you some tablets and told you to take as many or as few as you liked for the rest of your life?”

It is hard to overstate the importance of this point to the fluoride debate, particularly considering that fluoride’s risks come primarily from ingestion.

When water fluoridation commenced in the 1940s, dentists believed that fluoride’s main benefit to teeth came from being swallowed during the tooth-forming years. This belief that fluoride’s primary benefit was “systemic” and “pre-eruptive.” A “systemic” benefit is one that comes from ingesting fluoride, and a “pre-eruptive” benefit is one that occurs by swallowing fluoride before the teeth erupt into the mouth. The premise underlying this belief was that, since ingesting fluoride increased the fluoride content of the teeth, the teeth would be more resistant to decay for life.

Although this “systemic” paradigm was the premise that launched water fluoridation and fluoride supplementation programs, it has now been discarded by the dental research community. Today the overwhelming consensus by dental researchers is that fluoride’s primary effect is topical, not systemic, and that this topical effect occurs after the teeth have erupted into the mouth (i.e., post-eruptive), not before. There is no need, therefore, to swallow fluoride, especially during infancy and early childhood when the immune system is still developing. As the US Centers for Disease Control (CDC) stated in 1999 “fluoride prevents dental caries predominately after eruption of the tooth into the mouth, and its actions primarily are topical for both adults and children.” The US National Research Council has concurred, stating in 2006 that “the major anti caries benefit of fluoride is topical and not systemic.”

What is dental fluorosis?

Dental fluorosis is a discolouration of teeth caused by too much fluoride ingestion during childhood. Fluorosis stains are generally cloudy white splotches and streaks, but children who swallow too much toothpaste can develop the more advanced forms of fluorosis, which are marked by brown and black stains and enamel erosion. When present on the front teeth, fluorosis can cause significant anxiety and embarrassment for the child, and may require cosmetic treatment, which can be costly.  Dental fluorosis is a known biological marker, only caused by over-exposure to fluoride.

Recent research, including the largest dental survey ever conducted in the U.S. and an ongoing NIH-funded study have reported data showing that fluoridated water, and overall fluoride intake from all sources, is far more likely to cause dental fluorosis than it is to reduce a cavity. Thus, although fluorosis was once a rarity, a recent national survey in the U.S. found that 41% of adolescents now have some form of the condition. There have been NO equivalent studies conducted in Western Australia, however anecdotal reports from the local dental community indicate similar figures to those in the USA.