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Fluoride & Fluoridation in Dentistry

One of the Ten Most Important Public Health Measures of the 20th Century

By Dr. Amid I. Ismail

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Why The Controversy?

In addition to fluorosis and mottling of tooth enamel, most of the arguments against fluoride, particularly water fluoridation are “rights arguments” premised on opposition to government’s interference with individual rights. Those who argue against it cite risks such as dental fluorosis, skeletal fluorosis, bone fractures, cancers, birth defects, affects on thyroid/kidney function, low IQ, and even Alzheimer’s.

In 1986 the Environmental Protection Agency (EPA) established a maximum allowable concentration for fluoride in drinking water of 4 ppm, a guideline designed to prevent the public from being exposed to harmful levels of fluoride.

However, a 2006 National Research Council (NRC) study, commissioned by the EPA sparked the latest controversy. It found that in addition to unsightly enamel fluorosis (at 4 ppm/L and above), there is a possible increased risk of bone fracture in certain conditions, skeletal fluorosis, and potential to cause bone cancer — incidence and qualified evidence however are lacking.

As fluoride ingestion has increased, in 2015 the U.S. Public Health Service (PHS) changed the recommendation to 0.7 mg/L to optimally provide the best balance of protection from dental caries while limiting the risk of dental fluorosis.

Fluoride — Rinses, Gels, Varnishes And More

The beneficial effects of topical fluorides are based on a sizable body of knowledge. Evidence-based research involving more than 65,000 children and adolescents in over 130 controlled trials, studied over fifty years, shows that fluoride toothpastes, mouth rinses, gels, and varnishes reduce dental caries, regardless of water fluoridation or other sources of fluoride exposure.

The evidence also shows that children using another form of topical fluoride therapy with fluoride toothpaste gain additional reductions in dental decay. Current clinical practice usually includes an additional topical fluoride modality such as fluoride mouth rinses, gels or varnishes commonly applied professionally at a dental office, for children at higher risk of developing dental caries.

The World Health Organization (WHO) continues to emphasize the effective use of fluorides for the prevention of tooth decay in the 21st century. Everyone should brush daily with fluoride toothpaste. Where the incidence and prevalence of decay is moderate to high, water fluoridation is the method of choice.



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