Water fluoridation has become a hot topic recently in part due to comments by Robert F. Kennedy Jr, incoming nominee to lead public health in the US. Before RFK Jr. made waves about fluoride, a federal judge made a ruling putting fluoride safety in question. Obviously if there is a safety concern then we should follow the science and error on the side of safety. To date, the scientists who study the risks and public health benefits of fluoride continue to recommend it’s use. The CDC considers water fluoridation on the top 10 public health initiatives in the 20th century. Fluoride decreases both the number of cavities and the severity; studies have shown an average of 25% decrease in cavities. Other studies have shown that the number of children needing general anesthesia to treat dental decay and infection is severalfold higher in cities without fluoridation. The advantage of water fluoridation is that it is available to people in all socioeconomical backgrounds with a low cost per person. If fluoride is removed from the water, it is the most vulnerable citizens who will suffer the most which causes increases the financial burden on public assistance programs.
As a dentist my job is to prevent, diagnose, and treat dental disease while doing no harm. Therefore, I will continue to advocate for the use of fluoride in our water system as recommended by the CDC and American Dental Association. This article’s focus is not to debate fluoride but to instead discuss what to do if fluoride is no longer available in the future or if you choose to avoid it. Even if there isn’t fluoride added to the drinking water in your area currently or in the future, fluoride is naturally occurring and may continue to be present in an effective quantity. There are publicly available listings online about which water systems are fluoridated and if not, what the natural levels are. In Sioux County, only Alton, Hawarden, and Orange City add fluoride to the water to meet the recommended .7mg/L of fluoride which is far below the level of safety concerns and yet effective in decreasing tooth decay. Other water systems in the county list a natural level between .2 and .5mg/L on the CDC website listing. https://nccd.cdc.gov/DOH_MWF/Default/Default.aspx
Fluoride in the water is safe and effective, but if not available there are several other ways to gain the effects. These include toothpaste, mouthwashes, and fluoride treatments in the dental office or public health setting. In my practice I have observed an increase in patients who are choosing to avoid fluoride in both the water and toothpaste. Even though I recommend fluoride, I respect an individual’s choice to look for alternatives.
The benefit of fluoride is that it strengthens enamel, prevents tooth decay, promotes remineralization, and is widely available. Unfortunately, no alternative can match fluoride in all these areas, but in recent years there have been two options for toothpaste that mimic some of the benefits but not to the same degree. These two options are calcium phosphate and hydroxyapatite (and nano-hydroxyapatite) toothpastes. Both have been shown to have some remineralization and prevention for cavities. Both are also considered more natural with their chemical make-up being similar to natural tooth structure. The negative is that neither is as widely available as fluoride toothpaste and both cost 2-3 times as much.
Keep an eye on this space and if there is a push to remove fluoride from your local water focus on what you can control by considering fluoride toothpaste, brushing, flossing, and minimizing sugary and acidic foods and drinks. Without fluoride, the risk of decay is higher which will make regular visits to the dentist even more important to catch cavities when they are smaller, easier, and less expensive to treat.
This post was written by Dr. Joiner for the Staying Healthy Article in the Capital Democrat newspaper in November 2024.
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