The issue of fluoridation and whether it should be a mandated additive to our public water system is decades old. Its origins are rooted, believe it or not, in post-war fear of a communist takeover, ostensibly enabled by poisoning the American water supply. While accepted as a great public health benefit by the majority of scientists and lay people, it has remained, for one reason or another, a somewhat contentious – if marginal – matter for some.
The majority of dentists and physicians, relying on overwhelming scientific evidence, recommend adding fluoride to our water, as a means of maintaining good dental hygiene. In conjunction with topical application of fluoride via pastes and rinses, it has been shown to significantly reduce the incidence of dental cavities within communities. This recommendation is supported by plentiful studies and clinical experience, all indicating a clear benefit with minimal to no risk of serious adverse effects.
However, there is a subset of patients and healthcare workers, who do believe that adding fluoride to the water supply of the general public not only presents ethical concerns, but also potentially grave health consequences for those who consume too much. While this group does offer some science to support their theory, it has generally been accepted that the studies and evidence have been misinterpreted or misapplied to make the argument fit. Most other corroboration is anecdotal, from what seems like a very frustrated patient population with a wide range of problems for which they seek explanations.
What are the studies that suggest a link between fluoride and autoimmune disease or other health issues?
Other than one study on rats, there are no available studies suggesting a link between fluoride and autoimmune disease in human beings, including thyroid disease. There is a bit of questionable evidence demonstrating a possible cancer association, though as noted above, the quality of this evidence is lacking as the majority of studies do not indicate an association. Also, there is a possibility that excess fluoride in the blood vessels may contribute to coronary artery disease, though much more research is needed.
The vast majority of online sources citing some other purported negative health effects from fluoride are advocacy and other non-scientific groups, with little or no supporting evidence. Some of these include NoFluoride.com and FluorideDebate.com. Many such sites appear organized by one of two parties: patients or family members hoping to find the cause of their health issues, and/or conspiracy theorists with a variety of reasons and explanations for their concerns.
What is often confusing is that many such sites use the term “fluoride poisoning” – which is a real medical emergency requiring treatment – to indicate the possible effects of long-term exposure via water. While there is plenty of research describing the mechanism and effects of fluoride poisoning, none of it applies to the chronic water-based scenario.
What are the studies that refute a link between fluoride and autoimmune disease or other health issues?
There have been a number of studies and reviews performed to examine the possible connection between excessive fluoride intake and health problems, with virtually none demonstrating a positive correlation, and most suggesting no link between the two. Most professional organizations, basing their decisions on such research, still recommend water fluoridation as a means of improving dental health. Otherwise, it is difficult to formulate research that seeks to prove the absence of something, but without evidence to the contrary, it is hard to make a case for proven ill effects of fluoride, based on what we know at this point in time.
What is the average amount of fluoride in the water supplies of most cities?
This is a tougher question to answer than one might think. The actual amount at any given moment may vary slightly, but the United States Public Health Service has established a range of 0.7 to 1.2 mg/L as both safe and effective for preventing tooth decay, without presenting significant risk of any kind. The World Health Organization, on the other hand, has set a maximum threshold of 1.5 mg/L, with a suggested range of 0.5 to 1.0 mg/L. This is still far lower than is considered dangerous in terms of physical ingestion or absorption. These levels are set to balance the benefit of preventing tooth decay with the possibility of dental fluorosis, and not because they are anywhere near the amounts necessary for any known ill effects. In addition, the Environmental Protection Agency has set a limit of 4.0 mg/L in all public drinking water, to ensure protection from severe skeletal fluorosis that may occur with prolonged intake at levels above this cutoff.
Do most cities in the US have fluoride in the water supply?
Over two-thirds of the cities and municipalities in the United States have fluoride added to their drinking water. Since it is not regulated on a federal level, there are certain areas that have opted against fluoridation.
Is fluoride at high levels unsafe?
According to current available evidence, the only real concern with unintentional (i.e., via water, and not from swallowing tons of toothpaste or other fluoride-containing substances) high fluoride intake is fluorosis of the teeth. This is seen in a small percentage of patients, who present with discoloration of the teeth and sometimes pitting enamel. However, this is mainly an aesthetic concern, and usually disappears on its own after puberty. At normal water levels, fluoride is otherwise safe to consume. Skeletal fluorosis, which occurs rarely, may happen as the result of chronic exposure to very high amounts of fluoride. It involves changes to bone structure that may or may not present a problem.
Acute fluoride toxicity/poisoning does present health concerns, such as nausea, vomiting, diarrhea and other gastrointestinal and systemic symptoms. But this is almost always the result of ingestion of a massive amount of fluoride at one time, whether intentionally or accidentally, and would not occur from consuming even large amounts of water from community sources. Fluoride, like many substances we take into our bodies, is toxic at incredibly high levels, but one could never achieve these levels from simple water consumption.
Questions for your doctor:
- What are your thoughts and feelings about water fluoridation?
- Are there other concerns with fluoridation besides dental fluorosis?
- Should I be using a water filter at home to remove some/all fluoride?
- What percentage of your patients have had issues caused by excessive fluoride?
- What about the fact that fluoride prevents some enzymes in your body from working? Isn’t it a poison?
About the Author
Dr. Rothbard is a professional medical writer and consultant based in New York City, specializing in medical education articles targeted at a variety of audiences, from children through clinicians. After leaving medicine, he worked as a biology and medical science educator for several years, before deciding to pursue writing full-time. He may be reached at firstname.lastname@example.org.