Thank you for another great article on public health issues. Many years ago, as part of a medical school rotation, I spent a month with a Family Practice physician, whose office was close to the borders of Maryland, Pennsylvania, and West Virginia. He showed me, as we saw patients, that he could tell if they were from West Virginia, as soon as the children smiled, as West Virginia had no fluoride in the water, and Pennsylvania and Maryland did. I think it was a most “Vivid”, public health lesson.
I grew up in small-town WV with fluoridated water 40 years ago. This may be true in rural areas where people rely on well water, but these sorts of blanket statements are not helpful.
A few case reports: (1) I grew up drinking beautiful mountain spring water and have spent way too much time since in dentists' chairs, including in the era before local anesthesia was available. (2) I recently tutored an ESL student who grew up near Mexico City, where the water is naturally fluoridated. Somewhere around age 45, she had to go to a dentist for her FIRST cavity ever! She also had some of the most beautiful teeth I've seen anywhere. Of course RFKjr seems generally off-the-wall and we can hope our Senators will have the sense to see that. But thanks for the informative article, YLE!
As dentist and someone that values science, your review of fluoridation benefits and risks was very good. Thank you for removing the non scientific hype and sharing this data.
I had my own little study of fluoride effectiveness with my two kids as infants and toddlers. Our local water system in suburban New Jersey did not have fluoride. Our pediatrician prescribed either vitamins with fluoride or fluoride tablets. My daughter always accepted the droppers of nasty vitamins or swallowed the tiny fluoride tablet. Even with years of braces, she was well into adulthood before she developed a cavity. My son spat out the vitamin drops as an infant so I had to put them in his formula and was never sure how much he got down since the oily drops didn’t mix well. As a toddler he was adept at hiding the pills in his mouth while pretending to swallow. I was always finding the spat-out tablets behind the couch and in the bottom of the toy box. He had a mouthful of childhood cavities and had sealant on his molars until adulthood. I guess I am a good example myself. My rural hometown did not fluoridate and no one prescribed fluoride. I had a filling in every molar by age 11 when we moved to a city with fluoridation. I had no more cavities after.
Thanks. An interesting contrast to Leana Wen’s take in her WAPO column, https://www.washingtonpost.com/opinions/2024/11/14/fluoride-water-kennedy-rfk-brain-development/. While I favor the European precautionary approach, as you point out it is not what we apply in the US, and our public health regime needs consistency. Getting public water systems to stop over fluoridating water supplies would certainly seem reasonable. Why we make dental care a second class of health care in the US is criminal, both for children and the elderly- good subject for a future post.
I like YLE version better than Leana Wen’s, who ends up giving RFKs agenda-driven lack of fluoride nuance too much credibility.
I’m also concerned by the proliferation of fluoride-free toothpaste. Interestingly this takes up more than half of the shelf space at Whole Foods, so I assume it is selling well. Paradoxically the Whole Foods shoppers and their kids that tend to have more resources 💴 stand to lose more if fluoridation is banned AND they are using fluoride-free fancy toothpaste with baking soda stripping enamel away, too.
Ryan, your comment made me remember how that high resource demographic were anti-vax 20 years ago. I learned the hard way not to confront directly--I lost patients and the opportunity to potentially change opinions.
Thank you. And thanks to those who have commented.
Logic seems a small contributor to beliefs of our culture. Any question or controversy can be enough to reinforce beliefs. Your calm, confident, and reasoned presentation I appreciate as the most helpful for anyone trying to make a rational choice. Good job.
Thank you for addressing this. The articles published here are always so well researched, we appreciate that! I just want to make a correction to the spelling of the Alaska city that banned fluoride in 2007 - it is Juneau. Thanks again!
Politics also came into play several decades ago when many communities were choosing to not do fluoridation or stop doing it. People often voted against it, remembering that sodium fluoride used to be sold and used as an insecticide. Roaches crossing sodium powder fluoride put under sinks would die. Fluorides are still used as pesticides in agriculture. So advocates got states to pass mandatory fluoridation laws, preventing communities from opting out. 13 states have these laws.
The CDC at first said there was a beneficial systemic effect for toothless infants, but then had to remove that from its webpage on this risk when asked for evidence. The CDC now says it's safe to use fluoridated water for infant formula preparation, but that is like saying it's "safe" to have your child swallow a bit of lead. The risk is still there. Eventually the CDC hid its advice on the website making it difficult to find.
The American Academy of Pediatrics (AAP) made the decision to not inform their members about this fluorosis risk. These are the health professionals who could advise parents on this risk, as nobody takes to toothless infant to see a dentist. The AAP supports fluoridation.
Efforts to have the CDC advice appear on water quality reports still are being rejected by water systems today, no doubt due to public health institutions and other fluoridation advocates persuade water systems to ignore this. A few cities and one state did put the CDC advice on water quality reports. The ADA opposed a New Hampshire law requiring the CDC advice on all fluoridating water systems water quality reports. Infant formula manufacturers refused to put this advice on their packaging, thinking it would hurt sales. Thus, very few parents know about this fluorosis risk and how to avoid it.
Most of the world has rejected doing water fluoridation, and as you wrote some have stopped doing it entirely - the latest to stop is Israel. A number of made up reasons have appeared to try and explain this.
Elites in general do not drink fluoridated water themselves. Congressmen could be drinking it in their offices, but are supplied with non-fluoridated bottled water when they could be supplied with fluoridated bottled water. In congressional meetings photos show non-fluoridated bottled water being served. Fluoridated water is now considered good for adults, so why are so many not drinking it when they could be drinking it? Where I live fluoridated bottled water, marketed as being good for children, has disappeared from the store shelves. That's due to customers not buying it.
And you of course omitted studies that showed fluoridation is now completely or almost completely ineffective. That's not surprising since you depend on literature that does cherry picking.
Our bodies have no use for fluoride and try to get rid of it immediately when ingested. But like lead, some cannot be eliminated and gets stored in the bones and hard tissues. Fluoride is an enzyme poison, and has been used in science to study enzyme poisoning. Fluoride is so toxic that fluoride supplements cannot be bought over the counter, but require a prescription. Fluoride toothpaste now has a poison warning label on it after so many children were made sick resulting in thousands of calls to poison control centers. Fluoride toothpaste is also a fluorosis risk when swallowed by children. In the past TV ads showed putting a full stripe across toothbrush bristles. Now we are only supposed to put a pea sized dab of toothpaste on a brush, and only a smear for an infant. This is to reduce fluorosis risk.
Fluoridation is a wasteful practice, as people only ingest less than 1% of the tap water that is produced. There is no need to have fluoride in water used to wash a car or water a lawn. Fluoridation results in more fluoride building up in the environment. No real environmentalist group is in favor of it.
The chief fluoridation chemicals used in the U.S. has a nickname the CDC told the producers to stop using because it sounded bad. That would be scrubber liquor. It comes out of a air pollution scrubber system and is used because it is cheap and has a fairly high fluoride content. This chemical has a lot of other nasty pollutants like arsenic, but in very small amounts so it's said to be safe for us to drink.
So it's not surprising that ADA and CDC "experts" on fluoridation do not answer questions about it.
I'm not going to bother with this knucklehead's entire Gish gallop, because it's pointless and unlike YLE he seems to think that citing credible sources is beneath him, but an easy one to refute is the claim that toothpaste has "poison warning labels". Well, I walked to my bathroom and checked. No "poison warning labels" whatsoever.
1: "However, some places in the U.S. (~0.6% of the total population) have natural fluoride in their water that reaches up to 1.5 parts per million." The acceptable level of fluoride in tap water in the U.S. is 4 parts per million. A few have more than 4ppm. Many people in the U.S. have more than 1.5 ppm fluoride in their tape water. In the U.S. water systems are required to notify the public when there is more than 2ppm fluoride, so that parents keep that water away from their children. The reason for this is a word you studiously avoided in this post: fluorosis.
2: "Fluoride toxicity first impacts the skeletal bones, beginning at an exposure of 5 mg/kg of body weight per day." There is no debate that skeletal bones are affected by fluoride toxicity at much lower levels than that. In the U.S. the maximum contaminant level for fluoride in tap water is 4mg per liter. Above that level the EPA says there is a risk of skeletal fluorosis, which is caused by fluoride being toxic to bones. You should take a look at photos of skeletal fluorosis, which affects millions of people in the world. Your own supporting link from the ADA says this:
"The single dose (consumed at one time) of fluoride that could cause acute fluoride toxicity is 5 mg/kg of body weight (11mg/kg of body weight of sodium fluoride). This dose is considered the probably toxic dose (PTD) which "is defined as the minimum dose that could cause serious or life-threatening systemic signs and symptoms and that should trigger immediate therapeutic intervention and hospitalization."
3. "In the past five years, a few studies have questioned whether safety signals exist in children’s cognitive development." There many such studies, not just a few. And some were from more than 5 years ago. The number of such studies finding no safety signals is extremely low, like maybe 1. So the truth is completely the other way around. In the National Toxicology Report all of the high quality studies showed some negative cognitive development risk to children. A federal judge in a landmark, firs of its kind TSCA case, found that fluoride even at the seemingly low levels of water fluoridation very likely was a developmental risk to children and ordered the EPA to do something about it. The EPA does not get to sit back and do nothing.
Some fluoridation advocates are now agreeing that at 1.5ppm and above there is some development cognitive risk. But they completely ignore the margin of safety that is applied to all other minerals and chemicals. The margin of safety is typically 100 to 1. Some children will drink twice as much fluoridated water or be exposed to twice as much fluoride, getting a typical daily dose equal to an average daily dose at 1.5ppm. These advocates for fluoridation are also completely ignoring all the Americans whose tap water is at 1.5ppm and above, as if they don't exist. From your link regarding fluoridation in Europe: "Fluoride as a neurotoxin has been proven in several animal studies."
4. "Most Western European countries have ended public water fluoridation." No, most western European nations rejected fluoridation and never started doing it even after an extensive U.S. effort to persuade them to start it up in the 1950's. Some (not most) nations in Europe did stop fluoridation, but it was not due to starting up free dental care for kids, starting fluoridated salt, or more recently adopting different approaches to assessing health care. I bet you can't get into specifics about individual nations in Europe and their decisions about fluoridation.
An ADA lie about this was in an earlier edition of their "Fluoridation Facts" where they claimed 80 nations were practicing water fluoridation. They eventually removed that lie. The real number is 23 out of 195 nations in the world. Fluoridation is not widespread in many of those nations, with more people in the U.S. consuming fluoridated water than the rest of the world combined.
Now for the things you omitted:
Over half of all U.S. children now have some form of dental fluorosis. That's way above the 10% level estimated to occur in the 1950's when fluoridation started. The high level of observed fluorosis led to 2 reductions in the amount of fluoride added to U.S. tap water since the 1950's, the last reduction occurring about 9 years ago.
Breast milk is ideal for toothless infants - extremely low in fluoride at about .01mg per day. Ready to feed infant formula after the 1970's was made with fluoride levels as low as possible. It's also extremely low in fluoride making it the best choice. As much as possible fluoride has been removed from all powdered infant formulas since the 1970's. But powdered infant formula when prepared using fluoridated tap water gives an infant a huge dose of fluoride, higher than any other age group in terms of body weight. This exposure is a fluorosis risk to permanent teeth, and this was admitted in 2006 by the ADA and the CDC. When there are no erupted teeth, fluoridated water has no benefit for toothless young infants 0-6 months of age. Nobody says it does. So using fluoridated water to prepare infant formula is a risk for no reward situation.
But then politics came into play after 2006. The idea that fluoridated water is not good for toothless infants caused doubt about fluoridation in general, and sometimes there are still public votes on this issue. So public health institutions like the CDC and a sponsored trade called the ADA (American Dental Association) decided it would be best to not let parents know about this fluroosis risk. The ADA initial advice was to advise parents to use of non-fluoridated water to prepare infant formula. That changed to saying health professionals could actually recommend fluoridated water for infant formula preparation but only if the health professional knew about the fluorosis risk. Health professionals did not have to tell the parents about the risk, and were not told to do that by the ADA. Of course if the health professional had never heard about the fluorosis risk they are not going to tell the parents there is any risk, and the parents then use fluoridated water as it's cheaper than buying bottled water. The WIC programs (Women, Infants, Children) provide free powdered infant formula to low income families. In California the WIC advisors were told what to say about this, but to say nothing unless their low income clients brought up the issue first.
No, they don't. Tooth decay declined in Europe at the same rate it declined in the U.S. The rates are roughly the same today. A lot of excuses are offered up for this. When cities in East Germany were told by the West Germans they had to end fluoridation, many expected the tooth decay rate to go up in those cities. It went down instead. So fluoridationists had to look around for something to try and explain that. Maybe dental care increased a bit in East Germany. You don't need fluoride to have perfect teeth.
If fluoridated toothpaste obscured the answer, then you would expect to still see more tooth decay in Europe because public health says even with fluoride toothpaste there is an additional reduction in tooth decay of about 25%. But the data shows tooth decay is about the same anyway In Europe compared to the U.S. You simply can't trust public health to be honest about a policy they defend.
If so, then it feeds into the idea that fluoridated toothpaste is sufficient without fluoridated water. If not, then it helps justify fluoridating the water.
Teeth are forming long before they appear and are able to be brushed. When I was working in Well Baby Clinics as a public health nurse in an area that had no fluoridated water, we dispensed fluoride drops to parents to give to their babies and toddlers. They often knew about the benefits of fluoride but had no idea that it was not in the local water.
For toothless infants (0-6 months of age) fluoride drops and supplement are no longer recommended. Breast milk is extremely low in fluoride, and nobody has claimed that breast fed infants have more tooth decay.
I couldn't agree with you more! I live in Calgary, AB, and was horrified when they voted to remove the fluoride from our drinking water. I grew up with fluoridated water in BC, and never had cavities until living in Calgary from 2010 onwards. My oldest child was born in 2010, and both kids and myself have had cavities since then. My son had to go under general anesthesia at age 4 to have 8 cavities filled and silver caps put on his molars -- we were fortunate to have great dental insurance to pay for this expensive procedure. And yes we brushed twice daily with fluoride toothpaste. Not all families are so lucky to have regular access to dental services. While it's true that Calgary voted in 2021 to re-introduce fluoride into the drinking water, it has not happened yet. The latest update is that this should be happening by early 2025 after updates to the water treatment system are completed. Thanks as always for your fantastic writing!
Thank you for another great article on public health issues. Many years ago, as part of a medical school rotation, I spent a month with a Family Practice physician, whose office was close to the borders of Maryland, Pennsylvania, and West Virginia. He showed me, as we saw patients, that he could tell if they were from West Virginia, as soon as the children smiled, as West Virginia had no fluoride in the water, and Pennsylvania and Maryland did. I think it was a most “Vivid”, public health lesson.
I grew up in small-town WV with fluoridated water 40 years ago. This may be true in rural areas where people rely on well water, but these sorts of blanket statements are not helpful.
A few case reports: (1) I grew up drinking beautiful mountain spring water and have spent way too much time since in dentists' chairs, including in the era before local anesthesia was available. (2) I recently tutored an ESL student who grew up near Mexico City, where the water is naturally fluoridated. Somewhere around age 45, she had to go to a dentist for her FIRST cavity ever! She also had some of the most beautiful teeth I've seen anywhere. Of course RFKjr seems generally off-the-wall and we can hope our Senators will have the sense to see that. But thanks for the informative article, YLE!
As dentist and someone that values science, your review of fluoridation benefits and risks was very good. Thank you for removing the non scientific hype and sharing this data.
Thank you. As always, the information you offer here is clear and extremely helpful which, unfortunately, we need more than ever right now.
I had my own little study of fluoride effectiveness with my two kids as infants and toddlers. Our local water system in suburban New Jersey did not have fluoride. Our pediatrician prescribed either vitamins with fluoride or fluoride tablets. My daughter always accepted the droppers of nasty vitamins or swallowed the tiny fluoride tablet. Even with years of braces, she was well into adulthood before she developed a cavity. My son spat out the vitamin drops as an infant so I had to put them in his formula and was never sure how much he got down since the oily drops didn’t mix well. As a toddler he was adept at hiding the pills in his mouth while pretending to swallow. I was always finding the spat-out tablets behind the couch and in the bottom of the toy box. He had a mouthful of childhood cavities and had sealant on his molars until adulthood. I guess I am a good example myself. My rural hometown did not fluoridate and no one prescribed fluoride. I had a filling in every molar by age 11 when we moved to a city with fluoridation. I had no more cavities after.
Fascinating on so many levels. Thanks for sharing this!
Thanks. An interesting contrast to Leana Wen’s take in her WAPO column, https://www.washingtonpost.com/opinions/2024/11/14/fluoride-water-kennedy-rfk-brain-development/. While I favor the European precautionary approach, as you point out it is not what we apply in the US, and our public health regime needs consistency. Getting public water systems to stop over fluoridating water supplies would certainly seem reasonable. Why we make dental care a second class of health care in the US is criminal, both for children and the elderly- good subject for a future post.
I like YLE version better than Leana Wen’s, who ends up giving RFKs agenda-driven lack of fluoride nuance too much credibility.
I’m also concerned by the proliferation of fluoride-free toothpaste. Interestingly this takes up more than half of the shelf space at Whole Foods, so I assume it is selling well. Paradoxically the Whole Foods shoppers and their kids that tend to have more resources 💴 stand to lose more if fluoridation is banned AND they are using fluoride-free fancy toothpaste with baking soda stripping enamel away, too.
Ryan, your comment made me remember how that high resource demographic were anti-vax 20 years ago. I learned the hard way not to confront directly--I lost patients and the opportunity to potentially change opinions.
Good point! Instead of confronting directly, appeal to common values, like protecting kids, then steering towards the lower risk proposition?
Thank you. And thanks to those who have commented.
Logic seems a small contributor to beliefs of our culture. Any question or controversy can be enough to reinforce beliefs. Your calm, confident, and reasoned presentation I appreciate as the most helpful for anyone trying to make a rational choice. Good job.
Thank you for addressing this. The articles published here are always so well researched, we appreciate that! I just want to make a correction to the spelling of the Alaska city that banned fluoride in 2007 - it is Juneau. Thanks again!
Thank you for a masterpiece of information here!
Listening to people talk about whether or not they want the water supply fluoridated, for better or worse, is a litmus test for me.
Thank you for addressing Fluoride
A few more comments on the fluoride debate:
Politics also came into play several decades ago when many communities were choosing to not do fluoridation or stop doing it. People often voted against it, remembering that sodium fluoride used to be sold and used as an insecticide. Roaches crossing sodium powder fluoride put under sinks would die. Fluorides are still used as pesticides in agriculture. So advocates got states to pass mandatory fluoridation laws, preventing communities from opting out. 13 states have these laws.
The CDC at first said there was a beneficial systemic effect for toothless infants, but then had to remove that from its webpage on this risk when asked for evidence. The CDC now says it's safe to use fluoridated water for infant formula preparation, but that is like saying it's "safe" to have your child swallow a bit of lead. The risk is still there. Eventually the CDC hid its advice on the website making it difficult to find.
The American Academy of Pediatrics (AAP) made the decision to not inform their members about this fluorosis risk. These are the health professionals who could advise parents on this risk, as nobody takes to toothless infant to see a dentist. The AAP supports fluoridation.
Efforts to have the CDC advice appear on water quality reports still are being rejected by water systems today, no doubt due to public health institutions and other fluoridation advocates persuade water systems to ignore this. A few cities and one state did put the CDC advice on water quality reports. The ADA opposed a New Hampshire law requiring the CDC advice on all fluoridating water systems water quality reports. Infant formula manufacturers refused to put this advice on their packaging, thinking it would hurt sales. Thus, very few parents know about this fluorosis risk and how to avoid it.
Most of the world has rejected doing water fluoridation, and as you wrote some have stopped doing it entirely - the latest to stop is Israel. A number of made up reasons have appeared to try and explain this.
Elites in general do not drink fluoridated water themselves. Congressmen could be drinking it in their offices, but are supplied with non-fluoridated bottled water when they could be supplied with fluoridated bottled water. In congressional meetings photos show non-fluoridated bottled water being served. Fluoridated water is now considered good for adults, so why are so many not drinking it when they could be drinking it? Where I live fluoridated bottled water, marketed as being good for children, has disappeared from the store shelves. That's due to customers not buying it.
And you of course omitted studies that showed fluoridation is now completely or almost completely ineffective. That's not surprising since you depend on literature that does cherry picking.
Our bodies have no use for fluoride and try to get rid of it immediately when ingested. But like lead, some cannot be eliminated and gets stored in the bones and hard tissues. Fluoride is an enzyme poison, and has been used in science to study enzyme poisoning. Fluoride is so toxic that fluoride supplements cannot be bought over the counter, but require a prescription. Fluoride toothpaste now has a poison warning label on it after so many children were made sick resulting in thousands of calls to poison control centers. Fluoride toothpaste is also a fluorosis risk when swallowed by children. In the past TV ads showed putting a full stripe across toothbrush bristles. Now we are only supposed to put a pea sized dab of toothpaste on a brush, and only a smear for an infant. This is to reduce fluorosis risk.
Fluoridation is a wasteful practice, as people only ingest less than 1% of the tap water that is produced. There is no need to have fluoride in water used to wash a car or water a lawn. Fluoridation results in more fluoride building up in the environment. No real environmentalist group is in favor of it.
The chief fluoridation chemicals used in the U.S. has a nickname the CDC told the producers to stop using because it sounded bad. That would be scrubber liquor. It comes out of a air pollution scrubber system and is used because it is cheap and has a fairly high fluoride content. This chemical has a lot of other nasty pollutants like arsenic, but in very small amounts so it's said to be safe for us to drink.
So it's not surprising that ADA and CDC "experts" on fluoridation do not answer questions about it.
I'm not going to bother with this knucklehead's entire Gish gallop, because it's pointless and unlike YLE he seems to think that citing credible sources is beneath him, but an easy one to refute is the claim that toothpaste has "poison warning labels". Well, I walked to my bathroom and checked. No "poison warning labels" whatsoever.
False statements in your post:
1: "However, some places in the U.S. (~0.6% of the total population) have natural fluoride in their water that reaches up to 1.5 parts per million." The acceptable level of fluoride in tap water in the U.S. is 4 parts per million. A few have more than 4ppm. Many people in the U.S. have more than 1.5 ppm fluoride in their tape water. In the U.S. water systems are required to notify the public when there is more than 2ppm fluoride, so that parents keep that water away from their children. The reason for this is a word you studiously avoided in this post: fluorosis.
2: "Fluoride toxicity first impacts the skeletal bones, beginning at an exposure of 5 mg/kg of body weight per day." There is no debate that skeletal bones are affected by fluoride toxicity at much lower levels than that. In the U.S. the maximum contaminant level for fluoride in tap water is 4mg per liter. Above that level the EPA says there is a risk of skeletal fluorosis, which is caused by fluoride being toxic to bones. You should take a look at photos of skeletal fluorosis, which affects millions of people in the world. Your own supporting link from the ADA says this:
"The single dose (consumed at one time) of fluoride that could cause acute fluoride toxicity is 5 mg/kg of body weight (11mg/kg of body weight of sodium fluoride). This dose is considered the probably toxic dose (PTD) which "is defined as the minimum dose that could cause serious or life-threatening systemic signs and symptoms and that should trigger immediate therapeutic intervention and hospitalization."
3. "In the past five years, a few studies have questioned whether safety signals exist in children’s cognitive development." There many such studies, not just a few. And some were from more than 5 years ago. The number of such studies finding no safety signals is extremely low, like maybe 1. So the truth is completely the other way around. In the National Toxicology Report all of the high quality studies showed some negative cognitive development risk to children. A federal judge in a landmark, firs of its kind TSCA case, found that fluoride even at the seemingly low levels of water fluoridation very likely was a developmental risk to children and ordered the EPA to do something about it. The EPA does not get to sit back and do nothing.
Some fluoridation advocates are now agreeing that at 1.5ppm and above there is some development cognitive risk. But they completely ignore the margin of safety that is applied to all other minerals and chemicals. The margin of safety is typically 100 to 1. Some children will drink twice as much fluoridated water or be exposed to twice as much fluoride, getting a typical daily dose equal to an average daily dose at 1.5ppm. These advocates for fluoridation are also completely ignoring all the Americans whose tap water is at 1.5ppm and above, as if they don't exist. From your link regarding fluoridation in Europe: "Fluoride as a neurotoxin has been proven in several animal studies."
4. "Most Western European countries have ended public water fluoridation." No, most western European nations rejected fluoridation and never started doing it even after an extensive U.S. effort to persuade them to start it up in the 1950's. Some (not most) nations in Europe did stop fluoridation, but it was not due to starting up free dental care for kids, starting fluoridated salt, or more recently adopting different approaches to assessing health care. I bet you can't get into specifics about individual nations in Europe and their decisions about fluoridation.
An ADA lie about this was in an earlier edition of their "Fluoridation Facts" where they claimed 80 nations were practicing water fluoridation. They eventually removed that lie. The real number is 23 out of 195 nations in the world. Fluoridation is not widespread in many of those nations, with more people in the U.S. consuming fluoridated water than the rest of the world combined.
Now for the things you omitted:
Over half of all U.S. children now have some form of dental fluorosis. That's way above the 10% level estimated to occur in the 1950's when fluoridation started. The high level of observed fluorosis led to 2 reductions in the amount of fluoride added to U.S. tap water since the 1950's, the last reduction occurring about 9 years ago.
Breast milk is ideal for toothless infants - extremely low in fluoride at about .01mg per day. Ready to feed infant formula after the 1970's was made with fluoride levels as low as possible. It's also extremely low in fluoride making it the best choice. As much as possible fluoride has been removed from all powdered infant formulas since the 1970's. But powdered infant formula when prepared using fluoridated tap water gives an infant a huge dose of fluoride, higher than any other age group in terms of body weight. This exposure is a fluorosis risk to permanent teeth, and this was admitted in 2006 by the ADA and the CDC. When there are no erupted teeth, fluoridated water has no benefit for toothless young infants 0-6 months of age. Nobody says it does. So using fluoridated water to prepare infant formula is a risk for no reward situation.
But then politics came into play after 2006. The idea that fluoridated water is not good for toothless infants caused doubt about fluoridation in general, and sometimes there are still public votes on this issue. So public health institutions like the CDC and a sponsored trade called the ADA (American Dental Association) decided it would be best to not let parents know about this fluroosis risk. The ADA initial advice was to advise parents to use of non-fluoridated water to prepare infant formula. That changed to saying health professionals could actually recommend fluoridated water for infant formula preparation but only if the health professional knew about the fluorosis risk. Health professionals did not have to tell the parents about the risk, and were not told to do that by the ADA. Of course if the health professional had never heard about the fluorosis risk they are not going to tell the parents there is any risk, and the parents then use fluoridated water as it's cheaper than buying bottled water. The WIC programs (Women, Infants, Children) provide free powdered infant formula to low income families. In California the WIC advisors were told what to say about this, but to say nothing unless their low income clients brought up the issue first.
Thank you so much for your continuing expertise. I forward these far and wide. Once again, we need all the information we can get.
If Europe doesn't fluoridate, do they have worse dental care outcomes than the USA?
No, they don't. Tooth decay declined in Europe at the same rate it declined in the U.S. The rates are roughly the same today. A lot of excuses are offered up for this. When cities in East Germany were told by the West Germans they had to end fluoridation, many expected the tooth decay rate to go up in those cities. It went down instead. So fluoridationists had to look around for something to try and explain that. Maybe dental care increased a bit in East Germany. You don't need fluoride to have perfect teeth.
It seems to me that the use of fluoridated toothpaste may obscure the answer to that.
If fluoridated toothpaste obscured the answer, then you would expect to still see more tooth decay in Europe because public health says even with fluoride toothpaste there is an additional reduction in tooth decay of about 25%. But the data shows tooth decay is about the same anyway In Europe compared to the U.S. You simply can't trust public health to be honest about a policy they defend.
If so, then it feeds into the idea that fluoridated toothpaste is sufficient without fluoridated water. If not, then it helps justify fluoridating the water.
Teeth are forming long before they appear and are able to be brushed. When I was working in Well Baby Clinics as a public health nurse in an area that had no fluoridated water, we dispensed fluoride drops to parents to give to their babies and toddlers. They often knew about the benefits of fluoride but had no idea that it was not in the local water.
For toothless infants (0-6 months of age) fluoride drops and supplement are no longer recommended. Breast milk is extremely low in fluoride, and nobody has claimed that breast fed infants have more tooth decay.
I couldn't agree with you more! I live in Calgary, AB, and was horrified when they voted to remove the fluoride from our drinking water. I grew up with fluoridated water in BC, and never had cavities until living in Calgary from 2010 onwards. My oldest child was born in 2010, and both kids and myself have had cavities since then. My son had to go under general anesthesia at age 4 to have 8 cavities filled and silver caps put on his molars -- we were fortunate to have great dental insurance to pay for this expensive procedure. And yes we brushed twice daily with fluoride toothpaste. Not all families are so lucky to have regular access to dental services. While it's true that Calgary voted in 2021 to re-introduce fluoride into the drinking water, it has not happened yet. The latest update is that this should be happening by early 2025 after updates to the water treatment system are completed. Thanks as always for your fantastic writing!