Hey Laura, what’s the deal with fluoride?

“Beancess” writes:

Hey Laura,
What is the best toothpaste? What ingredients should we avoid, and specifically what do you think about fluoride?

Oh fluoride! I have been totally intimidated by the fluoride debate and have been avoiding the research for my own family out of sheer mental laziness. I already know that it’s going to be one of those murky, “We say X” vs. “They say Y” kind of issues and those are the hardest to get a straight set of facts upon which to base a decision.

But, thank you Beancess for making me a better, more informed parent. I’m going to give you a dissertation on fluoride, then talk about toothpaste options clear down at the end. Don’t be tempted to skip down there! I think everyone should know what’s going on with fluoride!


What is Fluoride, anyway?
Fluoride is a naturally occurring mineral that is already found in low amounts in a lot of our water sources and even foods. (Read the Wikipedia entry on Fluoride for a more thorough definition.)

Fluoride is associated (never proven, despite what proponents will tell you) with the reduction of cavities and tooth decay. It was discovered when dentists noticed that people in a town in Colorado had super ugly teeth (they were getting too much fluoride, resulting in fluorosis), but no cavities. (You can read more about the interesting history of fluoride here.)


What’s all the fuss about?
The main debate is over the government fluoridation of public water supplies, something that has been widespread in the US since the 1960s. There are a lot of reasons people object to fluoridation. I’ll go over a few key ones, trying to avoid the most inflammatory/crazy ones.


“Evil toxic chemicals, eek!”
Most of the fluoride used to supplement US public water supplies contains Hexafluorosilicic acid, a by-product from phosphate fertilizer manufacturing, rather than the naturally-occurring (but just as toxic in high doses) Sodium Fluoride. There is a concern that contaminants (lead, for instance) can tag along with fluorides from industrial sources and do more harm than any good the fluoride could be doing.

The more cynical/conspiracy-loving opponents of fluoridation believe that the big fertilizer companies are paying off our government to save them a buck for the hazardous waste processing they’d have to do if their by-products weren’t being used for fluoridation purposes. I will leave that one up to you to decide!


Health issues
The EPA’s Headquarters Professionals’ Union (which represents the approximately 1500 scientists, lawyers, engineers and other professional employees at EPA Headquarters in Washington, D.C.) objects to fluoridation. Their objections list numerous health issues (neurotoxicity, reduced IQ in children, earlier onset of puberty, cancer risks, and bone disease) all related to excess fluoride. Since fluoride is readily available in toothpastes, rinses, and other forms, these folks believe that the risk of over-fluoridation is too great to justify pumping into our water supply.


Questionable efficacy
While the CDC claims water fluoridation is responsible for the decline in tooth decay over the last 50 years or so, similarly declining trends can be seen in other countries where water fluoridation is not in practice. Furthermore, mounting evidence exhibits that the real benefit of fluoride is in topical application, such as with toothpastes, mouth rinses, and gels.

3/2/2011 update! EPA is reversing its fluoride stance!

Because of the strong uptick in dental fluorosis amongst American teenagers, the US Department of Health and Human Services is recommending a reduction in municipal fluoride levels.


Ethics of Mass Medication
Fluoride supplements are routinely prescribed (particularly for children), indicating that fluoride is indeed a medicine. When it is added to artificially raise fluoride levels in order to lower the incidence of dental caries, it fits the description of compulsory medication. Many European countries have already abolished water fluoridation for this very reason.

Fluoridating public water supplies opens a whole new can of ethical worms. Where do we stop? This bioethicist believes that we should be fortifying municipal water with lithium, since initial surveys have shown that communities with higher amounts of naturally-occurring lithium have seemingly corresponding lower rates of suicide. He bravely states:

Time will reveal whether lithium is indeed the next fluoride. Far more important [than individual liberty] is the revolutionary prospect of harnessing the common water supply to deliver life-saving and health-enhancing therapies to the public at low cost. The water belongs to the public, after all, and should be used for the collective good.

Before I wrote this article, I’d never really considered the fluoridation of our water supply as a political issue, but it is. It surprises me that more people aren’t up in arms about the government medicating us through our water system. It might have been slightly more justifiable public health-wise 50 years ago, when people didn’t have ready access to fluoride toothpastes, but that is hardly the case anymore; nowadays it’s the non-fluoridated toothpastes that are financially out of reach to the poor!

Medicating the many for the benefit of the few does not sit well with me. Particularly when some of the “many” experience life-threatening side effects from consuming fluoridated water. Better to have government-subsidized toothpaste and fluoride drops than to taint the water supply and not give anyone a choice in the matter!


Is my water fluoridated?
It’s easy to find out. The CDC has a handy little map that catalogues each US state’s fluoridation status. My Canadian friends can check this list of municipalities. In the UK, check here. The rest of the world can check this Fluoridation by Country entry on Wikipedia as a good start. You can always just contact your water provider and ask for a report!


So, what about those toothpastes?
If you’re concerned about over-exposure to fluoride, there are a number of non-fluoride toothpastes available, usually at heath food stores. Fluoride-free toothpastes are always recommended for children under 2 and any kid (like mine) who still swallows the toothpaste on a regular basis. I would avoid toothpastes containing sugar (or worse, high fructose corn syrup), since that is a big culprit in decay! Look for xylitol-sweetened products instead. I’m dead-set against artificial colors and flavors, too.

Here are some Amazon links to brands I have tried.
- JASON Sea Fresh Toothpaste

- Tom’s of Maine Antiplaque Tartar Control Plus Whitening Toothpaste (our standby).

- Tom’s of Maine Propol-Myrrh-Fennel Toothpaste.

- Tom’s of Maine Silly Strawberry Toothpaste for Children.

- Jason “Kids Only” Strawberry Toothpaste (the picture is wrong, but the product is correct. Caution: it has a very strong flavor; Tom’s is preferred around here!).

- While I haven’t tried these, Burt’s Bees makes a peppermint “Multicare” formula and a “Berry Bee” kids’ formula.


How else can I help prevent tooth decay?
Brush and floss your teeth! And get your routine dental cleanings twice a year. These should be no-brainers by now!

Nutrition is one of the biggest contributors to oral health (or lack thereof). Limit sugars and refined carbohydrates - you shouldn’t be eating a lot of that junk for other reasons as well! Here’s a helpful fact sheet about nutrition and oral health and a web page with similar info. If you do choose to use fluoride, don’t use it as a crutch to justify bad eating habits and poor oral maintenance.

Did you know that raisins could help fight oral bacteria? Neat!


Additional resources
If you need some more head-spin regarding the fluoride debate, here are some good places to go.

Dr. Jay Gordon’s concise recommendation against fluoride as well as additional links.

The FluorideDebate.com’s exhaustive rebuttals to the ADA’s Fluoridation Facts. (You don’t have to click the second link (it’s a pdf download); the Fluoride Debate people provide both the ADA assertions and their dismantling of them on their site. This seems to be well documented and has a lengthy bibliography. Worth reading if you have a lot of time and interest in the subject!

The California state government site has a referenced Fluoridation Facts & Fiction section, but I found it to be rather disingenuous. For instance, their answer to “Are fluorides used to fluoridate water supplies a waste product of the phosphate fertilizer industry and aluminum manufacturing industries?” is No, because

Fluorides used to fluoridate water supplies are a by-product of the phosphate fertilizer industry, as are many products in use today. The aluminum industry is a consumer of fluoride, not a producer. The fluoride from the phosphate fertilizer industry is a naturally occurring constituent of the phosphate rock and is recovered during the production of the phosphate fertilizer

(my emphasis).

It is true that the aluminum industry is a consumer of fluoride. But there is no getting around the fact that fluoride is produced by, and unneeded by, the manufacturing of phosphate fertilizer. Not calling it a “waste product” is just weasely, if you ask me.

Second Look, a non-profit initiative “that evolved from grassroots frustration with public policies that are so controversial that useful, factual information becomes almost impossible for the public and even professionals to sort out.” Very helpful! I wish they covered more than just fluoridation!

The Fluoride Action Network’s 50 Reasons to Oppose Fluoridation. I’ve been very impressed with their citation of supporting research and lack of inflammatory language when addressing the issue.


There you have it. A solid foundation for your fluoride decision-making. Congratulations on being an informed consumer!

Hey Laura, I think... Hey Laura, what’s the deal with fluoride?

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