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Fluoride Supplement Dosing Schedule

In the 1940’s, water fluoridation officially started in the United States.  While it is believed that water fluoridation does reduce tooth decay, there are many areas of the United States that don’t have fluoride added to their water.

In the same decade that water fluoridation commenced, people in non-fluoridated areas wondered how their children could reap the the benefits of fluoride if their water supply was not yet fluoridated.

Trials were performed in which dietary fluoride supplements were administered to children in order to determine if they could receive fluoride’s anti-cavity effects in pill form.

After this trial period, the American Dental Association (ADA) came up with the very first fluoride dosage schedule in 1958.  In the years that followed, the American Academy of Pediatrics as well as the ADA had two separate fluoride dosage schedules.  Unfortunately, many children started getting dental fluorosis, and as a result, the amount of recommended fluoride was gradually reduced.  Finally, in 1994 the ADA and AAP finally agreed on the following schedule, which was reaffirmed in 2010.

Fluoride Supplement Dosage Schedule Fluoride Supplement Dosage Schedule

Do All Children Need Fluoride Supplements?

Even if your water does not contain fluoride, your child may not need fluoride supplements.  The American Dental Association states that fluoride supplements are intended for use by children “living in non-fluoridated areas and at high risk of developing tooth decay.”

Your child’s dentist can help you determine how at-risk your child is for developing tooth decay.  If your child is at low risk of developing cavities, then fluoride supplements are inappropriate whether or not your family’s drinking water is fluoridated.

While fluoride can help prevent cavities in high-risk children, it’s important to remember that cavities aren’t caused by a deficiency in fluoride.

Learn about what really causes cavities here.

Do you have any questions about fluoride supplements?  Feel free to leave your questions and comments in the section below.  Thanks for reading!

Pregnant Women and Fluoride Supplements

Fifty years ago you could have walked into a pharmacy and seen fluoride drops that were specifically targeted toward pregnant women. The packages claimed that fluoride drops, when taken during pregnancy would help keep their children cavity-free.

That all changed on October 20, 1966 when the FDA cracked down on the fluoride supplement makers.  They banned them from making claims that fluoride would benefit unborn babies’ teeth due to a lack of clinical evidence to substantiate that claim.

Source: Food and Drug Administration: Statements of general policy or interpretation, oral prenatal drugs containing fluorides for human use. Fed Regist Oct. 20, 1966

You may be wondering what we’ve figured out in the past 50 years about taking fluoride supplements during pregnancy.

Should Women Take Fluoride Supplements During Pregnancy?

Pregnant Women and Fluoride SupplementsThe answer is no — there is no evidence that taking fluoride supplements during pregnancy helps improve the baby’s chances of having healthier teeth.

Since fluoride supplements taken by the mother can cross the placenta, there is a chance that the well-meaning mother-to-be could actually cause their baby to get dental fluorosis.

The Evidence Against Taking Fluoride Supplements During Pregnancy

Here’s three different credible sources that all agree that there is no benefit derived from taking fluoride supplements during pregnancy.

A Clinical Trial

This clinical trial took 1400 pregnant women and divided them into two groups.  One group received 1 mg of fluoride per day during the last six months of their pregnancy while the other group received a placebo.  The kids were followed until age 5.  No noticeable difference in the amount of cavities was noted between the two groups.

A Scholarly Article

This scholarly article from the journal Pediatric Dentistry states, “Although fluoride crosses the placenta, prescribing fluoride supplements to pregnant women is not recommended because there is little evidence that fluoride provided to the mother during pregnancy reduces caries prevalence in their offspring.

A Statement from the American Academy of Pediatric Dentistry

This guideline from the American Academy of Pediatric Dentistry states, “The AAPD does not support the use of prenatal fluoride supplements to benefit the fetus.”


Although 50 years ago many people thought that taking fluoride supplements during pregnancy was good for their baby’s teeth, it turns out that modern science has debunked that myth.

There is no reason to take fluoride supplements during pregnancy.  And there’s actually a good reason not to: dental fluorosis.

Do you have any questions or thoughts regarding fluoride supplements and pregnancy?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!

Fluoride in Bottled Water

Did you know that bottled water is about 500 times more expensive than tap water? Despite this fact, many Americans (myself included) buy billions of bottles of water every year.

In 1945, Grand Rapids, Michigan was the first city to add fluoride to the public water supplies.  Fluoride makes teeth more resistant to cavities, but with so many people turning to bottled water these days, are they still getting the benefits of fluoride?

I decided to investigate the amount of fluoride in bottled water by taking a look at 13 popular bottled water brands and finding out how much fluoride each bottled water brand contains.

I was fairly successful in finding out, except for one brand, but I should be getting something in the mail from them if things go right!

Fluoridated Bottled Water - Photos Courtesy of Manufacturers

How Much Fluoride is In Bottled Water?

Many people claim that bottled water doesn’t contain any fluoride. While analyzing 13 of the more popular bottled waters in the United States, I found out that all of these bottled waters do contain some fluoride.

Here’s the results of each bottled water brand and how much fluoride it contains.  You can skip down to the bottom for a summary graph.


Aquafina claims that their bottled water contains less than 0.05 ppm fluoride in the Aquafina Water Quality Report (PDF), however the U.S. Department of Agriculture did some testing and found the average to be .05 ppm fluoride with some bottles of Aquafina containing up to 0.09 ppm fluoride.


According to the Arrowhead Quality Report (PDF), Arrowhead brand spring water contains anywhere from less than 0.1 to 1.3 ppm fluoride.

Crystal Geyser

How Much Fluoride Is In Bottled Water?Crystal Geyser brand Contains Anywhere from 0.088 to 0.74 ppm fluoride depending on which of their six bottling plants the spring water comes from according to the Crystal Geyser FAQ Page.

Below is a link to the bottled water quality report for all six bottling plants. Crystal Geyser appears to be the most transparent bottled water company when it comes to divulging their fluoride levels.

The Crystal Geyser Benton, Tennessee spring contains 0.088 ppm fluoride.
The Crystal Geyser Moultonborough, New Hampshire spring contains 0.16 ppm fluoride.
The Crystal Geyser Mt. Shasta, California spring contains 0.25 to 0.34 ppm fluoride.
The Crystal Geyser Norman, Arkansas spring contains 0.11 ppm fluoride.
The Crystal Geyser Olancha Peak, California spring contains 0.61 to 0.74 ppm fluoride.
The Crystal Geyser Salem, South Carolina spring contains 0.29 ppm fluoride.


Dasani’s Water Quality Report (PDF) only states that fluoride was not detected above 0.8 ppm. Not very specific, if you ask me!

Since Dasani water is simply purified municipal water that is filtered via reverse osmosis, most of the fluoride is removed from Dasani water before the bottle makes it into your hands.

The U.S. Department of Agriculture’s study found that Dasani bottled water contains on average, 0.07 ppm fluoride, with values ranging anywhere from 0.02 to 0.19 ppm fluoride among the 20 Dasani water bottles that were tested.

Deer Park

Deer Park spring water contains <0.10 to 0.19 ppm fluoride according to the Deer Park Water Quality Report (PDF).

Deja Blue

Deja Blue appears to contain less than 0.10 ppm fluoride based on this report.

After one unanswered email and two calls to Dr. Pepper/Snapple (the first time they routed me to Kellog Cereals for some reason) they couldn’t tell me how much fluoride was in their water, all I got was, “I’m sorry, but we do not have that information available.”

I then asked for a bottled water quality report, and she said that she thought they could send that to me. I gave them my address and if they send it to me, I will update this section. I’m under the impression that they legally have to provide a water quality report to inquiring consumers, but I’m not a lawyer!


Evian’s Water Quality Report (PDF) states that Evian contains less than 0.10 ppm fluoride. The U.S. Department of Agriculture’s study pins Evian’s fluoride content right at 0.10 ppm fluoride, with values ranging from 0.07 ppm to 0.15 ppm fluoride.


FIJI artesian water contains 0.29 ppm fluoride according to the FIJI Water Quality Report (PDF).

Ice Mountain

Ice Mountain contains a trace amount of fluoride up to a maximum of 0.072 ppm fluoride according to the Ice Mountain Bottled Water Quality Report (PDF).

Nestle Pure Life

Contains trace amounts of fluoride up to 0.13 ppm fluoride per the Nestle Pure Life Bottled Water Quality Report (PDF).


Ozarka natural spring water contains 0.07 to 0.088 ppm fluoride according to the Ozarka Bottled Water Quality Report (PDF). Interestingly, they also show that their fluoridated spring water contains 0.77 ppm fluoride.

Poland Spring

Poland Spring bottled water contains 0.075 to 0.17 ppm fluoride according to the Poland Springs Water Quality Report (PDF). They also state that their fluoridated brand of spring water contains 0.86 ppm fluoride. It’s interesting that both Ozarka and Poland Spring, which are owned by Nestle, appear to add differing amounts of fluoride to their fluoridated subset of drinking waters.


Zephyrhills spring water contains 0.064 to 0.13 ppm fluoride according to the Zephyrhills Water Quality Report (PDF)

Summary of Fluoride Concentrations in Bottled Water

Here’s a summary graph showing how much fluoride is present in the various brands of bottled water.

Fluoride Concentration of Bottled Water

Another note I forgot to add to the graph is that when the bottled water quality reports stated that there was an “undetected amount” or that it was “below the minimum reporting limit” I simply used 0.01 ppm fluoride in the graph above.

Bonus Fluoride Fact!

Since I love Perrier sparkling water so much, I did some research to find out how much fluoride it contains. Perrier contains 0.18 ppm fluoride according to the Perrier Water Quality Report.

Questions, Comments, and Concerns about Fluoride in Bottled Water?

If you have any questions, comments, or concerns about the amount of fluoride in bottled water, feel free to leave a comment in the comments section below.

Also, in order to find out which bottled waters to include, I took the top 20 bottled waters worldwide, then picked out 13 that are widely sold in the United States.  If you’re curious about the amount of fluoride in a different brand of bottled water, simply ask in the comments and I’ll try to find out.

Cute Little Girl Brushing Teeth
©Oksana Kuzmina/

Oral Answers LinksIt’s been a long week, and I’m excited for the weekend!  Two more weeks until the end of the semester, then we’re going to go exploring to find a place where we’ll end up after dental school.

We’ve been to Maine and Vermont.  We’re headed to Maryland in August.

10 more months and I’ll be a dentist.  Time’s passing by fast!

Here’s some interesting links that caught my eye over the past week:

Is Your Dentist Putting Germs Around Your Neck?

I read this Fox News article and was a little grossed out.  It turns out that the little chains dentists use to hook the patient napkin around your neck can harbor bacteria from the previous patient.

Germs on Dental Chains
Does Your Dentist Hang Germs Around Your Neck?

I always thought my dental school was just being cheap — we tape our patient’s napkins to their shirt to hold them on rather than using the standard chain.

Today I did an externship at a community dental clinic and the germophobe in me made me sanitize the chain that we were using there.  Hopefully, it fit into the 80% of “uninfected” chains after I was done with it…

An Eggsperiment to Understand Your Teeth

Crest whipped up a little experiment to help kids understand dental decay.  It involves using an egg, vinegar, and Crest toothpaste (of course no other brand would work!  Any fluoridated toothpaste should fit the bill.) to understand how the bacteria in your mouth eat away at your teeth and weaken them, and how fluoride can make your teeth stronger.

If you don’t want to do the experiment, but want the educational experience, try reading the article Try to Keep Your Teeth Below Freezing.

Fairbanks De-Fluoridates Their Water

The city of Fairbanks, Alaska has stopped adding fluoride to their public water supply.  Given that their water is already naturally fluoridated with 0.3 ppm of fluoride and people are getting fluoride from other sources, it may not be such a bad move to balance out the prevention of dental fluorosis as well as the prevention of cavities.

If you want a closer look into the water fluoridation debate, check out this final report from the Fairbanks Fluoride Task Force.  It is a PDF file, so it may take a bit longer to load.

Questions or Comments?

I’d love to hear what you have to say about any of these articles.  Feel free to leave a comment in the comments section below.  Thanks for reading – have a great weekend!

Fluoride Toothpaste on Brush
©Tamas Panczel Eross/

My brother was at the dentist a few days ago and he was wondering if it was worth it to have his dentist apply a fluoride gel to his teeth.  He wanted to know if there was really that much more fluoride in the dentist’s gel than is in his toothpaste and fluoride mouthwash.  I told him that there is a lot more fluoride in the professionally-applied gels than there is in his home dental care products.

Usually dentists only give children fluoride gel at routine appointments, however adults may benefit from fluoride treatment.  In the book Fluoride in Dentistry, Ole Fejerskov states, “Fluoride-containing mouth gels may be applied, usually by the dental professional once yearly, to individuals living in communities with low concentrations of fluoride in the water supply.” If you live in a community with water fluoridation and you brush your teeth with fluoridated toothpaste, you may want to consult with your dentist on whether or not the extra fluoride will do any good. After answering his question, I thought that other people may be interested in how much fluoride there is in different dental products. To make the amounts more clear, I will talk about fluoride concentration in parts per million in this article.

You can get a better perspective on PPM in the following article: How Much Fluoride Is in a PPM (Part per million)?

How Much Fluoride is In Various Dental Products?

1 PPM: Tap Water.  Since the dental community has worked so hard to get fluoride in the public water supply to help prevent cavities, I figured I would add water into this list.  The concentration goes up to 3 PPM if you boil that water in a Teflon-coated pot or pan. 226 PPM: Fluoride Mouth Wash.  226 PPM is the maximum allowable fluoride concentration available in over the counter fluoride mouthwashes (0.05% NaF), such as ACT Restoring Mouthwash. 910 PPM: Prescription Fluoride Mouthwash.  910 PPM is an acceptable concentration for prescription-strength fluoride mouthwash.  Some prescription fluoride mouthwashes that contain stannous fluoride have a concentration of 970 PPM. 1500 PPM: Toothpaste.  Most toothpastes are now at 1500 PPM of fluoride.  The number has gradually increased over time.  In the 1990’s most toothpaste in the United States had only 1000 PPM of fluoride.  If you don’t want to spend the money on fluoride mouthwash, you can get the same cavity-fighting effect by simply brushing longer so that the toothpaste remains in contact with your teeth for more time. 12,300 PPM: Fluoride Gel.  Remember the strawberry/orange/mint-flavored gel that your dentist gave you when you were a kid?  The reason that it helps your teeth is because it contains so much fluoride — it’s made up of 1.23% acidulated phosphate fluoride. 19,300 PPM: Alginate Impression Material.  Unexpectedly, that pasty stuff that dentists use to take impressions of your teeth contains a lot of fluoride!  This study evaluated eight types of alginate and listed the PPM of each.  I took the average to come up with 19,300 PPM.  Another study has also looked at the fluoride concentrations in alginate impression material and came up with similar results.  Don’t worry about getting too much fluoride though, since most of it stays locked up inside the impression material. 19,400 PPM: Stannous Fluoride Topical Solution.  Although this isn’t used as much as the fluoride gels and varnishes, some dentists do apply topical stannous fluoride to their patients. 22,600 PPM: Fluoride Varnish.  Fluoride varnish is painted on your teeth, similarly to how nail polish is painted on your nails.  We usually use this to help combat tooth sensitivity.  Fluoride varnish can also be used in children rather than the gels since it is easier for kids to swallow lots of the gel than it is for them to swallow a lot of the fluoride varnish.


As you can see, there is a lot of fluoride in many of the dental products that are out there. Do you have any questions, comments, or concerns about the amount of fluoride in dental products?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!

Is Water Fluoridation Legal?

Ever since the government started adding fluoride to the public water supplies in 1945, there have been many people who have challenged the legality of fluoride in our water supplies.

They raised concerns about whether a city has the right to add a drug to the water supply that could help many people, but have side effects such as dental fluorosis.

This has caused some cities to stop fluoridating their water supplies.  For example, two of the three largest cities in Alaska, Fairbanks and Juneau no longer fluoridate their water supplies.

A recent news broadcast by the CBS TV station in Anchorange, Alaska asks whether or not Anchorange will be the next Alaskan city to stop fluoridating the public water supply.

Is Water Fluoridation Legal?

A new website aims to answer the question of whether or not water fluoridation is legal. It is called FLUID, which stands for Fluoride Legislative User Information Database.

FLUID Fluoride Legality

The site contains a database of federal, state, and local actions regarding water fluoridation as well as legal opinions of state and federal courts and allows anybody to search throughout this goldmine of information.

The website states that its mission is the following:

FLUID was created to be an up-to-date, user-friendly tool to answer questions about the legal and policy status of community water fluoridation in all 50 U.S. states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. The goal of FLUID is to enable users to access information based on legal fact and to be a resource that allows them to compare their current or proposed policies with others from across the country.


When the legality of water fluoridation is questioned in court, it seems that water fluoridation is usually upheld by the courts as legal.

What are your thoughts?  Do you think it’s legal to fluoridate public water supplies?  You can leave your thoughts in the comments section below.  Thanks for reading!

Water Fluoridation Conspiracy

We’ve heard about a lot of conspiracy theories lately:

Is bin Laden really dead?
Was Obama really born in the United States?
Was 9/11 planned by the U.S. Government?

Today, I’m going to address a popular water fluoridation conspiracy theory: Is big business profiting from water fluoridation?

Is Water Fluoridation a Conspiracy?The theory goes along these lines:

Fluoride is a waste by-product of manufacturing, such as the manufacture of fertilizer.

The companies that make the fertilizer can’t find a cheap way to safely dispose of it, so they decide to sell it to the thousands of unsuspecting municipalities around the country by telling them that if they dump it in their water, they will have healthy teeth.  A frequent argument against water fluoridation is that companies are getting paid to dispose of their toxic waste and we are being forced to drink it!

De-Bunking the Water Fluoridation Conspiracy Theory

A spokesman for Alcoa, during an interview in 1972 stated that fluoride sales were not more than an “infinitesimal part” of Alcoa’s business model.  He said, “We are in business primarily to make and sell aluminum.  The future prosperity of the thousands of employees and shareholders who make up Alcoa depends principally upon how well we make aluminum, not on whether communities fluoridate their water.” (Source: Fluoridation Reporter, American Dental Association, 10(2), 1972.  Emphasis added!)

The American Water Works Association recently reported in this article and in this article that we are experiencing shortages of fluorosilicic acid, a by-product of the phosphate fertilizer industry.  It would seem that if companies were making such a huge profit selling their “toxic waste” fluoride, then there would be a huge supply of fluorosilicic acid, rather than a shortage.

Find out if your water is really fluoridated with toxic waste fluoride.

The article notes that “At one point, Cleveland Water was only one day away from running out of FSA, but its supplier has managed a delivery in time for the utility to maintain fluoridation.”

It would seem that Cleveland Water would have a herd of shady businessmen knocking on their doors trying to sell them their “toxic waste” if this conspiracy theory were really true.


In summary, companies aren’t getting rich by selling their waste products for us to drink.

You can read all of the other articles I’ve written about water fluoridation.

Do you have any questions, comments, or concerns about water fluoridation?  Also, do you think that this conspiracy theory is true?  I’d love to hear what you have to say below in the comments section.  Thanks for reading!

Fluoride in Water and Toothpaste

Jake (whom I assume is a dentist) left an interesting comment about fluoride on Sunday.  He said:

I had an anti-fluoride patient the other day that was saying he read somewhere that a pea-sized amount of toothpaste contains the same amount of fluoride in 1 liter of tap water (1 ppm). His argument was that the toothpaste labels says to call poison control if more than a pea-sized amount is swallowed (which it doesn’t), and the same amount is in 1 liter of water. So he was wondering if he should call poison control every time he drinks more than a liter of water. It sounded ludicrous, but how much fluoride is actually in a pea-sized amount of toothpaste in comparison to 1 liter of water?

Fluoride Warnings On Toothpaste
Fluoride Warnings on Toothpaste (Click to enlarge)

I enjoy talking about water fluoridation.  Looking back, I’ve actually written 15 different posts about fluoride!

Jake’s comment really got me wondering about how the fluoride levels compare between fluoridated water and toothpaste.

Do Toothpastes Contain a Warning Telling You to Call Poison Control?

First, let’s take a look at the common anti-fluoride claim that fluoride is poison.  I took a picture of the back of three different brands of toothpastes: Colgate, Aquafresh, and Crest.  If you click on the picture, you can view a large size that will let you read the warning.  Each tube has a similar warning.  The back of the Colgate Total toothpaste box states:

If more than used for brushing is accidentally swallowed, get medical help or contact a Poison Control Center right away.

But how much do people really use for brushing?  There’s the ultra-conservative pea size, and then there’s the large stripe that toothpaste manufacturers want us to use so that we buy lots of toothpaste!

I decided to find out how much toothpaste is in a large stripe by conducting a two-part experiment.

My Toothpaste Experiment

On the back of the toothpaste tube, it states that you should call the poison control center if you swallow more than is used for brushing.  This is what the toothpaste manufacturers write.  I took the liberty of assuming that a normal amount of toothpaste for them is a thick stripe on a manual toothbrush (like they show in their commercials).

I decided to find out exactly how much toothpaste is in a big stripe so that I could figure out how much fluoride it has.  I got carried away and tried two different brands.

Here’s the large stripe of Colgate Total that I put on my wife’s toothbrush (are your toothbrush bristles as straight as hers?  If not, it may be time to get a new toothbrush):

A Large Stripe of Colgate on a Brush

I measured the toothpaste and found that it filled the 1/4 teaspoon – giving us 1.25 ml of toothpaste:

Colgate Toothpaste Measured

Out of curiosity (and because it seemed like a fun idea after taking two finals over the past 36 hours), I measured the Crest Toothpaste as well.  I was able to get a slightly bigger stripe on the brush this time.  Unfortunately, the stripe I created just wasn’t as good looking as it is on the toothpaste commercials!  However, if you want to practice making a beautiful stripe of toothpaste on your brush, I have to recommend the Crest since it is much thicker.

Crest Stripe on Toothbrush

This large stripe of Crest ended up overflowing the 1/4 teaspoon, giving us about 1.75 ml of toothpaste:

Crest Toothpaste Measured

I decided to take the average of my two “large stripes” to use as the baseline amount of toothpaste you can swallow and still be safe (according to the toothpaste manufacturers) – which appears to be 1.5 ml from my unscientific experiment.

Contrast this with a peasize amount of toothpaste which is only 0.2 ml.  Who would’ve guessed that the average pea only takes up a volume of 0.2 ml?

Now that we know how much toothpaste we use, we can figure out how much fluoride we would ingest if we swallowed a large stripe of toothpaste.

How Much Fluoride is in Toothpaste?

A majority of toothpastes on the market contain about 0.15% fluoride ion, which comes out to 1500 ppm (parts per million.)

In 1.5 ml of toothpaste (the large stripe pictured above) you would find 2.25 mg of fluoride.

In a pea sized amount of toothpaste, you would only find 0.3 mg of fluoride.

How Much Fluoride is in Fluoridated Water?

Most fluoridated water contains about 1.0 ppm.  That means that in 1 liter of water, you would find about 1 mg of fluoride.

Not sure how much fluoride is in your water? Then find out how much fluoride is in your tap water!

Comparing the Amount of Fluoride In Water with the Amount of Fluoride in Toothpaste

As you can see, you would have to drink over 2 liters of water to get the same amount of fluoride that you would get by swallowing a large stripe of toothpaste.  You would only have to drink 300 ml of water (a little less than a 12 oz. can of soda) to get the same amount of fluoride you would get by swallowing a pea size amount of toothpaste.

You Don’t Need to Call Poison Control When You Drink Fluoridated Water!

I’m sure Jake’s patient was just trying to make a point.  Point taken!  However, according to the American Dental Association (Page 31 in their Fluoridation Facts PDF), it would take 5-10 grams of fluoride to cause fluoride toxicity in an average 155-pound man.  That means that a 155-pound man would need to drink 5,000 liters of water (over 1300 gallons!) in order to get a toxic dose of fluoride.

The water would kill you (as this tragic story illustrates) long before the fluoride would have any toxic effect.


Interestingly, there is more fluoride in a liter of water than in a pea-sized amount of toothpaste, but more fluoride in a large stripe of toothpaste than in a liter of water.  Here’s what I found:

  • In a pea size amount of toothpaste, there’s 0.3 mg of fluoride.
  • In a large stripe of toothpaste, there’s 2.25 mg of fluoride.
  • In one liter of fluoridated water, you’ll find 1 mg of fluoride.

Although fluoride is great for your teeth, too much of it during development of the teeth can cause dental fluorosis.

Do you have any questions about toothpaste fluoride content or water fluoride content?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!

Water Fluoridation: Where I Stand

This is the final post dealing with water fluoridation in my week-long series discussing both sides of the water fluoridation debate.

Is Water Fluoridation Good?Hopefully you enjoyed the articles this week.  If not, don’t worry!  I’ll be back into my regular oral health writing routine next week.

If you missed the two previous articles, each of them explored one side of the water fluoridation debate.  You can read them by following the links below:

Top 10 Reasons to Support Water Fluoridation

Top 10 Reasons to Oppose Water Fluoridation

In this article, I’ll share a few of my own thoughts on the water fluoridation issue.

Where I Stand on Water Fluoridation

I do see valid arguments to both sides, and to be quite honest, I’m torn.  I think that the best way to express my feelings on the water fluoridation issue is to talk about two children — first, my son, and then someone else’s son.

Water Fluoridation

My Son and Water Fluoridation

I brush my children’s teeth every night before they go to bed.  When I started using fluoride toothpaste with my son, I made sure he spit it out.  I feel like my wife and I are in charge of his oral health, and that he wouldn’t have any cavities with or without water fluoridation.  With that said, I think that the only thing that would happen to my son as a result of drinking fluoridated water would be mild dental fluorosis.

We get fluoride from a number of sources.  I sometimes wonder if water fluoridation will provide enough extra fluoride to push him over the edge and cause his teeth to have the white speckled appearance characteristic of mild dental fluorosis.

Contrast this with the story below.

Another Child and Water Fluoridation

Now, imagine another child who grew up with parents who don’t really care about oral health.  We’ll call him Leroy.  Leroy’s parents let him eat candy all day and they are too busy to worry about brushing his teeth.  Water fluoridation is the only thing that Leroy has working in his favor when it comes to oral health.  His parents don’t even take him to the dentist.

In Leroy’s case, water fluoridation could potentially keep his baby teeth in good enough shape that he doesn’t get an infection from a tooth with a large cavity.  In this case, water fluoridation is a great thing!  The fluoride he receives every day when drinking could keep that little boy from having to go to the hospital due to a dental infection.

Should Both Kids Drink Fluoridated Water?

When you look at my son and Leroy, you can see that some people would benefit greatly from fluoride while other people could end up with enamel fluorosis and be embarrassed because of their teeth.

In an ideal situation, my son wouldn’t have to drink the fluoridated water.  In fact, he would probably give his fluoridated water to Leroy so that he could get a double dose of dental protection.  Unfortunately, water fluoridation is an all-or-nothing deal.  You can’t selectively fluoridate certain people’s water because that would be construed as discrimination.

This problem has led me to a lot of thinking.  It made me wonder if water fluoridation is the best way to get fluoride to kids like Leroy.

Is Water Fluoridation the Best Method?

There are alternatives.  Switzerland has had some success fluoridating the salt.  This would be relatively easy to do.  In 1924, Morton started putting iodine in salt.  They did this because iodine deficiency is the leading preventable cause of mental retardation.

In the book Fluoride in Dentistry, author Ole Fejerskov states, “Water fluoridation reaches everybody, a major advantage in terms of oral health and a problem in terms of social policy for those who dislike the overtones of compulsion. When domestic salt with added fluoride appears along-side non-fluoridated salt on the supermarket shelves, consumers have a choice. This makes fluoridated salt more palatable from the social policy viewpoint, but weakens its caries-preventive impact across the whole population.”

Salt fluoridation does have its drawbacks, which I will discuss in another article, but it is something to think about.

Since we began adding fluoride to water over 60 years ago, a lot has changed.  We are now surrounded by toothpastes with fluoride, mouth rinses with fluoride, and floss that is coated in fluoride.  Fluoride is even found in many of the packaged foods and drinks we consume.  I think we are ingesting too much fluoride.  Apparently that is the prevailing opinion, one which brought about the recent recommendations to reduce the amount of fluoride in our drinking water.


As you can see from what I’ve written above, I am both for and against water fluoridation.  One might say that although I’m in favor of using fluoride in appropriate doses, I see some definite problems with the mass water fluoridation that we see across much of the country.

Where do you stand?  Please share your thoughts in the comments section below.  Thanks for reading!

10 Reasons to Oppose Water Fluoridation
©Maxim Blinkov/

Ever since communities started fluoridating their water, there have been people that are adamantly opposed to water fluoridation.

As you can see in the 1950’s era flyer to the right, some people even alleged that water fluoridation was some kind of communist plot to overthrow the American government.

Was Water Fluoridation a Communist Plot?Some of the arguments of anti-fluoridationists are very extreme and therefore seem like they are not based in truth.  I think that when people hear outlandish arguments alleging fluoride to be a giant conspiracy, they don’t take the anti-fluoridationists very seriously.  Because of this, I think that the many sound arguments against water fluoridation that do exist are never fully considered by the general population.

In the following article, I’ve attempted to consolidate ten of the best arguments against water fluoridation.  If you want to take a look at the opposing viewpoint, you can check out yesterday’s article, Top 10 Reasons to Support Water Fluoridation.

Top 10 Reasons to Oppose Water Fluoridation

Reasons to Oppose Water Fluoridation

1 – Water Fluoridation Is Associated with Dental Fluorosis

Dental fluorosis is a condition resulting from a child ingesting too much fluoride while the permanent teeth are developing.  In its mildest form, faint white specks can be seen on the teeth.  In more severe forms, the teeth can appear brown and mottled.

Dental fluorosis has been found to be more common in children that consume fluoridated water.  One source for this claim is this article published in the Journal of the American Dental Association in October of 2010.

Want to know more? Read this article about dental fluorosis.

2 – Water Fluoridation is a One-Size-Fits-All Approach

Water fluoridation assumes that every person needs the same amount of fluoride.  It also assumes that everyone drinks about one liter of water per day.  While those statements may sound great in theory, the truth is that people are varied and have different needs.

Not everybody needs the same amount of fluoride.  People with poor oral hygiene may benefit from more fluoride while those with perfect oral hygiene who brush with fluoride toothpaste and floss could easily have a clean bill of oral health without water fluoridation.

The ideal situation would be to have people talk with their dentist about how much fluoride they actually need.  That way the dentist can assist the parents by providing an accurate assessment of their child’s fluoride needs.

3 – Water Fluoridation Prescribes a Drug to Everyone

Fluoride is technically considered a drug, since it does alter the way the body works. When fluoride is added to the drinking water, everyone gets prescribed a drug regardless of their individual situation.  A doctor would never prescribe a drug without taking into account the medical history of a patient, so it is interesting that communities allow everyone to “be prescribed” fluoride by putting it in their water source.

4 – There Is No Informed Consent with Water Fluoridation

If people are going to be drinking fluoridated water, it seems logical that they should be aware of any risks and benefits. A main problem with water fluoridation is that many people don’t really know the main benefits and risks.  The main benefit of fluoride is in reducing tooth decay.  The main risk is getting dental fluorosis.

To illustrate an example of this, in the cover story of the October 2010 issue of the Journal of the American Dental Association, it recommended to not use fluoridated water to mix baby formula.  It states:

“If liquid concentrate or powdered infant formula is the primary source of nutrition, it can be mixed with water that is fluoride-free or contains low levels of fluoride to reduce the risk of fluorosis. These include water labeled as purified, demineralized, deionized or distilled, as well as reverse-osmosis filtered water. Many stores sell these types of drinking water for less than $1 per gallon.”

I highly doubt that very many parents even know that they aren’t supposed to be mixing infant formula with fluoridated water.  Even if they did, for some families it may be an excessive financial burden to continuously purchase reverse-osmosis filtered water for their baby.  Is it fair that a baby can’t even drink from the public water supply without endangering the appearance of their permanent teeth?

In light of this situation, the anti-fluoridation website Fluoride Action Network has started a petition to require water utility companies to add the following statement to all of their customers’ bills:

“Your public water supply is fluoridated. Fluoridated water should not be used or added to infant formula, foods, or drinks intended for babies 12 months of age or younger in order to avoid dental fluorosis.”

5 – Water Fluoridation is Mass Medication Without Choice

Many people believe that health matters are a personal choice and that they should not be forced to drink water that has been medicated with fluoride.

6 – The Water Supply Should Be Used for Delivering Water, Not Medicine

What if the gas company tried to sneak an additive into the gas supply that was touted to improve your health, but it also had some drawbacks?  Do you think that the utility companies should focus on delivering quality utilities or adding health-promoting chemicals to the utilities you consume? Many would argue that the same logic applies to water fluoridation and that people should be supplied with water and water alone.

7 – Water Fluoridation Takes Away Personal Responsibility

Water fluoridation is one example of the government trying to do things for the people.  It is a person’s responsibility to learn about the pros and cons of fluoride and then decide if they want to utilize fluoride in their oral health routine.  By allowing the government to make this choice for us, personal responsibility is diminished.

8 – Tooth Decay is Decreasing In Countries Without Water Fluoridation

The main reason that fluoride is added to water is to reduce cavities.  A recent article in the British Medical Journal contains a thought provoking graph that illustrates the downward trend in cavities over the past 40 years in 12 year-old children in Europe regardless of the fluoridation status of their country.

9 – Nobody Keeps Track of How Much Fluoride You Swallow

Let’s say you’re an avid jogger and you drink a LOT of water everyday.  Water fluoridation is based on the assumption that you’ll only drink around 1 liter of water per day.  What are you supposed to do if you’ve already had too much fluoride for the day and you’re thirsty?

Would you know if you’ve been ingesting too much fluoride?

On the other side of the spectrum, consider that the bottled beverage industry has grown explosively since water fluoridation began in 1945.  In 1945, most people drank tap water or beverages that were made from tap water.  With bottled beverages (such as water) so popular now, many people are not getting fluoride in the intended dose.

Learn how much fluoride is in bottled water.

Has fluoridating water become irrelevant?

10 – Where do you Draw the Line?

Ted Ferrioli, an Oregon state senator, has said that putting chemicals in the public’s drinking water takes away people’s choice and sets a bad precedent.  He states, “If I can fluoridate your water, where do I draw the line?”

I remember attending a dental public health lecture during my first year of dental school where the lecturer extolled the benefits of water fluoridation.  After the class, one of my friends went up and talked to her.  He asked her if she thought it would be a good idea to put other vitamins and minerals in the public water supply.  The lecturer replied that this was a topic that they have been researching.

Anti-Water Fluoridation Resources

If you want to learn more about the arguments against fluoridation, here are some of the sites dedicated to eliminating fluoride from the public water supply:

I don’t necessarily agree with everything contained in the sites in the four links above, but I thought it was important to include them to provide a balanced view of the water fluoridation issue.

What do You Think?

Are there any good anti-fluoridation arguments that I missed?  What are your views on water fluoridation?

I’d love to hear about them in the comments section below!

10 Reasons to Oppose Water Fluoridation
©Dmitry Naumov/

You’re either with us, or against us” has been a popular quotation throughout history.  I think that phrase describes the water fluoridation debate fairly well.  There are many people against fluoride being added to their water, and many people that support the addition of fluoride to the public water supplies.

Reasons to Support Water FluoridationI’ve felt caught in the middle.  In my dental school we are bombarded with presentations on the benefits of water fluoridation and much of academia doesn’t seem to acknowledge that there are good arguments on both sides of the water fluoridation debate.

Today and tomorrow I’m going to try to give the best arguments for and against water fluoridation so that you can be more informed and decide which side you fit with.  Or, maybe this balanced view will leave you feeling much like me — stuck in the middle.

Top 10 Reasons to Support Water Fluoridation

1 – Water Fluoridation Saves Teeth

Water fluoridation prevents cavities — obviously, this is the main reason why fluoride is added to public water supplies.  Systematic reviews are considered near the top when it comes to reliable evidence because they comb through all of the studies on a certain topic, weed out the unreliable studies, and publish the combined results of the best studies.

In 2000, the British Medical Journal published a systematic review on the effectiveness of water fluoridation at reducing cavities.  The following sentence comes from their results:

“Water fluoridation was associated with an increased proportion of children without caries and a reduction in the number of teeth affected by caries.”

When cavities are prevented, teeth last longer.

2 – Water Fluoridation Strengthens Teeth

By drinking fluoridated water, you can incorporate fluoride into the enamel of your teeth.  When fluoride is present in your teeth, it makes them more resistant to being dissolved by acid.

Learn more about the three ways fluoride strengthens your teeth.

3 – Water Fluoridation Is Accessible to Everyone

Many people can’t afford to routinely go to the dentist for a checkup and cleaning — water fluoridation allows them to improve their oral health free of charge.  Fluoridated water helps both rich and poor alike.

4 – Water Fluoridation Saves Everybody Money

Unlike many public health measures, water fluoridation ends up saving money.  It can save individuals money by preventing cavities which allows you to avoid paying a dentist for a filling.  On a national level, it can save taxpayer dollars by preventing cavities in those who are insured by programs such as Medicaid.

The CDC has estimated that for every dollar invested in water fluoridation in communities of over 20,000 people, $38 in dental care is avoided.

5 – Water fluoridation Is Natural

Fluoride is naturally found in the water supply. Here’s a world map that shows where the water is naturally fluoridated at 1.5 PPM or above. Opponents of water fluoridation may argue that since water is fluoridated with a different type of fluoride, it’s hazardous. You can read more about that below.

Find out now: Is water fluoridated with toxic waste?

6 – The Fluoride Concentration Used In Public Water Supplies is Safe

Many opponents of water fluoridation claim that since fluoride is toxic in large quantities, we shouldn’t be adding poison to our water supply.  I would argue that most anything is toxic in excessive amounts.  Even water can kill you if you drink too much too quickly.  In small concentrations, fluoride is beneficial.

The Environmental Protection Agency sets maximum acceptable limits for many different substances that are in the water supply.  They have set the maximum limit for fluoride at 4.0 PPM.  A majority of fluoridated water contains fluoride at a concentration of 1.0 PPM.  That’s only ¼ of the allowable level.

7 – Water Fluoridation is Easy to Utilize

All you have to do is drink water and your teeth get the benefits of fluoride.  Since many people drink water when they’re thirsty, they can get the benefits of fluoride without even thinking about it.  People are more likely to drink water than they would be to rinse with a fluoride rinse every day.

8 – Water Fluoridation is Cheap

This study determined that depending on the community size and method of calculation used, water fluoridation costs between $0.46 and $3.44 per person every year.

That’s not much money considering that a filling can cost over $100 and a tooth that needs a root canal and crown can cost well over $1,000 to restore.

9 – Water Fluoridation Benefits Everyone

Even people who don’t live in areas with fluoridated water consume food products that were packaged in areas with fluoridated water.  By consuming foods and drinks processed in areas with water fluoridation, they can obtain the benefits of water fluoridation.

This is has sometimes been called the fluoridation halo effect and can be likened to the benefits of herd immunity that occurs with vaccinations.

10 – Water Fluoridation is Recognized As One of the Great Public Health Achievements of the 20th Century

The CDC included water fluoridation on their list of ten great public health achievements between 1900 and 1999.  The CDC has this to say about the impact of water fluoridation:

“Fluoridation of drinking water began in 1945 and in 1999 reaches an estimated 144 million persons in the United States. Fluoridation safely and inexpensively benefits both children and adults by effectively preventing tooth decay, regardless of socioeconomic status or access to care. Fluoridation has played an important role in the reductions in tooth decay (40%-70% in children) and of tooth loss in adults (40%-60%.)”

Pro Water Fluoridation Resources

If you want to learn more about the benefits of water fluoridation, here’s two great PDF brochures from the ADA and CDC and another helpful webpage.

What’s Your Take?

I’d love to hear what you think about water fluoridation in the comments section below!

Do you think I left out any important reasons to support water fluoridation?  Do you disagree?

Water Fluoridation Week on Oral Answers
©Rob Byron/

66 years ago this week, Grand Rapids, Michigan became the first city to add fluoride to its public water supplies.   Since then, a great debate has ensued regarding whether or not public water supplies should be artificially fluoridated.

Drinking Fountain Fluoridated WaterIn 1962, the United erectile dysfunction States government recommended that water be fluoridated with 0.7 to 1.2 PPM (How much is a PPM?)  Most water systems ended up fluoridating their water right around 1 PPM.  You can find out how much fluoride is in your tap water here.   Just over three weeks ago, the United States Department of Health and Human Services lowered the upper recommended limit of fluoride in public water to simply 0.7 PPM.

This week, I will take a close look at both sides of the fluoride debate and publish three different articles about water fluoridation:

1 – 10 Reasons to Support Water Fluoridation (Tuesday)
2 – 10 Reasons to Oppose Water Fluoridation (Wednesday)
3 – My Opinion on Water Fluoridation (Friday)

If you have any opinions on water fluoridation that you’d like to share, go ahead and leave them in the comments section below.

Dental Fluorosis Stains Teeth Chalky White
©Dozenist/Wikimedia Commons

Dental fluorosis happens when children swallow too much fluoride before their teeth have finished forming (usually before age 8.)  It was actually dental fluorosis that led researchers to eventually find that small amounts of fluoride can be beneficial for the teeth.

Dental fluorosis can range in severity from mild to severe.  The mild form appears as white specks on the teeth, as seen in the picture below.

Dental Fluorosis

The severe form of fluorosis is usually brown in color as seen in the picture below:

Severe Dental Fluorosis

It also looks like that person in the above picture has some cavities (the black spot on the tooth in the upper left of the picture and the other gray/white areas near the gumline)

Causes of Dental Fluorosis

Dental fluorosis is caused by swallowing too much fluoride.  This can happen in a number of ways, including:

  • Children being prescribed unnecessary fluoride supplements by their dentist (it does happen!)
  • Swallowing too much toothpaste when brushing
  • Babies drinking infant formula mixed with fluoridated water

How to Prevent Dental Fluorosis

You can reduce the risk that your child will get dental fluorosis by doing the following:

  • Not giving your child fluoride supplements if your child is not at risk for cavities
  • Using a fluoride-free  “training” toothpaste until your child can spit out all of the toothpaste when they’re done brushing
  • Mix infant formula with water that does not contain added fluoride


Dental fluorosis is a preventable condition.  By monitoring your child while they brush their teeth and taking steps to prevent unnecessary exposure to fluoride for your children, you can avoid this problem.  Remember, an ounce of prevention is worth a pound of cure!

Do you have any questions about dental fluorosis?  Please leave your questions and comments below and I’ll get back with you.

Is Water Fluoridated with Toxic Waste Fluoride
©Olivier Le Queinec/

Not too long ago I was talking with my mom about water fluoridation.  She said that she isn’t a big fan of it.  When I asked her why, she said that although she thinks it is good for teeth, she doesn’t like that they use toxic waste fluoride to fluoridate our public water supplies.  I was pretty skeptical, but I figured it wouldn’t hurt to look into this claim.

Here’s what I found.

The Three Types of Fluoride That Are Used in Water Fluoridation

Is Fluoride Toxic Waste?There are three main types of fluoride used to fluoridate public water supplies in the United States: sodium fluoride, sodium fluorosilicate, and fluorosilicic acid.  Here’s a quick overview of each of those materials:

Sodium fluoride is a white powder or crystal.  It is easy to transport and is  the “gold standard” of water fluoridation.  When artificial water fluoridation began, sodium fluoride was the powder that was used.  Unfortunately, sodium fluoride is relatively expensive, so some utility companies use other fluoride-containing compounds.  It is made up of the elements sodium and fluorine.

Fluorosilicic acid is a liquid by-product formed when phosphate fertilizers are made.  It is a liquid that has varying concentrations.  Due to the liquid form, it is expensive to ship.  It is made up of the elements hydrogen, silicon, and fluorine.

Sodium fluorosilicate is similar to fluorosilicic acid, but it is in powder form.  It is much less expensive to ship and has thus found widespread usage in many cities throughout the United States.  It is made up of the elements sodium, silicon, and fluorine.

Just to clarify above, fluorine is an element whose ion is known as fluoride.

Fluoride Used in Water Fluoridation Must Meet Rigorous Standards

The American Water Works Association has set rigorous standards that fluoride must meet in order to be used in public water supplies.  Here is how they describe each set of guidelines:

“The purpose of this standard is to provide purchasers, manufacturers, and suppliers with the minimum requirements for [the particular type of fluoride], including physical, chemical, packaging, shipping, and testing requirements.”

Here are their guidelines for the three types of fluoride used to fluoridate public water supplies:

Is Water Really Fluoridated With Toxic Waste Fluoride?

Is Fluoride an Air Pollutant?

Water is fluoridated with the above three fluoride-containing chemicals.  Many times, these fluoride chemicals are by-products of fertilizer production or other industrial by-products.  Calling them “toxic waste” may be a bit of a stretch.

Before the fluoride “waste products” can find their way into our water, they must be purified and have any contaminants removed so that when they are added to water, the water can still meet the minimum water quality guidelines.

If you’re interested in learning more about the water quality guidelines in the United States, here’s a good resource put out by the Environmental Protection Agency of all the chemical contaminants that are regulated in the public water supply.


If pure toxic waste were added to our drinking water, it wouldn’t be safe to drink.  Fluoride, when added to water has been found to make teeth more resistant to cavities.  On the flip side of the coin, fluoride also causes dental fluorosis.

If you have any questions, comments, or opinions to share on the chemicals we use to fluoridate our water supplies, please leave them in the comments section below.  Thanks for reading!

Fluoride in Water History

Water fluoridation is a public health measure designed to reduce the amount of dental decay in populations.  In fact, the CDC has praised water fluoridation as one of the ten great public health achievements of the 20th century.

How water got to be fluoridated in a majority of the United States is an interesting story.  It all started over 100 years ago with a recent dental graduate in Colorado Springs, Colarado.

Water Fluoridation History

Brown, Stained, and Pitted Teeth

Upon graduating from dental school at the University of Pennsylvania, Frederick McKay moved to Colorado Springs, Colorado to practice dentistry in 1901.

He was immediately troubled by an interesting phenomenon — a lot of his patients had teeth with unsightly brown stains and pits.  In fact, he found that over 80% of the people in Colorado Springs had a defect with their enamel.

In 1905, McKay moved to St. Louis for three years.  He didn’t see one case of stained teeth there.  Upon returning to Colorado, he suspected that there was an environmental factor in play.  He had the drinking water tested in areas with the brown stain, but nothing turned up.

Frederick was puzzled.  He had no idea what was causing the brown teeth, but his curiosity led him to continue to search for an answer.

Frederick McKay Gets Some Publicity

Frederick Mckay noticed that the brown stains occurred without regard to sex, race, or the amount of money people had.  He also noticed that it was isolated to whole communities throughout the United States.

Mckay and Black Investigate Colorado Brown Stain in 1909A prominent dentist caught wind of McKay’s observations and came out to Colorado to write about them.  They even took a picture of themselves analyzing the teeth of a young Coloradan boy.  As you can see in the picture to the right, everybody seems to be thoroughly enjoying themselves!

As stated above, McKay suspected the culprit was something in the water, but since his initial tests didn’t turn up any significant clues, he was still without answers.  As a result, other theories as to the origin of the brown stains began to develop.  Some of the theories included a nutritional deficiency, too much iron, radiation exposure, and genetics.  One researcher even found an association between freckles and stained teeth.

Something In the Water

McKay could not let go of his suspicions that the water was the source of the brown stains.  The small town of Oakley, Idaho was one of the many towns that had an epidemic of brown stained teeth.  However, people living on the outskirts of Oakley who drank from a spring (a different water source than the rest of Oakley) had beautiful, pearly-white teeth without any of the brown staining.

McKay persuaded the town to change its water supply to the spring water.  To make a long story short, when McKay returned years later, he found that the children who had been born after the water supply switch had beautiful teeth that were  free from brown stains and pits!

To see before and after pictures of Oakley, Idaho children and for more information, read this article published in 1939 (PDF).

Naturally Fluoridated Water is Found All Over the World

It’s not just Colorado that has naturally fluoridated water.  Since then, research has found many areas in the world with naturally fluoridated water.

To find out which areas in the world have naturally fluoridated water, view this world map that shows naturally fluoridated water.

The Fluoride In the Water Made the Teeth More Resistant to Cavities

Right about now, you’re probably wondering what this has to do with teeth.  Don’t worry, that’s what we will discuss next!

Along with the brown staining, McKay also made other observations about the teeth of the people affected by the staining.

In 1916 McKay said, “Contrary to what may be expected [the brown staining] does not seem to increase the susceptibility of the teeth to decay.”

Then in 1925 McKay asked the question, “How do we explain the comparatively high immunity to decay of mottled enamel when its structural elements lie wrecked and disorganized?”

Finally, in 1928 McKay proclaimed that mottled teeth exhibit “a singular absence of decay.”  In other words, there were no cavities in the people with stained teeth.

People started thinking that if mottled teeth exhibit greater resistance to cavities, maybe if we got a small enough dose of whatever was in the water, it could protect us from cavities without making our teeth look too ugly.

After a lot of testing and numerous studies, it was eventually discovered that the fluoride in the water was what caused the brown, ugly teeth and also the resistance to cavities.

What Is the Optimal Fluoride Concentration In Water?

Throughout the 1930’s, researchers set out to find the “optimal fluoride concentration” in water that would both reduce the amount of cavities and minimize the cosmetic effects of enamel fluorosis.

A man by the name of H. Trendley Dean came up with a scale to record the severity of fluorosis.  After weighing the cons of fluorosis versus the pros of teeth more resistant to decay, the “optimal fluoride concentration” was deemed to be 1 ppm (part per million) of fluoride.

Curious about how much 1 PPM of fluoride really is?  Read the article How Much Fluoride is in a PPM?

The Idea to Add Fluoride to Water Supplies

Gerald J. Cox is the man who usually gets the credit for suggesting water fluoridation as a public health measure.  He was a biochemist from the University of Pittsburgh School of Dental Medicine.  In a published article, he stated that adding fluoride to the water supply would be the “most practical means of approaching the goal of sound teeth for all children.”

He also thought that adding fluoride to the water  should be less controversial than adding chloride to sanitize water.  Judging by the polarized fluoride debate that rages on today, I think it’s safe to say that he was wrong regarding that second assumption!

Artificial Water Fluoridation Begins in 1945

Artificial Water Fluoridation System
Artificial Water Fluoridation System in Minnesota in 1987

Grand Rapids, Michigan was selected as the first city to test artificial water fluoridation.  Muskegon, Michigan would be the control city.  That way, the researchers could evaluate whether or not water fluoridation was effective.

In January of 1945, fluoride was added to a public water supply in Grand Rapids for the first time.  The initial trials showed an improvement in oral health.  After that, cities across the nation were clamoring to get fluoride in their water supplies.

Since then, the number of people receiving artificially fluoridated water has steadily increased.  As of 2008, nearly 200 million United States citizens were receiving fluoridated water.  Here’s a map that shows the increase in water fluoridation between 1992 and 2006.


To read a much more detailed history of water fluoridation, check out the book The Fluoride Wars.  It is the most balanced book I’ve read yet on the topic; although you wouldn’t think it’s balanced by reading the reviews from the many anti-fluoridationists!

What do you think about water fluoridation?  Let us all know by leaving a comment below.  Thanks for reading!

Water Fluoridation Debate One Sided

I read an opinion piece about water fluoridation this past Wednesday written by Katherine Kelly.  Katherine was one of the people who sponsored Measure A on Crescent City, California’s ballot, which would put a stop to water fluoridation in Crescent City.

Water Fluoridation ArgumentsIn her editorial she brings up two scientific sources, one from the American Dental Association and one from the Centers for Disease Control.  She acts like both of these sources have “admitted” that water fluoridation isn’t effective.  I took a look at both of these articles, and here’s what I found.

The ADA Article on Water Fluoridation

Katherine says that the American Dental Association article “clarified for every dentist that the swallowing of fluoride presents no significant benefit, that if there is a benefit it would be from applying it to the surface of the tooth.”

Let’s look at what John Featherstone, the author of the ADA’s cover story in July 2000, actually said:

“Fluoride, the key agent in battling caries, works primarily via topical mechanisms: inhibition of demineralization, enhancement of remineralization and inhibition of bacterial enzymes.”

Water Fluoridation: A Hotly Debated TopicDr. Featherstone also suggested that we “exploit [fluoride’s] known effects on bacteria, inhibition of demineralization and enhancement of remineralization by using ‘topical’ fluoride delivery by means of dental products, drinking water, beverages and foods.”

So, the author stated that fluoride works by being in direct contact with teeth.  Drinking fluoridated water puts it in contact with teeth, so he supports the fluoridation of drinking water based on his statement.

The CDC Article on Water Fluoridation

Katherine also mentioned that the CDC stated in 2001 that water fluoridation was one of the top 10 public health achievements of the 20th century.  She goes on to say the following:

On page 4 of the same report [the] CDC declares there is no correlation between fluoride incorporated in the enamel of teeth due to ingestion and the incidence of tooth decay.  Whoa! Shouldn’t this have halted fluoridation? Well not necessarily, because the support of fluoridation by seemingly prestigious groups was not about fact, it was about endorsements of the public policy goal.

By saying this, Katherine makes it seem like the CDC is contradicting itself and that it really doesn’t know what it’s talking about when it comes to water fluoridation.  The CDC was simply stating that fluoride’s role in preventing cavities isn’t by getting incorporated into the tooth as a result of swallowing it.  Water fluoridation protects the teeth by increasing the fluoride concentration in the mouth, allowing the fluoride to get incorporated into teeth by coming in direct contact with them.

If you have any doubts about the CDC’s position on water fluoridation, here’s one of their pages describing the benefits of fluoride.

Why does fluoride make teeth stronger?  Click here to read why!

It’s Not Just Opponents of Fluoride That Tell Half-Truths

I don’t mean to put down Katherine for what she wrote.  Even as a dental student, I’m not sure where I stand on the water fluoridation issue.  It is very complex!

Despite there being arguments both for and against water fluoridation, it doesn’t seem that either side recognizes the valid claims its opponent makes.  This refusal to either address the opposing view or to admit that the other side has any credibility at all weakens the argument of both sides.

One striking difference between these two groups are how they define fluoride.

How the American Dental Association Defines Fluoride

The American Dental Association defines fluoride as follows in their Fluoridation Facts booklet:

Fluoride is a naturally occurring compound that can help prevent dental decay.  Fluoride compounds are components of minerals in rocks and soil.  Water passes over rock formations and dissolves the fluoride compounds that are present, releasing fluoride ions.  The result is that small amounts of fluoride are present in all water sources.

How a Prominent Anti-Fluoride Researcher Defines Fluoride

John Yiamouyiannis, one of the anti-fluoridation movement’s greatest supporters defines fluoride as follows in his publication The Lifesaver’s Guide to Fluoride:

Fluoride is a poison and has been used as a pesticide. It is more poisonous than lead and just slightly less poisonous than arsenic. Procter & Gamble, the makers of Crest, acknowledges that a family-sized tube of fluoride toothpaste “theoretically, at least, contains enough fluoride to kill a small child.” While no one is going to die from drinking one glass of fluoridated water, just as no one will die from smoking one cigarette, it is the longer-term chronic effects of glass after glass of fluoridated water that takes its toll in human health — and life.

Both Sides Fail to State the Whole Truth

Reading the ADA’s definition, you would think that we should all be getting an optimal amount of fluoride to prevent tooth decay.  John Yiamouyiannis’ definition makes me want to get as far away from fluoride as I can.

The ADA doesn’t mention that fluoride is a poison when ingested in sufficient quantities.  John Yiamouyiannis failed to mention that fluoride is able to make teeth more resistant to cavities.

A Neutral Voice

I enjoy discussing the water fluoridation issue.  In fact, in one of my classes next week I will be participating with another student in a debate on the subject of water fluoridation.  I will be arguing against water fluoridation.  Preparing for this debate has helped me learn a LOT about this topic.

I’ll be posting a lot more articles on water fluoridation in the future.  If you have any issues you would like me to address, leave them below in the comments section.  Thanks for reading!

Pots & Pans Fluoride

Did you know that you could be tripling the level of fluoride in your water just by cooking in a Teflon-coated pot or pan?  Similarly, you can also cut the amount of fluoride in your water by boiling it in an aluminum pot for just 15 minutes.

Are Your Pots and Pans Altering Fluoride Levels?You may think that you never boil water.  However, many people use water for cooking.  If you’ve made macaroni & cheese or another pasta, rice, oatmeal, or mashed potatoes lately, then you’ve probably boiled water.

Back in 1975, some researchers had a question.  They wondered whether the type of container in which you cook food can have an effect on the fluoride content of what you eat.  You can read the complete study by clicking the following link (FYI – It is in PDF form so it may take a bit to load): Effect of cooking vessel composition on fluoride. By: Full, CA and Parkins, FM.

The Procedure of this Fluoride Study

The researchers analyzed a community’s water supply and found that it had 1 PPM of fluoride (click here to find out how much a PPM is)  They then took one pint (16 fluid ounces or two cups) of water and boiled it in one of four different containers.  They used an aluminum pot, a stainless steel pot, a Pyrex bowl, and a Teflon pot.  They turned the heat on high to obtain a rolling boil, and then reduced the heat “to maintain a moderate degree of boiling for 15 minutes.”  Next, they put the water in a clean bottle for storage and tested each sample to see how the boiling had affected the fluoride levels.  They even had a “control” bottle of water to ensure that their testing was accurate.

Their two significant findings were that the Teflon coated cooking vessel tripled the fluoride concentration from 1 PPM up to 3 PPM.  They also found that the aluminum pot reduced the fluoride concentration of the water from 1 PPM down to 0.3 PPM.  The Pyrex and stainless steel pots altered fluoride content slightly, but not enough to be statistically significant.

A Bar Graph of the Results

Here is a graph that I adapted from the paper showing the quantity of fluoride in PPM that was found in the water after boiling it for 15 minutes in the pot/pan made of that particular material.   If you’re not sure what a PPM of fluoride is, read this article to find out how much a PPM is.

Fluoride Levels of Boiled Water
A bar graph showing the increase in the fluoride concentration in the water boiled in Teflon and a decrease in the fluoride concentration of the water boiled in the aluminum pot.  Modified from graph in original study.

Why Did Teflon and Aluminum Change the Fluoride Level of the Water?

Teflon is actually the brand name for Polytetrafluoroethylene, which is a compound that contains only carbon atoms bonded to fluoride ions.  In fact, it contains more than twice as many fluoride ions as carbon atoms.  When water is boiled, some of the fluoride ions get dissolved into the water, thus increasing the fluoride concentration in the water.  You can read more about Teflon on Wikipedia.

As for the aluminum, the researchers guessed that the aluminum was reacting with the fluoride to form the compound Aluminum Fluoride.  Whether the compound stayed on the pan or formed in the water was not known.


I found this interesting that the type of metal our pots and pans are made of can affect the fluoride concentration in what we cook.  I am currently studying a lot about fluoride and water fluoridation.  I don’t think that the findings of this study really support or oppose water fluoridation, but it is interesting to know that we may be getting different amounts of fluoride from our water depending on what we do with it.

What do you think?  If you have any opinions, comments, or questions about fluoride levels in your water, please leave them in the comments section below.

Fluoride PPM

Have you ever wondered exactly how much fluoride is in your drinking water?  Usually fluoride is measured using the vague unit ppm.  The abbreviation ppm stands for parts per million.

PPM Measure FluorideLet’s say that you run a test to find out how much fluoride is in your drinking water and you find that the fluoride level is 2 ppm.  That means that for every one million units of water, there are two units of fluoride.

The main problem with this measurement is that it’s pretty hard for most people to actually visualize one million units of anything.

It’s much easier to understand the fluoride content of water through the use of measurements that are more easily visualized and understood by our brains.

With that in mind, I’ve come up with some examples to help you visualize what one ppm of fluoride really represents.  I decided to use one ppm of fluoride since that is the average fluoride concentration in most fluoridated water.

I’ve used the rough estimate available from a few different sources online that there are about 90,000 drops of water in a gallon.  I’m also assuming you have pure fluoride in liquid form (which is a bit of a stretch, but use your imagination!)

Water Fluoridation Levels Map
©Nelson Marques/

Lately, I have been researching water fluoridation a lot.  I’m almost obsessed with it.  The anti-water-fluoridationists are extremely vocal and passionate.  Those who feel that water fluoridation is a good thing have very good arguments.  I think I’m still a fence-sitter on this issue.  I came across a map showing the levels of water fluoridation in 1992 and comparing them with 2006 levels of water fluoridation for all 50 states.

Whether or not you agree with water fluoridation in the United States, one thing is for certain: water fluoridation is growing.

Watsonville California Water Fluoridation
©Robert Kylio/

I usually don’t post on Tuesdays, but I found an interesting article in the Los Angeles Times about the fluoridation of the water supply in the 50,000 population-town of Watsonville, California.

Downtown Watsonville California
Downtown Watsonville, CA

The article, entitled Anger Fuels Water-fluoridation Debate in Watsonville, Calif. talks about how the town is experiencing a dental decay epidemic.  The town has a large proportion of migrant workers that perhaps cannot afford regular dental care.  A study of local students showed an average of two abscesses in each classroom, not to mention a large number of cavities.  Obviously, something needs to be done to improve the oral health in this town.

In 2002 there was a vote on water fluoridation.  The people voted by a narrow margin of 2% to not fluoridate their water.  However, that vote conflicted with a California mandate  that had been set forth in 1995 to fluoridate the water of larger towns when there is outside money available for fluoridation.

World Map Showing Fluoride in Water

Last week, I wrote about how to find out how much fluoride your water contains.  A reader wanted to know what parts of the country contain high levels of fluoride naturally.  In the first year dental school, I learned about the “Colorado Brown Stain” story where some dental researchers discovered fluoride in the water in Colorado and found a link between the fluoride and healthier teeth.

World GlobeI figured that Colorado couldn’t be the only place on earth with high levels of fluoride — and that turns out to be true.  There are several areas in the world where fluoride can naturally be found in the water supply.

After a lot of research, I found a research paper entitled, A Systematic Review of the Efficacy and Safety of Fluoridation published by the National Health and Medical Research Council in Australia.  Using the data that it contained, I constructed the following map that shows the locations in the world that contain greater than 1.5 ppm of fluoride in the groundwater.

Worldwide Fluoride Distribution Chart
Click on the map to see a larger version.

This map visually puts into perspective the fact that water fluoridation isn’t about adding some synthetic chemical to our drinking water, it is simply about adjusting the amount of fluoride in our water to an optimal level that will help prevent tooth decay.

How Much Fluoride in My Water
©Piotr Marcinski/

Water fluoridation began in the United States in Grand Rapids, Michigan in1945.  It is considered one of the Ten Great Health Achievements of the 20th Century. In spite of this, many people don’t know how much fluoride is in their water — and although I find this hard to believe, it seems that water fluoridation isn’t a topic that comes up around the dinner table each night!

Most people get their water from either public water systems or a private well.  Here’s how to find the fluoride concentration:

Find Out How Much Fluoride is in Your Public Water System

Fluoridated Tap WaterMethod #1: Visit a website. If your municipality provides your tap water, then you’re in luck because there’s a simple site to find out your water fluoride concentration that the Center for Disease Control has made.

It’s called My Water’s Fluoride.  All you have to do is click that link, then click on your state and county.  You also need to know your municipality name or your water company’s name.  If you’re unsure, you can take a look at a recent water bill.

The site will then tell you a number of interesting facts about your water, like how many people it serves, where the water comes from, how much fluoride it contains, and when fluoridation started.

Method #2: Simply call your water service provider.  They should have a contact number on every bill you receive.  Most water companies will be happy to give you the fluoride concentration over the phone.

Find Out How Much Fluoride is in Your Well-Water

Since you probably don’t know how many fluorite crystals your well-water rubbed up against before it got to your well, it would be a good idea to get your water tested for fluoride.  Don’t worry though, it doesn’t have to be expensive!

Method #1: Get Your Well-Water Professionally Tested. This can end up being rather expensive, depending on how you go about it.  If you look in your phonebook and get someone to come to your house, that might be rather expensive.

Another way you could do it would be to find a water testing company online.  Simply searching on Google for fluoride water testing gives you quite a bit of sponsored advertisements for companies that want to test your water for a fee.  They usually have you fill up a bottle or two that they provide and then send it to their laboratory.  Then they test it and send you the results.  These can be good companies, but you should be careful as some companies may be fraudulent.  It’s best to ask around your circle of friends to see if any of them have had their water tested and have any recommendations.

Method #2: Test Your Water Yourself. This is probably the method I would choose if I drank well-water.  There are various kits that you can receive that will allow you to test your own water at home.  3M is a fairly respectable company and they provide one such test called the Fluoricheck Water Analysis Kit.  It is inexpensive and should provide fairly accurate results. (Note, I had to remove the link as it appears that 3M discontinued the Fluoricheck system).  Another option is to buy a fluoride meter such as this one, although they can be finicky and rather expensive.

What is the Optimal Water Fluoride Concentration?

The optimal fluoride concentration ranges from 0.7 to 1.2 ppm (parts per million, also known as milligrams per liter).  If you live in a warmer climate, you will want less fluoride in your water, since you’ll probably be drinking a lot more.  If you live in a colder climate, then you will want more fluoride in your water since you probably won’t be drinking as much.

In fact, some water companies even adjust the level of fluoride in their water based on the season.  During the summer when people tend to consume more water, they will decrease the amount of fluoride, and during the winter they will increase the concentration of fluoride in the water.

What If I Don’t Have Enough Fluoride In My Water?

If your water contains less than 0.7 ppm, then there are ways to get more fluoride, such as drinking water from public sources that are fluoridated, prescription fluoride supplements, brushing with fluoride-containing toothpaste, and using fluoride-containing mouthwash.

Also, since over half of the United States receives fluoridated water, fluoride can be found in many canned and bottled beverages as well as processed foods.

To be honest, I grew up without fluoride in my water and I did have a few cavities growing up, but it really wasn’t that big of a deal to me.  Sure, maybe fluoridated water would have prevented one of those cavities, but it doesn’t keep me up at night.

How Much Fluoride Is Too Much?

Fluoride continues to help your teeth resist cavities at all concentrations.  However, too much fluoride can cause enamel fluorosis which can range in appearance from small white imperfections in your teeth to unsightly brown stained teeth.

The CDC recommends that children under 8 years of age not drink water that is fluoridated above 2 ppm, as it could result in enamel fluorosis in developing teeth.  If you’re over 8 years old, then the CDC recommends not consuming water that is fluoridated above 4 ppm.  If your well water is that high, I would recommend installing a filter that can effectively reduce the amount of fluoride in your water.

If you have any experiences with fluoridated water or any questions, please share them in the comments section below.

Fluoride Protects Teeth

Fluoride is an ion that has proven to be very effective at keeping our smiles looking as good as they can for as long as they can.  In the early 1900’s, a group of children were discovered in Colorado that had brown teeth.  Their dentist also noticed that these stained teeth were very resistant to tooth decay.

After a lot of research, it was discovered that the mysterious element behind their ugly, cavity-resistant teeth was the fluoride ion.

The Three Ways Fluoride Protects Your Teeth

1. Fluoride incorporates itself into our teeth everyday through remineralization.

The Mineral Fluorite
The Mineral Fluorite

This is the most important way that fluoride protects our teeth!

When you eat a meal, you’re not just feeding yourself, you’re feeding thousands of bacteria inside of your mouth.  After they’re done eating, they excrete acid which slowly dissolves your teeth  (See my post entitled What Every Human Needs to Know About Plaque for more on this.)

Luckily, our saliva has a neutralizing action on this acid.  After our saliva has neutralized the acid, it goes to work building back our enamel.  If you have fluoride available in your saliva, then your teeth an be repaired with fluorapatite instead of hydroxyapatite.  This means that the next time you eat, your teeth will be much more resistant to the acid that the plaque in your mouth is producing.  So, even if you didn’t have fluoridated water when you were little (I didn’t), you can still get the benefits of fluoride in your mouth everyday when your enamel remineralizes after a meal!

2. Fluoride helps children up to age 7 while their permanent teeth develop. Fluoride ingested at a young age can help alter the structure of the tooth enamel to make it stronger.  Enamel is the hardest substance in the human body, and it coats the visible surface of all the teeth in our mouth.  Enamel is made up of tiny crystals called hydroxyapatite. When fluoride is available during tooth development, it incorporates itself into the enamel structure to create fluorapatite. Fluorapatite is much more resistant to the acid that dental plaque produces.  You can think of it as a strong shield that your body has in the fight against tooth decay.

3. Fluoride can decrease the acid production of plaque — you can think of it as a poison for plaque. Fluoride is able to inhibit some of the enzymes that the bacteria use to create acid.  Although it doesn’t completely stop the production of acid, it is able to put a big dent in its acid production.   This is a major factor in the reduction of tooth decay.  Just imagine, if the bacteria in your mouth can’t produce as much of the acid that destroys your teeth, then your teeth will remain stronger and healthier.


While fluoride can drastically improve the lifespan of your teeth, it can’t do it all.  For example, if you get the daily recommended amount of fluoride but aren’t removing the plaque from your teeth, eventually the plaque will build up a big enough barrier than the fluoride can’t make it to the tooth surface.  So even if you’re getting an optimal amount of fluoride in your diet it is still important to brush and floss daily.

If you have any questions about fluoride, please don’t hesitate to ask them in the comments below.  Thanks for reading!