If someone is trying to persuade you of something and only talks about how awesome it is, no one could blame you for raising an eyebrow: What are they NOT telling me?
The truth is that it’s impossible to make an informed decision without knowing about risks as well as benefits. Yet fluoridation is one of those things that often gets promoted as all benefit, no risk. A new and timely review of the science offers a strong counterpoint.
The authors of the study – which include noted researchers Christine Till and Philippe Grandjean – acknowledge that there is “strong” evidence that fluoride can be effective when applied directly to the teeth.
Laboratory and epidemiological studies conducted over the past 50 years have shown that fluoride’s beneficial effect is predominantly topical, after tooth eruption.
At the same time, though, research has shown that the dental benefit of fluoridated water has decreased over time. For instance, they cite the recent Cochrane review that we blogged about a while back, which found that today, fluoridation may help reduce decay by only about 4% or less. That number used to be higher – back when fluoride was much less available in toothpaste and other oral hygiene products.
The Cochrane findings are consistent with a recent study of 6.4 million people in the United Kingdom showing that the number of decayed, missing, and filled teeth was only 2% lower among people living in fluoridated versus nonfluoridated areas.
Another problem is that, beyond the brief contact it makes with the teeth, there’s little evidence that fluoridated water has any dental benefit when it’s swallowed. It does, on the other hand, carry some significant systemic risks – particularly to women and young children, whose health is the ultimate concern of this review. Those highlighted by the current review include
- Dental fluorosis (white spots or discoloration on teeth), resulting from too much fluoride exposure in early childhood. Rates have skyrocketed through recent years.
- Neurodevelopmental harms. Several high-quality studies have found links between fluoride exposure during pregnancy or early childhood and lower IQ scores – 3 to 7 points lower, on average, among kids exposed to more fluoride.
- Effects on thyroid function, particularly in pregnant women.
For a more comprehensive look at fluoride’s health impact – beyond maternal and infant health – see this paper from the International Association of Oral Medicine & Toxicology, which includes complete scientific references.
We, too, believe that the weight of the risks is reason enough to stop the practice of community water fluoridation. Once upon a time, it seemed to make sense.
However, as time passed, the landscape of dentistry and public health has evolved. Today, people use numerous fluoride-containing products, such as toothpaste, that offer targeted and highly effective protection against dental caries without the need to ingest fluoride.
And some, it should be noted, choose safer options, such as fluoride-free hydroxyapatite toothpaste or focus less on trying to mitigate damage and more on tackling the root cause of decay: diet and nutrition.
Each of us has a right to make health choices that align with our beliefs, values, and goals. We believe those choices should be informed ones.
