Oral Health Topics

Key Points

  • The ADA recognizes the use of fluoride and community water fluoridation as safe and effective in preventing tooth decay for both children and adults. For more information, please visit the ADA Fluoride in Water resource page.
  • Fluoride is a mineral that is found in all natural water sources and is the ionic form of the trace element fluorine, which is commonly found in the environment; fluorine reaches water sources by leaching from soil and rocks into groundwater.
  • When used as directed or within the context of community water fluoridation programs, fluoride is a safe and effective agent that can be used to prevent and control dental caries.
  • Fluoride can be delivered topically and systemically. Topical fluorides strengthen teeth already present in the mouth, making them more decay resistant, while systemic fluorides are those that are ingested and become incorporated into forming tooth structures. Systemic fluorides also provide topical protection because fluoride is present in saliva, which continually bathes the teeth.
  • Self-applied topical fluorides include toothpastes, mouthrinses, and gels.  Professionally applied topical fluorides include higher-strength rinses, gels, and foams; fluoride varnishes; and silver diamine fluoride.
  • Community water fluoridation is the process of adjusting the fluoride content of fluoride-deficient water to the recommended level for optimal dental health, which is currently recommended at 0.7 parts fluoride per million parts water.
  • Many bottled waters on the market do not contain optimal levels of fluoride. In addition, some types of home water treatment systems (e.g., reverse osmosis and distillation systems) can reduce the fluoride levels in water supplies, potentially decreasing the decay-preventive effects of optimally fluoridated water; however, carbon/charcoal filtration systems do not remove fluoride.
  • Fluoride supplements can be prescribed for children ages 6 months to 16 years who are at high risk for tooth decay and whose primary drinking water has a low fluoride concentration.
  • A potential risk of fluoride use is the development of fluorosis, which may occur when excess levels of fluoride are ingested during tooth development. Fluorosis varies in appearance from white striations to stained pitting of enamel.


    Fluoride is a mineral that is found in all natural water sources.1 Fluoride is the ionic form of the trace element fluorine. Fluorine is commonly found in the environment, and reaches water sources by leaching from soil and rocks into groundwater.1

    Topical Fluorides


    Systemic Fluorides

    Systemic fluorides such as community water fluoridation and dietary fluoride supplements are effective in reducing tooth decay. These fluorides provide topical as well as systemic protection because fluoride is present in the saliva.

    ADA Clinical Recommendations for Topical Fluorides (2013)

    In 2013, the ADA Center for Evidence-Based Dentistry and a panel of experts convened by the ADA Council on Scientific Affairs developed clinical recommendations for use of professionally applied or prescription-strength, home-use topical fluorides for caries prevention in patients at high risk of developing caries.8  The Panel evaluated sodium, stannous and acidulated phosphate fluoride for professional and prescription-strength home-use, including varnishes, gels, foams, mouthrinses and prophylaxis pastes. The Panel did not include over-the-counter products, slow-release delivery devices, dental materials that release fluorides or products containing sodium monofluorophosphate, silver diamine fluoride, and titanium tetrafluoride in its report. The Panel included 71 trials from 82 articles in the review and assessed the efficacy of various topical fluoride caries-preventive agents.

    ADA Clinical Practice Guideline on Nonrestorative Treatments for Carious Lesions (2018)

    In 2018, the ADA Center for Evidence-Based Dentistry conducted a systematic review and network meta-analysis26 informing a clinical practice guideline27 on nonrestorative treatments for carious lesions. The expert panel formulated 11 clinical recommendations, each specific to lesion type (i.e., cavitated, noncavitated), tooth surface (i.e., coronal, root surface [in adults]) and dentition (i.e., primary or permanent). The panel provided recommendations for the use of the most effective treatment options, including 38% silver diamine fluoride, sealants, 5% sodium fluoride varnish, 1.23% acidulated phosphate fluoride gel, and 5,000 parts per million fluoride (1.1% sodium fluoride) toothpaste or gel, among others. The panel also provided a recommendation against the use of 10% casein phosphopeptide–amorphous calcium phosphate. The chairside guides for primary and permanent dentition are available for download, and clinicians may also consult the online tool for personalized clinical recommendations based on the clinical parameters of the lesion.


    A potential risk of fluoride use is the development of fluorosis, which may result from fluoride ingestion during tooth development.6 Fluorosis of permanent teeth occurs when an excess quantity of fluoride is ingested for a sufficient period of time during the time that tooth enamel is being mineralized.6 The level of fluoride intake between the ages of about 15 and 30 months is thought to be most critical for the development of fluorosis of the maxillary central incisors.11 The mechanisms by which fluoride modifies tooth development are not fully understood; but may result from alterations in protein metabolism disrupting the crystal organization in the developing tooth.28

    ADA Policies on Fluoride and Fluoridation


Topic last updated: July 15, 2021

Prepared by:

Department of Scientific Information, Evidence Synthesis & Translation Research, ADA Science & Research Institute, LLC.


Content on the Oral Health Topics section of ADA.org is for informational purposes only.  Content is neither intended to nor does it establish a standard of care or the official policy or position of the ADA; and is not a substitute for professional judgment, advice, diagnosis, or treatment.  ADA is not responsible for information on external websites linked to this website.

*Online at https://www.ada.org/en/member-center/oral-health-topics/fluoride-topical-and-systemic-supplements