Do we need fluoridated drinking water? For 80 years, that hasn’t been a very prominent question. But recent actions by environmental and anti-fluoride groups—coupled with the possible appointment of Robert F. Kennedy Jr. (who’s spoken about the potential dangers of fluoride) to direct the Health and Human Services agency—has left many people questioning whether fluoride is a boon or a bust for our health.
The short answer: The dose makes the difference, experts suggest. Fluoride on its own is not inherently problematic—you actually get some of the mineral in foods and beverages—but when the levels start climbing, that’s when it can become a concern.
And the longer one: The United States maintains a low level of fluoride in drinking water, which is regularly monitored to determine fluoride amount. The type of dangers noted by anti-fluoride activists often involve much higher levels of fluoride than most people are drinking.
“Evidence is abundantly clear that low levels of fluoride in drinking water—about 0.5 to 0.7 mg per liter—are beneficial,” says Libbat-Tzion Shaham, M.D., a family medicine physician with Medical Offices of Manhattan in New York City. “Research is also clear that high levels of fluoride can lead to significant health problems. What’s important here is that U.S. water supplies are on that low end.”
How Water Got Fluoridated
To understand the current debate, it’s helpful to take a step back and look at what fluoride is, and why there’s fluoride in the water at all.
Fluoride is a naturally occurring mineral, which means it’s found in water, soil, and certain foods already—such as black tea, spinach, seafood, white wine, and baked potatoes. There are two types of minerals: macrominerals and trace minerals, each of which plays an important role in your body’s health. Macrominerals are needed by the body in larger amounts for various daily functions like building strong bones, and include calcium, sodium, and magnesium. Fluoride is a trace mineral, which is needed in smaller amounts, and helps with things like preventing tooth decay. Other trace mineral examples are iron, zinc, and iodine.
Research on fluoride’s properties began in 1901, when a young dental school graduate named Frederick McKay opened a practice in Colorado and was struck by the prevalence of brown stains on the teeth of most residents—but despite being unappealing, these teeth were highly resistant to decay. After decades of research, McKay found it was high levels of fluoride in the local water supply that was prompting both the staining and the protective effect.
Fast forward to 1945, when the city of Grand Rapids, Michigan did a pilot project using advice from researchers based on McKay’s findings. The city fluoridated its drinking water at a low level, theorizing it could provide dental benefits without the drawback of stained tooth enamel. During the 15-year project, the cavity rate among the city’s children dropped by 60%, leading to widespread fluoridation efforts throughout the country.
Today, approximately 73% of the U.S. public drinking water (meaning the water that runs through pipes into your house) is fluoridated, according to an article published in JDR Clinical & Translational Research. The water you might buy at a store that comes in bottles marked as “distilled” or “purified” is typically not fluoridated. Water labeled as “spring” or “mineral” water may still contain naturally occurring fluoride.
Benefits of Fluoride in the Water
In terms of pros and cons, let’s start with the advantages of fluoride. According to the American Dental Association, the benefits of water fluoridation include:
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Maintenance of teeth throughout a lifetime, beginning with tooth formation in childhood
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Preventing decay in teeth as well as decay in tooth roots that are below the gum line
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Retaining teeth for a longer period of time as you age
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Strengthening the enamel surface of teeth
A 2018 study on the associations between fluoridated community water and cavities in the U.S. looked at data on nearly 20,000 children and teens and found that living in a county in which 75% or more of the drinking water contained at least 0.7 mg per liter of fluoride was associated with a 30% reduction in cavities for primary teeth and a 12% reduction in permanent teeth.
“Even in an era with widespread availability of fluoride from various sources, studies show that community water fluoridation prevents at least 25% of tooth decay in children and adults throughout their life span,” says Linda Edgar, D.D.S., president of the American Dental Association who is based in Federal Way, WA. “The scientific weight of sound evidence around the benefit of community water fluoridation is clear and compelling.”
Drawbacks of Fluoridated Water
On the other side of the debate are the negative aspects of fluoride, which are being used to support legal actions and bolster the argument that fluoride should be removed from the water supply. For example, a federal court in California recently ruled against the Environmental Protection Agency (EPA), and directed the agency to do more work in assessing whether fluoride is harmful or helpful.
In that ruling, the judge cited a review by the National Toxicology Program, which concluded that high levels of fluoride may be linked to lowered IQ in children. That research is due to be published in early 2025, according to the agency. In a summary of the results, the program noted that drinking water containing more than 1.5 mg of fluoride per liter was associated with cognitive issues in children. However, it was also emphasized that there’s insufficient data to determine if the low fluoride level of 0.7 mg per liter (the maximum amount allowed in fluoridated drinking water) has the same effect.
Anti-fluoride activists have also asserted that fluoridated drinking water may contribute to other health issues like cancer and delayed development in children, but those potential effects haven’t been supported by research, according to the National Cancer Institute.
Another significant aspect of fluoride that’s prompted concern is that the mineral can remain in the body for a long time; the National Institutes of Health notes that adults hold about 50% of the fluoride they absorb, predominantly in the bones and teeth, while young children retain up to 80% of absorbed fluoride because more of the mineral is taken into their developing bones and teeth.
In theory, the health risks of chronic excessive fluoride exposure could include dental fluorosis (white spots or streaks, or in severe cases brown stains), skeletal fluorosis (hardening and weakening of bones), and possible cognitive or neurological impacts (still being researched). But in practice, even with the retention noted by the NIH, there hasn’t been any compelling scientific evidence showing that a “build-up” of fluoride throughout a lifetime can become dangerous, says Dr. Edgar.
The Final Word on Fluoridated Water
A question once thought settled, the debate over whether fluoride should be allowed in drinking water is bubbling to the surface again, particularly with Kennedy noting that soon-to-be President Trump will remove fluoride from the water supply “on day one” of being in office. Given the nuances of pros vs. cons, however, perhaps a more useful conversation might be: What are the dangers of fluoride at different levels? And what are the health hazards posed by low levels versus higher levels?
“Further research could be randomized, controlled trials to compare various low levels of fluoride and health outcomes so we can optimize the best possible level to have in the water supply,” says Dr. Shaham, adding that such an approach would be far more useful than removing fluoride completely.
Until then, drink up with confidence: After 80 years of collecting data, the U.S. Health Department has yet to record a single death from fluoride in properly treated drinking water at the levels used for public water fluoridation.
Original article online at: https://www.healthcentral.com/news/nutrition/fluoride-in-drinking-water