The great fluoride debate! Well, fluoride concentration in water has been a contentious issue in the field of health for a long time. Fluoride is a mineral that can be found naturally in water and some foods. The ionic form of the element fluorine is namely fluoride, and it is believed to promote the growth of new bone while preventing or reversing dental caries, or tooth decay.
For some time now, a debate has raged around this mineral, with strong opinions on both sides regarding its safety and necessity. In one hand, fluoride is heralded as a crucial element in dental health, significantly reducing the prevalence of cavities and tooth decay. On the other hand, experts warn against its ill effects on bones, the nervous system and dental health.
Fluoride as an agent
The Centers for Disease Control and Prevention (CDC), the national public health agency of the United States, has gone on to identify community water fluoridation as one of the ten great public health achievements of the 20th century, highlighting its role in reducing dental caries across populations.
Dr Navatha, Consultant Maxillofacial Surgeon, CARE Hospitals, Hitech City, Hyderabad says, “Fluoride helps in the remineralisation process, which strengthens tooth enamel and makes it more resistant to acid attacks from plaque bacteria and sugars in the mouth. Studies have shown that communities with fluoridated water supplies have lower rates of tooth decay compared to those without. Fluoride reduces the ability of bacteria in plaque to produce acid, which is the primary cause of tooth decay. It can help reverse early stages of tooth decay before they become serious.” She adds that water fluoridation is considered a cost-effective public health measure, reducing dental care costs over time.
At the same time, Dr Navatha also highlights that excessive intake can cause dental fluorosis. It is characterised by changes in the appearance of the tooth enamel, ranging from mild discoloration to severe staining and pitting. It can lead to skeletal fluorosis – a condition that results in pain and damage to bones and joints. “Also, there are a few studies that suggest a potential link between high fluoride levels and reduced IQ in children. Although this is still a topic of debate and ongoing research.”
Setting a bar
The World Health Organisation reveals, “It is estimated that caries of the permanent teeth is the most prevalent of all conditions assessed, with 2.4 billion people globally suffering from caries of permanent teeth and 486 million children from caries of primary teeth. Public health actions are needed to provide sufficient fluoride intake in areas where this is lacking, so as to minimise tooth decay. This can be done through drinking-water fluoridation or, when this is not possible, through salt or milk fluoridation or the use of dental care products containing fluoride, and by advocating a low-sugar diet.”
How much fluoride is too much?
While the WHO recommends 1 PPM as the permissible limit for fluoride, IS (Indian Standards) considers 1.5 PPM a permissible limit. With each passing limit, various kinds of fluorosis start to set in, beginning with dental fluorosis, skeletal fluorosis, and finally affecting the central nervous system, which can be fatal. The excess of 1:5 ppm causes dental fluorosis, exceeding 3 PPM for longer periods causes skeletal fluorosis. Above 10 Ppm causes non skeletal fluorosis.
Consumption of naturally occurring fluoride-rich groundwater is typically the cause of excessive fluoride intake. Especially, in warm climates with higher water consumption or where high-fluoride water is used for crop irrigation or food preparation. There is no need for toothpaste that is high in fluoride where fluoride concentration in water already high.
There is emerging research suggesting links between excessive fluoride exposure and other health issues. Such as thyroid dysfunction and lowered IQ in children. These findings, though not universally accepted, fuel the argument for caution and further investigation.
Fluoride runs deep
Experts note that fluoride levels in India’s groundwater are exceptionally high, mostly impacting the country’s rural population. As per data released by the Jal Jeevan Mission, Department of Drinking Water and Sanitation, Ministry of Jal Shakti, a total of 14818 villages in 20 states have the presence of fluoride.
A press release issued by the Ministry of Jal Shakti in 2022 revealed that fluoride beyond the permissible limit (above 1.5 mg/l) has been encountered in certain isolated pockets of 370 districts in 23 states. Rajasthan is one of the worst affected areas. It has manifested as bone deformities and crippling among children and the older people.
Navneet Mishra, Lead-Partnerships, INREM Foundation says, “BIS prescribes it as 1-1.5 PPM and it is ok to have that level of fluoride in a drinking water source. In India, we consume fluoride through different sources but mainly through groundwater. In a village called Bankapatti in Rajasthan, the fluoride levels go up to 30 PPM. People in that village are not able to walk straight as everyone is battling bone issues. Considering the geography of India, the groundwater in western India is severely affected by fluoride. In that case, people should go for safer options like tap water provided by the government. Where people don’t have an option in that case, nutritional supplementation is necessary to mitigate the effects of fluoride.” India Natural Resource Economics and Management works towards improving water quality and fluoride.
Cheaper and easy way to treat water with fluoride
Dr Subrata Das, HOD, Internal Medicine and Diabetology, Sakra World Hospital, Bengaluru says, “3 mg of fluoride per day for women and 4 mg of fluoride per day for men is a recommended good dosage and shouldn’t be crossed. It helps in dental health with enamel formation. But if you go up to 10 mg per day, then you become prone to dental fluorosis and fractures. A lot of the rural population is suffering due to excessive fluoride concentration in water. They are experiencing body pains, bone pains and fractures. It also leads to developmental delays among children. There are medical treatments available for patients suffering from fluorosis but groundwater needs treatment in villages.”
Proponents argue that fluoride, when used correctly, is a safe and inexpensive way to protect teeth. They point to studies showing that communities with fluoridated water have lower rates of tooth decay compared to those without.
Balancing act
The conundrum lies beneath the issue of fluoride concentration in water. It’s debate is intricate and multifaceted. Despite the fact that fluoride has been shown to improve dental health. Especially, in terms of avoiding tooth decay, health problems due to overexposure must be taken into account. An additional degree of complexity is added by the impact on India’s rural population, which includes the older people and children. This emphasises the necessity for customised public health strategies that take into account local vulnerabilities and conditions. Like with any public health initiative, it is imperative to strike a balance between the advantages and disadvantages well.
Original article online at: https://www.thip.media/health-stories/health-feature-stories/fluoride-concentration-in-water-the-great-debate/73703/