Note from the Fluoride Action Network:
This article cites the Bashash 2017 study (noting it was published in 2016): “The results suggested a link between high levels of fluoride in the mothers and lower IQ scores in their children.” The article then incorrectly states, But other researchers who evaluated this study said the fluoride level used was double or triple the level found in drinking water in the United States.”  The testing of fluoride levels in this study was done by testing the pregnant women’s urinary fluoride levels, an accurate method to determine fluoride exposure from all sources. The urinary fluoride levels in the Bashash study were similar to the levels found in pregnant women living in fluoridated communities in Canada and the U.S.

The article incorrectly notes that “researchers have determined that studies linking major health conditions with fluoride are unreliable.” On the issue of neurotoxicity, the National Institute of Environmental Health Studies funded three Mother-Offspring fluoride studies that all reported reduced IQ in children whose mothers lived in fluoridated communities: the Bashash 2017 study, mentioned above, as well as Green et al. 2019 and Till et al., 2020. The Till study reported an even larger loss of IQ in bottle-fed infants living in fluoridated communities in Canada.

The article states, “Fluoride has been used in drinking water for 75 yearsTrusted Source and research has proven its safety.” This “trusted source” is the major promoter of fluoridation in the U.S. The author appears unaware that no regulatory agency in the U.S. has performed a risk assessment on the effects of community water fluoridation on the most vulnerable subsets in our society: pregnant woman, the fetus, and the bottle fed infant. The EPA, in charge of providing safe drinking water throughout the country, has never performed a risk assessment on the neurotoxicity of fluoride even though there are 69 published human studies that have reported on the association of fluoride exposure and reduced IQ.

The author states, “it is a myth that fluoride treatments or fluoridated water cause widespread harm…” The potential loss of IQ due to fluoride exposure in fluoridated communities in the U.S. is high. In June 2021, Grandjean et al. published, A Benchmark Dose Analysis for Maternal Pregnancy Urine-Fluoride and IQ in Children.

This analysis found that a maternal urine fluoride concentration of 0.2mg/L was enough to lower IQ by 1 point. This level is exceeded 4 to 5 times in pregnant women living in fluoridated communities.

Anyone aware of the neurotoxicity of fluoride in infants and children should be alarmed by this sentence in the article: “Experts recommend that even children who are too young to spit the toothpaste out themselves should use fluoridated toothpaste.” (EC)

Fluoride is a naturally occuring mineral that people add to water, food, and other products. Many toothpastes contain fluoride as it has benefits for protecting tooth health. Too much fluoride can pose risks to health, but the amounts contained in toothpaste are generally safe if a person uses the toothpaste as advised.

Toothpaste is an important part of good oral hygiene. With many options available, it can be difficult to know which one is the right choice.

Many toothpastes contain fluoride, a mineral that is naturally found in soil and rocks. This article examines what fluoride is and why manufacturers add it to toothpaste. It also covers the benefits and risks of fluoride and tips for choosing the best toothpaste.

Toothpaste ingredients

Producers have designed toothpaste to control dental plaqueTrusted Source. Plaque is a thin layer that forms on teeth after eating sugars. The bacteria in plaque break down tooth enamel, cause decay, and lead to cavities.

People use toothpaste with a toothbrush to gently sweep away plaque and other debris from their teeth. All toothpastes share some common ingredientsTrusted Source:

  • Abrasives such as calcium carbonate or calcium phosphate. These remove anything sticking to the surface of the teeth without scratching them.
  • Binders like sodium alginate or xanthan gum. These provide elasticity and form to the toothpaste, and help prevent it from drying out by binding water to it.
  • Humectants such as glycerol or propylene glycol. These retain water to prevent hardening of the toothpaste.
  • Foaming agents like sodium lauryl sulfate or sodium alkylsulfo succinate.
  • Preservatives, to prevent the growth of microorganisms.

Some toothpastes contain other ingredients, depending on their formulation:

  • fluoride, which strengthens enamel and prevents cavities
  • flavorings like spearmint, peppermint, or menthol
  • sweeteners, including sorbitol, glycerol, and xylitol
  • anti-sensitivity agents including strontium chloride or potassium nitrate

What is fluoride and why is it in toothpaste?

Fluoride is a naturally occurring mineral which exists in:

  • soil
  • rocks
  • water
  • many foods

It is an important part of tooth development in children under the age of 7, as it strengthens developing enamel. In children and adults it also slows down the acid-producing capability of plaque, which protects teeth from decay.

In many cities and countries, local authorities add fluoride to the drinking water, which has been shown to reduce tooth decay by at least 25%. Fluoride toothpaste provides an additional layer of protection against dental decay and plaque buildup.

Benefits of fluoride

Fluoride protects teeth against decay by helping strengthen developing enamel and slowing acid production of bacteria caused by plaque.

Fluoride protects teeth against a process called demineralization. This occurs when bacteria combine with sugars to create acid that erodes the tooth.

Further, fluoride promotes remineralization. This process brings calcium and phosphate ions to the tooth to create to new surface area which is acid resistant.


Too much fluoride can lead to dental fluorosis. Fluorosis is a condition that produces a change in the color of tooth enamel. This discoloration usually manifests as white or sometimes brown spots.

Fluorosis usually occurs when children who are in the teeth forming years swallow toothpaste rather than spitting it out. According to the Centers for Disease Control and Prevention (CDC)Trusted Source, the teeth forming years are before the age of 8.

Most cases of dental fluorosis are very mild to mild. In moderate to severe cases, more noticeable and extensive enamel changes happen, including dark spots and pits in the teeth.

The risk of getting too much fluoride from toothpaste is low and primarily a risk for children, who are more likely to swallow toothpaste.

To reduce the risk of dental fluorosis parents should:

  • supervise children age 6 and under to discourage swallowing toothpaste
  • use only a pea-size amount of toothpaste between the ages of 3 and 6
  • consult with a doctor or dentist about the use of fluoride toothpaste for children under 2 years of age. Typically a rice-sized amount of toothpaste is OK for children under 2.

Chronic exposure to high levels of fluoride can also lead to skeletal fluorosis. This occurs when fluoride builds up in bones, causing stiffness and pain. In the most severe cases, ligaments can calcify, causing pain and trouble moving. Typically this is a problem in areas with naturally occurringTrusted Source high levels of fluoride in drinking water.

Is fluoride safe?

While fluoride in toothpaste is generally considered safe, there is a larger, ongoing discussion of overall fluoride intake, from water, food, mouthwashes, and other sources.

The International Association of Oral Medicine and Toxicology (IAOMT), which advocates against the use of added fluoride in water and products, lists the following health problems which it associates with fluoride consumption:

One 2016 study [sic, should be 2017] of children in Mexico found that higher levels of fluoride exposure before birth could result in lower cognitive abilities for babies when tested at ages 4 and 6–12. Researchers tested fluoride levels in 299 pregnant women, and in their children at ages 4 and 6-12. The results suggested a link between high levels of fluoride in the mothers and lower IQ scores in their children.

But other researchers who evaluated this study said the fluoride level used was double or triple the level found in drinking water in the United States. Researchers also failed to take into account other factors that could have contributed to lower IQ scores in the study.

Researchers evaluating other health concerns have also found problems with unreliable data and poor study design.

Overall, researchers have determined that studies linking major health conditions with fluoride are unreliable.

Fluoride has been used in drinking water for 75 yearsTrusted Source and research has proven its safety. As with many substances, too much can lead to problems such as fluorosis, but the right amount can provide important dental protection and minimal negative health effects.

There are so many toothpaste options to choose from it can be difficult for people to determine which one is the right one for them.

The first question to ask is if someone wants toothpaste that contains fluoride. If so, most of the major brands have a variety of fluoride products available. If not, look for natural toothpaste, which is more likely to be fluoride-free.

If the choice is to purchase a fluoride toothpaste, children up to 3 years old should use toothpaste with a fluoride level of 1,000 parts per million (ppm). Anyone ages 3 and older should use toothpaste with a fluoride level of 1,350-1,500 ppm.

With any fluoride toothpaste, look for the American Dental Association’s seal of approval. It indicates the toothpaste will:

  • contain fluoride
  • have active ingredients to improve dental health such as lessening tooth sensitivity, preventing enamel erosion, or reducing gingivitis
  • not have sugar in the flavoring agents
  • provide scientific evidence demonstrating safety and efficacy

Beyond that, choose a toothpaste based on any personal preferences or specific dental needs. Whitening teeth, addressing tooth sensitivity, controlling tartar, and choosing different flavorings are all options.

A person should look at the ingredient label to ensure the product does not contain anything that would cause an allergic reaction.


Fluoride is a naturally occurring mineral found in soil, rocks, and water. It is a powerful tool in protecting teeth against decay and helping remineralize dental surfaces.

Toothpaste with fluoride is a popular option to protect teeth and fight plaque. It is widely available and generally a safe option, as long as someone spits it out.

Parents should supervise children’s use of toothpaste to ensure they do not swallow it. Ingesting too much fluoride during early tooth development can lead to fluorosis, which causes white or brown spots on teeth.

When purchasing fluoride toothpaste, look for the level of fluoride in it and the ADA seal of approval. For a non-fluoride toothpaste, choose a natural toothpaste option.

Last medically reviewed on July 8, 2021

Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.
Medically reviewed by Jennifer Archibald, DDS — Written by Karen Veazey on July 8, 2021

Everything you need to know about fluoride treatment

Fluoride is a naturally occurring mineral that helps build strong teeth and prevent cavities.

For more than 70 years, most of the tap water in America has contained small amounts of fluoride to reduce tooth decay. The Centers for Disease Control and Prevention (CDC) say that fluoridated water has reduced tooth decay by about 25 percentTrusted Source.

Fluoride treatments may offer even more significant benefits to protect teeth. These treatments can be beneficial to people at risk of tooth decay but may not be right for everyone.

In this article, we look at the benefits and side effects of fluoride and fluoride treatment, as well as treatment recommendations.

What is fluoride treatment?

A person at risk of tooth decay may benefit from fluoride treatment.

Fluoride treatments are typically professional treatments containing a high concentration of fluoride that a dentist or hygienist will apply to a person’s teeth to improve health and reduce the risk of cavities. These in-office treatments may take the form of a solution, gel, foam, or varnish.

There are also some high-concentration fluoride treatments that people can use at home but only under the specific direction of a dentist.

The fluoride dentists use in these treatments is similar to the fluoride in toothpaste. However, the treatment contains much higher doses and may offer more rapid benefits.

Benefits of fluoride and fluoride treatments

Fluoride has several benefits for the teeth:

  1. It helps the body better use minerals, such as calcium and phosphate. The teeth reabsorb these minerals to repair weak tooth enamel.
  2. It joins into the tooth structure when teeth are developing to strengthen the enamel of the teeth, making them less vulnerable to bacteria and cavities for life.
  3. It slows or even reverses the development of cavities by harming bacteria that cause cavities.

When taken together, these benefits may help to:

  • reduce the risk of cavities
  • slow the growth of cavities
  • delay the need for expensive dental work
  • prolong the life of baby teeth
  • reduce the amount of time and money a person has to spend at the dentist

By preventing cavities and slowing the growth of bacteria, fluoride treatment may also:

  • prevent gum disease
  • reduce tooth pain
  • prevent the premature loss of teeth

Fluoride treatments can improve oral health, which, according to the World Health Organization (WHO)Trusted Source, is a major predictor of overall health. Poor oral health can cause a range of other health conditions, including cardiovascular disease.

Side effects of fluoride

Some natural health advocates have expressed concern about fluoride at high doses. They also argue that fluoride is not safe for children, and even that fluoridated water may be dangerous.

However, it is a myth that fluoride treatments or fluoridated water cause widespread harm, although some people may experience some side effects, including;

Tooth discoloration

The most common side effect of fluoride is tooth discoloration.

Fluorosis is a condition that causes white streaks or other discoloration on the teeth. Fluorosis happens when a child ingests too much fluoride while their baby and adult teeth are developing under the gums. A child can develop fluorosis from birth to 8 years of age.

Discoloration is more common among young children who consume too much fluoride, either because they take fluoride supplements or swallow toothpaste.

The United States Public Health ServiceTrusted Source have set guidelines for the amount of fluoride that community drinking water should contain to help prevent tooth decay and minimize the risk of dental fluorosis. This level currently stands at 0.7 milligrams of fluoride per liter (mg/l) of water.

Experts recommend that even children who are too young to spit the toothpaste out themselves should use fluoridated toothpaste.

The American Academy of Pediatric Dentistry (AAPD) recommend that parents or caregivers use a minuscule amount of fluoridated toothpaste as soon as the child’s first tooth erupts. This protects a child’s teeth from cavities but does not put them at risk for fluorosis if the child accidentally swallows the toothpaste.

Allergies or irritation

A person may have an allergic reaction to fluoride or experience skin irritation, though these reactions are rare.

Toxic effects

Fluoride can be toxic if a person applies it incorrectly or at very high doses. However, this is unusual.

The American Dental Association (ADA) recommend the use of professional fluoride varnish on children under 6 years old. Fluoride varnish is the preferred option for young children, as they tend to swallow foams or gels, which may cause nausea and vomiting.

Fluoride treatment recommendations

The CDC and the ADA recommend that frequent exposure to small amounts of fluoride every day is the best for reducing the risk of dental cavities for all ages.

For most people, this means drinking tap water with optimal fluoride levels and brushing teeth twice a day with fluoridated toothpaste. For children and adults who may be at a higher risk of cavities, fluoride treatments can provide extra benefits.


Dental cavities are the most common chronic childhood disease, five times more common than asthma.

The American Academy of Pediatrics (AAP) recommend fluoride treatment for all children as soon as their teeth begin to grow to prevent decay, pain, and future dental infections.

Dentists or doctors should repeat fluoride treatment every 3–6 months, depending on a child’s risk of cavities.

To reduce the risk of overexposure to fluoride, dentists also recommend the following:

  • Caregivers should brush children’s teeth with a small amount of fluoride toothpaste to reduce decay and minimize fluorosis risk. For children under 3 years of age, use no more than a smear or rice-sized amount of fluoridated toothpaste. For children aged 3–6, use a pea-sized amount of fluoride toothpaste.
  • Always supervise a child’s brushing to ensure they use the right amount of toothpaste, and try to get them to spit out most it if they can.
  • Children under 6 years old should not use at-home fluoride rinses, such as mouthwash, since they may swallow too much fluoride.


Fluoride recommendations for adults vary. Different studies have investigated a range of concentrations, doses, and frequencies of treatment.

If a person is at a moderate-to-high risk of developing tooth decay, professional fluoride treatment can help. Experts recommend that people at high risk of cavities get professional fluoride treatments twice a year.

People should discuss the risks and benefits of fluoride treatment with their dentists. It is essential to consider all sources of fluoride, including fluoridated toothpaste and mouthwash.

People who live in areas where the water does not contain fluoride may gain more significant benefits from regular fluoride treatments.

How effective is fluoride treatment?

A sizeable body of evidence from randomized controlled trials, which are the gold standard of scientific studies, has established the benefits of topical fluoride treatments for preventing decay.

One systematic review reports that fluoride treatments, such as fluoride varnish, have a substantial effect on preventing cavities in both primary and permanent teeth.


Fluoride treatments are safe for most people. Even when there are side effects, those effects are usually minimal compared to the benefits. Most of the harm is likely to come from swallowing very high amounts of fluoride.

This does not mean that all fluoride treatments are safe for all people at all times. People with cavities or at risk of tooth decay should discuss their concerns with a dentist they trust.

*Original article(s) online at

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