Fluoridation Facts

I stole the above title from a newly released American Dental Association (ADA) pamphlet on the controversy about fluoridation of public drinking water. This is another area where people with little understanding of science have spread falsehoods leading to some resistance to a beneficial practice. A brief review of the executive summary makes it quite clear; fluoride prevents cavities.

Although I have never had doubts about the safety of adding fluoride to drinking water, twice a year I am faced with the question of whether to pay an extra $35 at the dentist for a fluoride treatment. I know there is evidence that these treatments, along with the fluoridation of drinking water and toothpaste, are beneficial for children’s teeth, but I wondered about the effectiveness for adults. 

The fact that my insurance company doesn’t pay for it raises some suspicion. Coverage decisions may be based on cost factors, but one cost factor they must consider is higher future dental bills. Normally they would prefer to pay for prevention than to pay more later.

I began my research on the effectiveness of fluoride treatment for adults at a site billing itself as “the top magazine for dental hygiene professionals.” One hygienist, whose boss wants her to push the treatment to increase business, asks directly whether every patient needs fluoride.

The answer goes to an ADA publication from 2007. (The advisor didn’t know of any more recent updates.) A patient whose risk is low “may not receive additional benefit from professional topical fluoride application.” Low risk is defined as "No incipient or cavitated primary or secondary carious lesions during the last three years and no factors that may increase caries risk." It goes on to say there are other factors to consider, but generally “blanket mandates of fluoride for everyone are not appropriate.”

Consumer Reports gives basically the same answer (with less dentist jargon). “Extra fluoride may be helpful if you’re at increased risk of developing cavities, indicated by frequent tooth decay in recent years, dry mouth caused by medications or disease, or gum recession that exposes the vulnerable tooth roots.” 

They go on to say that home treatments are not effective, and that those in the low risk category should do fine by brushing twice a day with fluoride toothpaste “especially if your water is fluoridated.”

The National Center for Biotechnology Information site reviews a compilation of research on the “effectiveness of fluoride in preventing caries in adults.” They believe that the authors' conclusions favoring the use of fluoride treatments for adults “appear to follow from the results presented, although the paucity of more recent studies and poor quality of the included studies limit their reliability and relevance to current populations.” This vague recommendation (also from 2007) is not very compelling.

A Healthline.com page from 2018 asks: “What Are the Benefits, Side Effects, and Recommendations for Fluoride Treatment?” Again the emphasis was on children and adolescents with some discussions of minor side effects of treatments and real dangers of fluoride supplements. A little new information was that it was “best to get fluoride both topically [gel or toothpaste] and systemically [ingested]” from drinking water.

With several references to the 2007 ADA advice, I went there next. In addition to brushing twice a day, flossing and regular dental examinations, a “key to good oral health is fluoride.” Maximum benefit “is achieved when fluoride is available both topically and systemically.” Treatments from a dentist are recommended for adults with high risk factors such as poor oral hygiene, active caries, eating disorders, drug or alcohol abuse, lack of regular professional dental care, high levels of bacteria in the mouth, exposed root surfaces” and a few others.

In my case it seems I have been correct in saving $35 per visit. I eat most of my meals at home, so I am able to brush three times a day. We use fluoridated tap water for cooking food and drinking. (Bottled water is non-existent in the house.) I have not had a cavity in at least ten years. (Knock on wood.) Nor do I have any of the other critical factors or habits.

It’s interesting what a little research – a factor in critical thinking – can do to help with everyday decisions. 

Blacken Your Teeth (to Whiten Them)?

Last time I gave an example of the desperation evident in people’s behavior to find some simple miracle to improve their health and wellbeing. All it takes is a celebrity endorsement, some anecdotal evidence on a TV doctor show, a news report about preliminary findings or a viral video and many people decide to adopt a new habit, product or procedure without any research.  The professionals are then forced to react with warnings and watch-outs to protect their patients from potential harm.

It happened again this month after a YouTube post by someone going by the name of Mama Natural became an instant success, reaching millions of viewers.  This was not about a miracle cure for your body, but for a miracle teeth-whitening solution.  Now, according to Fox News and others, dentists are “warning against using [this] DIY whitening trend that involves smearing a charcoal-derived black mixture on teeth” saying it “may lead to enamel deterioration and tooth erosion.”

Activated charcoal capsules are available in health food stores or on line.  The video recommends that you break open a capsule and mix the powder with water to achieve a pasty texture.  Then either brush it directly onto your teeth or instead just swish the powder around in your mouth.  Rinse after three to five minutes (some say up to ten minutes) and see the results.  Endorsements, testimonials and spokespersons say you will see whiter teeth almost immediately.

The theory is that activated charcoal absorbs impurities.  It has been used in air filters and in emergency rooms to treat poisonings and drug overdoses.  More recently activated charcoal has been adopted into beauty products, such as skin creams and facial masks, to supposedly produce benficial effects by absorbing impurities on the skin.  The next logical step is to use it to deep-clean teeth, remove the stains and get them sparkling white.

Not so fast!  The responsible articles point out that not enough evidence is available to tell if charcoal brushing is beneficial or dangerous.  The charcoal itself might be too abrasive.  Over time it might actually be removing enamel along with those stains.  When you lose enamel, not only do your teeth get sensitive, but the tooth enamel is lost.  Enamel can’t grow back as cut skin or broken bones do.  Once it’s gone, it’s gone.

While dentists are concerned, the natural websites are spreading the news.  This one gives instructions, promotes it as a "natural" way to whiten teeth and mentions only the messiness as a potential downside.  (The pictures accompanying some of these stories are really disgusting, so messiness is indeed a problem, though a minor one.)

But dentists have only themselves to blame.  Over the past 10 to 15 years I have noticed more radio, TV, direct mail and Internet advertising for dentists with most of them emphasizing the whiteness of your teeth over the health of your teeth.  Catch phrases like “show me your teeth,” “perfect smiles” and similar ones stress the superficial side of oral hygiene.  Most dentists offer tooth whitening as an extra service.  So why are they surprised? How can they really blame patients when a potentially less expensive way to get the same results comes on the market or over the Internet?  When you start appealing to appearances over the practical need to see a dentist regularly, it may work to bring in business in the short run but you will soon find yourself in a different competition.

Another (Preventable) Epidemic

A recent USA Today article tells about the latest problem that has been dubbed a national epidemic, tooth decay in children.  “Tooth decay is largely preventable, but it remains one of the most common diseases of childhood — five times as common as asthma, and seven times as common as hay fever, according to the Centers for Disease Control and Prevention.”

Such news is interesting for many reasons.  First, the recommendation about brushing very young children’s teeth has changed.  Instead of brushing with only water, they now recommend using a small smear of toothpaste.

Second, here is another epidemic where parental responsibility plays an important role.  Like the obesity epidemic, parents must be informed and involved to bring this problem under control, starting when the children are young to establish proper dental hygiene habits and later to monitor what their children eat and drink, especially those energy drinks and monster drinks.

Surprisingly though, no mention is made of the bottled water mania.  They do point out the importance of fluoride in cavity prevention.  “There are lots of water supplies where fluoride is naturally occurring, but the majority are not, so fluoride is added to the water to help as the teeth are forming.”  When parents insist on serving bottled water, for reasons of taste, convenience or supposed safety and health benefits, they are doing their children a disservice.  First, there are no valid safety concerns as this article thoroughly explains. 

The American Dental Association agrees that not only is fluoridated water safe and effective, they recommend the use of supplements by those who don’t have access to it.  “Individuals who drink bottled water as their primary source of water could be missing the decay preventive effects of optimally fluoridated water available from their community water supply.”

Furthermore the Mother Nature Network explains that bottled water is  “expensive, wasteful and — contrary to popular belief — not any healthier for you than tap water.”  They don’t even mention missing out on that important nutrient, fluoride.  

Yet, for some mysterious (illogical) reason, annual bottled water sales are now around 10 billion gallons and climbing.  This new “epidemic” is just one more reason for people to understand the foolishness of these purchases and behave accordingly.

Dental Care for Kids

Sticking with the subject of public outcry from last time (Fluoride in Drinking Water - 7/30) and how these situations call for strong behavior in the dimension of critical thinking, a number of years ago a group began to warn against the use of amalgam dental fillings, especially for children.  These fillings contain mercury, which is known to slowly leach into the mouth.  Mercury in sufficient doses can lead to serious health problems.  The anti-amalgam movement, taking the common, but often erroneous stance that any amount more than zero must be dangerous, began a campaign against this practice.  You can look up one of the main promoters of this view in a YouTube video telling us “amalgam fillings in your mouth are poisoning you.”

While the FDA, American Dental Association and others assured us that amalgam fillings were safe and have been standard practice for over 150 years, some dentists, based on these scary warnings, began recommending removal and replacement of all fillings with a newer type.  (Of course, they didn't do this for free.)  Statements such as those seen in this article fueled the controversy: "When you plant a neurotoxin two inches from the brain, can you say no one is ever harmed from that?" and "His group advocates that dentists be required to disclose the mercury content of amalgam fillings to patients. Four states and several cities mandate such disclosure…”

Now comes the irony.  The latest findings recently reported on CNN are that the alternative material for dental fillings contains bisphenol A (BPA), the same material used in the linings of metal cans that is under investigation for suspected links with problems related to “the brain, behavior, and prostate gland in fetuses, infants, and children.”  As a result the industry voluntarily stopped using BPA in the linings of baby bottles and tippy cups because of the bad publicity, although they continue to argue that it is safe.  BPA is still used in the newer dental fillings.

Taken at face value this news could leave us in a quandary.  We are told that both choices are dangerous, but so far neither the FDA nor any credible authority has declared either type of filling material unsafe.  Both are better than leaving children’s teeth untreated.

This dental story is a good reminder that we only have enough time and energy to be worried or scared about a few important things.  We can’t get upset and join the protest against every product, insisting that they be 100% pure, and boycotting all products that are not.  That unrealistic attitude would kill us for lack of anything to eat or drink.  Despite that, we can always count on the hype from advocates and the crisis-prone media, both of whom have their own vested interests - funding and audience.  


Our only defense against an unhealthy, knee-jerk reaction when it comes to our safety and that of our children is to exercise good perspective, remembering moderation and the importance of staying calm. Then use good critical thinking, separating fact from opinion and overblown claims, and acting accordingly.