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. 

Fluoride in Drinking Water

Add this to my series of examples of the battle between public outcry and the scientific evidence.  Here is an anthology of 13 articles on the subject of fluoridated drinking water published by the Center for Fluoride Research Analysis.  They have gathered in a single document “the official policy statements and consumer information on fluoride from the nation’s leading scientific and advocacy organizations that support community water fluoridation.”  (Additional support can be found on the new ADA website.)

A nice summary appears in the AARP document:  “In spite of its well-documented effectiveness and safety, 100 million persons in the United States remained without fluoridated water at the beginning of the twenty-first century.” 

Why would this be?  Part can be attributed to water supplies from private wells, but part is due to negative public reaction to fluoridation.  Another group of well-meaning people stare scientific evidence in the face and stir up opposition based on their personal interpretation of the studies.  As the article from the American Council on Science and Health puts it:  “The combination of a scientifically unsophisticated public and the profusion of easily accessible crackpot information on the Internet is indeed a prescription for disaster.”  The American Cancer Society article reinforces this:  “A review of more than 50 population-based studies…does not support the hypothesis of an association between fluoride exposure and increased cancer risk in humans.”

If so many reputable organizations promote the addition of fluoride to drinking water, where does the opposition come from?  There are, of course, the conspiracy theorists who once characterized it as a communist plot, but many have sincere and well thought out arguments.  The questions we must always ask about such information are: what are the sources, what are their qualifications, and do they have an outside agenda or possible conflict of interests?

Above all we must resist the temptation to stampede into action or opposition without full and reliable information.  See other instances of potential damage from public outcry in such cases as  the “pink slime” (April 2, 2012) and mad cow disease (April 30, 2012) controversies.