The Fluoride Controversy Explained

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By Dr. Kimberly Dyoco

brushteethOne of the biggest challenges about keeping yourself and your kids healthy these days is that it’s hard to actually pin down what’s good for you and what’s bad for you.

Unfortunately, what we often hear the most are health extremists or those ubiquitous news stories with absurdly alarmist headlines like, “Find Out Why Vegetables Could Be Killing You!”

If you do your own research, however, and look to the facts, you can usually get to the heart of the matter. The same is true for fluoride.

In recent years, there’s been a bit of a backlash about the stuff and many people have been left wondering what the story is. Given the fact that it was so widely accepted as beneficial for so long, a lot of people are confused about what’s changed.

Before we get into the controversy, however, let’s learn a little more about what it is and how it became a part of our oral health regimen.

The Basics

The first thing to understand about fluoride is that it’s a very common, naturally occurring mineral. It’s not synthetic, it’s not a chemical and it appears naturally in some foods, the soil and water without us doing anything at all. The nature-made version is known as calcium fluoride.

It can, however, be created in a lab as well. And the fluoride that’s used in dental care products and added to water supplies is made by scientists and known as sodium fluoride, which is preferred because it’s more soluble than the calcium fluoride.

Fluoride & Teeth

No matter what you eat or how fastidious you are about caring for your teeth, acid builds up in your mouth constantly. Over time, this causes a demineralization process that results in enamel erosion and cavities. What fluoride does is stop this process to prevent damage to your teeth.

As you probably know from having gotten fluoride treatments and your toothpaste tube, fluoride is effective when applied topically. But, it can also be effective at preventing tooth decay when it’s ingested.

A Brief History of Fluoride

The biggest issue that surrounds the fluoride controversy is the fact that, in most places, fluoride is added to the public water supply. So, to understand that aspect, it’s important to know how this practice started.

It all began over 100 years ago with Frederick McKay, a young dentist who moved to Colorado from the East Coast. When he started examining patients there, he was shocked to find that many people had teeth that were both badly stained, yet resistant to decay.

Not long after, he discovered that the same issue was occurring for populations in other parts of the country as well. To get to the bottom of this unusual condition, McKay began doing research into possible causes, only to discover that the areas that had this dental problem also had a water supply that contained a lot of fluoride, which caused the brown teeth known as fluorosis.

This discovery made scientists wonder if there was a way to use fluoride to help people’s teeth become more resistant decay, without causing stains. What they found was that a small amount of fluoride did the trick. So they decided to test it out on a large scale by adding the right amount of fluoride to the public water of Grand Rapids, Michigan back in 1945.

The result was just what they’d hoped – cavity rates in children went down by 60%. And just 6 years after this first trial, it became part of public policy to fluoridate public drinking supplies.

Why It’s Good

childteethAdding fluoride to our drinking water was basically a no-brainer. Considering the levels of poverty in this country, a huge amount of Americans don’t receive proper dental care. This is especially problematic for children and older people. So fluoridated water was a relatively easy and cheap way to help prevent cavities and tooth decay in the general population, regardless of income level.

And given that it’s a preventive measure that costs much less than fixing dental problems after they occur, it makes sense. In a large city, for example, it costs a mere 31 cents per person, per year. The CDC has said that, over the course of a decade, it can save $3 billion in dental treatments.

Another point on the side of fluoridated water is the fact that it’s been officially endorsed by both the American Medical Association and the CDC, which called it one of the top ten greatest public health achievements of the 20th century, along with immunizations and contraception.

Regardless of current controversies, there’s no denying that adding fluoride to public drinking water has done a great deal for preventing widespread tooth decay in Americans.

Why It’s Controversial

In the last decade or so, we’ve begun to question a lot of what used to be conventional wisdom around health. In recent years, an anti-fluoride movement has taken shape and now, many individuals and communities are beginning to re-think the necessity of fluoridating their drinking water.

For some, the issue is an ethical one – they say that it’s not right for the government to administer a medical treatment to the entire population, regardless of their consent. It isn’t easy or cheap for people to entirely avoid drinking tap water, so it doesn’t really give people a choice of ingesting fluoride or not.

Also, because times have changed and fluoride can easily be administered topically, many say that it’s no longer needed in water. In addition to dentist’s fluoride treatments, you can also find the stuff in most toothpastes, which wasn’t the case when we began fluoridating water in the first half of the 20th century.

Perhaps what we hear the most about is the health problems that some studies have linked to fluoride. The misleading part, however, is that most of these problems are the result of very high levels of fluorid, much higher than the levels in our drinking water. Opponents say, though, that the amount of fluoride that people get depends on the amount of water they drink, which cannot be controlled by the government.


It’s a tough call to make. While a large percentage of the population no longer needs to be ingesting fluoride because of modern dentistry, there are still huge numbers of people who don’t get the dental care they need. And for them, fluoridated water can help prevent serious damage that can’t be undone.

Because decisions about public water are made at the local level, some cities are taking action to stop fluoride from being added to their water. Portland, for example, has repeatedly voted down water fluoridation and seems to be, on the whole, quite adamant about keeping it that way.

As a dentist, I tend to support the preventative health measure as there isn’t enough evidence to show that there are any real dangers in the small amount of fluoride that you get through tap water. Sure, it can be toxic in large quantities, but anything can be toxic if you take enough of it.

The benefits, especially to underprivileged children, seem to far outweigh any negligible health and ethical drawbacks the opposition finds.

– Dr. Kimberly Dyoco is a dentist and the founder of One Mag Smile in Downtown Chicago. She’s passionate about educating her patients and readers about the importance of daily oral health care and all things dental. To learn more about Kim and her practice, visit today!