Fluoride: The Good, The Bad, The Ugly

Safe drinking water: we consider it a basic right. It’s treated and tested before it reaches us so we no longer have to worry about contracting deadly diseases from the kitchen faucet. Our tap water is even enhanced with minerals such as fluoride to improve our health. Very few would deny that the addition of fluoride prevents tooth decay. Fluoridation of public water systems in the US is considered one of the greatest public health accomplishments of the last century. But why are so many children sprouting teeth with white streaks and spots?

Fluoride makes teeth stronger and therefore less susceptible to decay. But exposure above a certain level damages enamel. This results in white spots and streaks on the teeth, called dental fluorosis. The staining is permanent, unsightly, and it means your child is ingesting more fluoride than is needed. Where is all the fluoride coming from? Well, first and foremost, over two-thirds of the US population receives tap water that contains added fluoride. So, the more tap water your child drinks, the more fluoride he or she is getting. Infants who are fed formula reconstituted with tap water also get a decent dose of fluoride (adult teeth are forming from infancy to approximately age 8). Fluoride is also found in toothpaste, fruit juices, and milk. And your child swallows some when the dentist applies it as a sealant; some children swallow enough to cause nausea and vomiting after leaving the dentist’s office. And don’t forget those yummy fruit-flavored toothpastes that toddlers love to swallow while brushing their teeth.

The white streaks that appear when developing teeth take up too much fluoride are the result of the multiple sources of fluoride your child ingests. If your water supply is fluoridated your child gets enough fluoride to prevent tooth decay from tap water alone. They will also receive enough when they eat that dab of toothpaste every night. And from drinking and eating the fruit juice and foods with high fluoride content (fish, soups). But when all these sources are added together, your child may be exposed to levels high enough to cause those ugly stains.

Fluoride is not considered a dangerous toxin and therefore has not received a lot of public attention. Ingested at very high levels it can cause bone deformities and kidney problems, but children in North America whose only sources of fluoride are tap water and food are generally not at risk. Nevertheless, children should not be unnecessarily exposed to additives that cause adverse health effects.

What can you do?

Don’t let your children eat toothpaste! Don’t let them dispense it themselves. Put a pea-sized dollop (or less) of toothpaste on the toothbrush. Or better yet, look for fluoride-free toothpaste, which is now readily available at most drugstores.

Do not give your child fluoride supplements if you live in an area with fluoridated water.

Monitor your child’s intake of bottled water and fruit juice. You do not know how much fluoride is in those products. There is no requirement on labeling so there may be little to no fluoride or there may be as much or more than tap water. If you live in an area where tap water is not fluoridated your children may not be receiving cavity protection. If you live in a fluoridated area, these sources together may provide too much extra fluoride.

Take-home point: If you live in an area where the public drinking water is fluoridated, your child does not need any additional flouride beyond the amount he or she receives from routine ingestion of tap water.

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