A Drop of Prevention; Fluoride in Water

Around the 2024 election, one of the many controversial topics discussed amongst the US population was the inclusion of fluoride in public water. Since its introduction into public water in the 40s, the debate has never been settled. Is fluoride bad for you? Does it cause adverse health effects? Fluoride does not cause adverse health effects.

Fluoride is a naturally occurring anion of fluorine. Fluorine is one of the most abundant elements on the planet. It can be found in rocks and minerals across the globe. Fluoride is naturally present in water. As groundwater comes up through rocks to be accessible, it catches fluoride deposits and presents itself in varying levels. A natural concentration could be 0.05 mg/L, while higher levels could be up to 10 mg/L.

Fluoride was first added to public water in Grand Rapids, Michigan in 1945. Roughly 18 years after its addition, the US Public Health Service recommended that all municipalities add fluoride to water to prevent cavities. Brushing your teeth twice a day and flossing are proactive recommendations to keep you out of the chair of nightmares!

Fluoride makes your teeth stronger by increasing the strength of enamel, which is the outer layer of the tooth. Cavities are formed when bacteria in the mouth break down sugars in food. The byproduct of such reaction is an acid that breaks down enamel. Fluoride is added into water at low doses (0.4-4.0 mg/L) to help the public keep their enamel strong.  There have been numerous studies completed to show the effects of long-term exposure to fluoride. The results of these experiments have shown there are no adverse effects above 0.7 mg/L. There has been a national cap set at 4.0 mg/L to prevent any adverse effects. The public must also be notified of any fluoride levels above 2.0 mg/L for cosmetic purposes. 

Two of the major arguments against fluoride in water are dental fluorosis and neurological development issues. Dental fluorosis is a cosmetic condition in which adult teeth present white streaks or marks when overexposed to fluoride at a young age (maybe put an image). High level of fluoride exposure has also been reported to lower IQ scores at a young age. There is not sufficient evidence to support that fluoride causes lower IQ scores at the recommended levels provided by the US government. Anything in high doses is bad for you. Medicines have recommended doses. There are recommendations on the number of macromolecules like fats, carbohydrates, and sugars you should consume in a day. Even overexposure to essential molecules like vitamins can have adverse health effects.

The study linked at the end of the paper discusses the implementation of fluoride in water and the effect it has on children. The paper reports that there is no direct affect from the water with the fluoride and the children’s intelligence. There is no proof that the fluoride makes the children more intelligent, however. The paper discloses there are biases in the experiment. Evidence shows that some children who consumed more fluoride had lower IQ scores, but this is where the outside bias comes into play.

Oral health products like toothpaste often have fluoride in them to ensure that people get their fluoride. Another key argument is overexposure via these pathways. Not everybody brushes their teeth twice daily, and not everybody drinks from the public water system every day. Why would one want to increase the likelihood of a cavity by removing fluoride from water? There are many people who do not have access to regular dental appointments. There are people in the US who do not have guaranteed access to clean drinking water.

As a pre-dental student myself, I have been shadowing dentists for over six years. I have had opportunities to observe in areas of Kentucky where there is a genuine need for improved oral healthcare. I have seen teeth burst when extracted due to poor enamel strength. It is recommended that people drink milk for the calcium to increase bone strength. Milk can increase cholesterol levels causing heart issues later in life. Should we take away milk?

Taking fluoride from those who struggle with their oral health is deprivation of an essential molecule that increases the quality of one’s life. The arguments for the removal of fluoride are understandable. Nobody wants their kid to have a reduced IQ or marks on their teeth. However, there is not enough evidence to support these claims. Fluoride in water was regarded as one of top 10 greatest medical innovations of the 20^th century. There is little traction to these claims and fluoride should be continued to be consumed.

By Drew Wood, A Master's of Medical Science student at the University of Kentucky

Studies and Facts Resources

https://jamanetwork.com/journals/jamapediatrics/fullarticle/2828425

https://www.cdc.gov/fluoridation/timeline-for-community-water-fluoridation/index.html