Preventing Tooth Decay in Kids: Fluoride and the Role of Non-Dentist Health Care Providers

The following post is a collaborative effort between myself and science-based dentist Grant Ritchey DDS. Dr. Ritchey is a co-host of the always excellent The Prism Podcast, most recently interviewing Dr. Robert Weyant and discussing how to teach critical thinking to dental and medical students. He can also be found on Twitter at @SkepticalDDS. Dr. Ritchey has written for SBM before on the topic of cranial osteopathy in dentistry.

As a pediatric hospitalist, I don’t deal with issues of dental health very frequently. Sure I see plenty of oral mucosal lesions, as occur during a primary herpes outbreak or a case of Kawasaki disease, but not many problems with the teeth themselves. I do admit a few dental abscesses here and there that need to be cooled down with IV antibiotics prior to definitive surgical drainage. And as a hospitalist that sees a fair amount of newborns, I also discover the occasional natal tooth. That’s when a baby is born with a tooth, usually a central mandibular incisor, having already erupted.

But as a pediatrician, I care deeply about the overall health of children and the network of caregivers that surround them. I guess you could say that I take a holistic approach, but I would prefer that you didn’t. Although we aren’t dentists, pediatricians recognize that oral health is integral to the well-being of a child and that many long-term dental maladies develop during the first two decades of life, often before the first tooth even appears. The most common, and one which non-dentist health care providers can have a major impact on, is the development of dental caries, or “cavities”.

Why not just let dentists take care of teeth?

Again, pediatricians are interested in every aspect of the health of their patients. Non-dentist health care practitioners that see kids also typically have access to them long before they ever see a dentist. The American Academy of Pediatrics (since 2003), American Academy of Pediatric Dentists and the American Dental Association all recommend that children be seen by a dentist at or near their first birthday, which leaves a lot of time for problems to develop. And pediatricians are often asked about dental health, particularly about fluoride and brushing.

It is critical in the first year of life for assessment of risk, and intervention in high risk patients, to be performed in order to prevent tooth decay. And it can be prevented. But there are a number of stumbling blocks that prevent children from receiving appropriate dental care. In many areas, dentists will not see young children, and the nearest pediatric dentist may practice a few towns over, limit what insurances they accept, or simply be too swamped to accept new patients. It is often very difficult for children of any age that are on Medicaid to find a dentist, and even when there is availability many parents don’t think of early dental care as a priority so they don’t make the appointment.

But some pediatricians are also to blame. Until 2003, the AAP did not recommend that most children first see a dentist until age three. And as with many aspects of medical care, there has been sluggish adoption of new recommendations by established practitioners. So the pediatrician and family doctor often find themselves providing dental care and education on cavity prevention.

What is dental caries and who gets it?

Simply put, caries is tooth decay. Often called a “cavity”, caries is actually one of the most common infectious diseases in humans, right up there with the common cold. In fact, it is the most common chronic disease in the pediatric age group. The process starts early, often in the first couple of years, and almost nobody is spared. Roughly 90% of us will have some degree of tooth decay during our lifetime. The other 10% must be on the Paleo Diet. I kid. Want an easy way to know if your diet is probably bogus? If it’s capitalized. Nobody capitalizes “the eat fewer calories” diet.

Breaking incidence down by age groups shows a steady increase in the prevalence of caries over time, which makes sense because a large portion of the risk is related to repeated exposure to cariogenic foods (sugar) and the bacteria that love them. The National Health and Nutrition Examination Survey (NHANES) III revealed that about a quarter of children ages 2 to 4 years were found to have decay in their primary, or “baby”, teeth. This increased to half of kids aged 6 to 8 years and roughly 60% of adolescents, with these being secondary, or “permanent”, teeth.

Rates of caries are higher, and it occurs much earlier, in the poor. Not surprisingly, it also tends to be worse. There are significant numbers of children out there not receiving any treatment for their dental decay, but poor children are considerably more likely to slip through the cracks.

But we are all at risk for the development of caries, even the most wealthy and privileged among us. But certainly some individuals are more prone to decay for a variety of reasons. As mentioned above, folks below the federal poverty line are more at risk and those above 200% of it are somewhat protected. The reason for these trends, though not completely understood, is likely the impact of the mélange (calm down Dune fans) of variables unique to groups, such as cultural practices, education, diet, hygiene and the availability (or lack of) dental care.

There are a number of additional risk factors which are child- or caregiver-specific. Kids who have had caries in the past are obviously more likely to develop it again. Children with visible dental plaque, who frequently expose their enamel surfaces to sugar, who don’t brush regularly and who have inadequate fluoride exposure are also at increased risk.

Remember that this is considered to be an infectious disease, and kids frequently swap oral flora with their parents. For this reason, I do not recommend spit cleaning a pacifier, but particularly if the caregiver has problems with caries. It appears that the worse off a caregiver’s mouth is, the more likely their child will develop decay, and this may be from spreading around cariogenic bacteria. This includes having multiple involved teeth and actual tooth loss. Modeling of behavior likely plays a big role as well. Parents who brush less than the recommended two times per day, or who express a lack of concern regarding oral health, teach their kids to do the same.

But it gets even more complicated because there is emerging evidence that genetics may contribute significantly to the risk of developing caries as well, perhaps as much as 50%. How the tooth is formed, the composition and flow of saliva, the affinity for ingesting high sugar foods and the immune response to the presence of cariogenic bacteria all likely play a role. Tooth decay truly is a complex, multifaceted process that clearly isn’t as simple as forgetting to floss every day or even the socioeconomic status.

The goal of dentists, and ideally all pediatric healthcare professionals, is to prevent the development of caries in the first place. And again, this is very possible. But as the numbers show, this rarely happens. Many of the risk factors listed above, which are more fully fleshed out by the American Academy of Pediatric Dentistry’s Caries risk Assessment Tool, are based on clinical findings or established habits and dentists are often playing catch up anyway. A great deal of damage has already been done by the time a child is seen in their office, with many children only referred to a dentist once there are complications.

Risk assessment ideally should take place before the first eruption of teeth, or very soon after, so that children at high risk for caries can be referred to a pediatric dentist, or at least one that will see an infant. Placing all children who live below 200% of the federal poverty level on the most intense caries prevention program is probably the easiest approach, but is likely not cost effective. Combining this with questions about the dental health of biological parents is probably the best means of flagging high risk kids. If done right, when the first teeth begin to appear sometime between five and eight months of age, true primary prevention can be initiated.

There are a few other risk factors for tooth decay which should prompt a referral to a pediatric dentist, if available. These include breast or bottle feeding past a year, use of a bottle at bedtime, visible plaque and enamel pits or defects. If there isn’t a dentist that will see a high risk child, which as you now know is fairly common, there are caries prevention strategies besides just education that can be implemented in the non-dentist’s office, the best for a variety of reasons probably being the application of a fluoride varnish. I’ll discuss this at length in a bit.

Why do we care about tooth decay?

Ultimately, untreated dental caries leads to loss of teeth. This is commonly seen as a minor inconvenience in children, with many unfortunately considering it to be a sort of rite of passage. In some communities I believe that a learned helplessness has set in, and the rotten teeth and subsequent telltale mouth full of silver crowns is accepted as inevitable. In my home town of Baton Rouge, this is an extremely common site. But although important for a variety of reasons (chewing, speech development, holding a space for adult teeth), those are typically primary teeth and will be replaced by an adult version. Loss of adult teeth is a much larger concern because we aren’t sharks. With rare exceptions, there are no more in the pipeline.

In children with untreated tooth decay, toothache is common with pain emanating from the tooth leading to thousands of emergency department and primary care practitioner visits each year. As untreated caries progresses, inflammation and infection of the gums (gingivitis) sets in, potentially followed by involvement of deeper tissues and surrounding bone (periodontitis). Or the tooth can just become loose, because the periodontal ligament is involved, and simply fall out. Finally, an abscess can form in the tooth or surrounding tissue that requires surgical intervention and sometimes admission to a hospital. Kids miss school. Parents miss work. All this costs money, but tragically this is still not the worst complication.

Here is a 2007 case where a child died because of untreated caries which apparently led to meningitis or a brain abscess. It’s difficult to tell from the article. But it highlights the issues I’ve raised very well. The author states that “Deamonte Driver’s life could have been spared if his infected tooth was simply removed– a procedure costing just $80.” While true, it’s important to point out that his life would likely also have been spared if he had been appropriately flagged as high risk and had a fluoride varnish applied by his pediatrician or family doctor, or perhaps even just counseling on better oral hygiene.

Tooth anatomy (Ritchey)

There is a large subset of children who see their pediatrician but don’t regularly see a dentist. And to dovetail with what Clay has already discussed, I think it would be worthwhile to briefly describe how fluoride works to reduce the incidence of dental caries, because fluoride is the best weapon in our arsenal against tooth decay and is something that can be understood and put into use by health care practitioners who didn’t go to dental school.

As we all learned in grade school and demonstrated in our 4th grade science fair projects, tooth enamel is the hardest substance in the human body. It is the translucent, whitish covering of the crown of the tooth, that part that is above the gum line. It averages a millimeter or so in thickness and protects the softer underlying dentin and pulp (nerve) tissues.

Tooth enamel is composed of approximately 96% minerals, with the rest consisting of water and a small amount of organic material. If you want to impress your friends at parties, you can nonchalantly drop that enamel is a crystalline structure composed of hydroxyapatite (HAP), arranged in parallel “rods” that extend from the external surface of the tooth toward the center. While this extremely hard hydroxyapatite structure allows us to chomp ice and have a dazzling smile, its Achilles’ heel is that it is susceptible to erosion from acids and mechanical forces (e.g. chewing, aggressive toothbrushing, etc.), in much the same way that acid rain and years of footsteps will erode the limestone steps of an old building. Once this demineralization occurs, it becomes a site where further bacterial colonization can occur, and when this happens, you have a cavity!

Role of fluoride

This is where fluoride comes in. Tooth enamel, when exposed to fluoride either systemically during tooth development or topically via toothpaste, fluoridated water, or professional application, becomes strengthened. The fluoride ion becomes incorporated into the hydroxyapatite crystalline structure to form a substance called fluorohydroxyapatite (FAP), which is significantly more resistant to acid attack and subsequent decay. Moreover, the presence of fluoride in saliva helps demineralized teeth absorb calcium and phosphate ions so that damage can actually be reversed, a process known as remineralization. Last, fluoride ions affect the bacterial plaque directly by interfering with a step in carbohydrate metabolism. This not only reduces the amount of acid the bacteria can produce, it retards the reproduction of bacteria, resulting in slower-growing plaque.

So, the bottom line is that fluoride is a triple threat in the fight against tooth decay, a veritable hat trick of protection. In fact, the Centers for Disease Control (CDC) has recognized water fluoridation as one of the top 10 public health achievements of the 20th century, right up there with vaccinations, birth control, and figuring out that smoking is not that good for you.

What’s the catch?

There’s a catch. There’s always a catch. Over the 100 years or so that fluoride has been investigated by dental researchers, it has been recognized that too much fluoride can have a negative effect on the teeth, and in extreme instances, bones.

The most common adverse effect of an excess of fluoride is dental fluorosis. During tooth development in children (essentially from gestation until age 8 or so), fluoride is incorporated into the enamel as it forms. Usually this is a good thing, as it strengthens the tooth as described above; however, if too much fluoride is present, it can disrupt the formation of enamel, resulting in cosmetic blemishes on the surface of some or all of the teeth. This can start with mild fluorosis, in which small, almost imperceptible white spots are found on a single or a few teeth. The spectrum then continues to moderate fluorosis (in which more teeth are involved and are more apparent), up to severe fluorosis, where the tooth becomes mottled and the stains are brown and quite unaesthetic. Severe fluorosis actually increases the risk of decay.

There is also a condition known as skeletal fluorosis, in which excessive environmental fluoride can become incorporated in the bones, resulting in pain, limited movement, and disfiguration. It must be emphasized that skeletal and severe fluorosis of the teeth do not occur as a result of any sort of community water fluoridation, or because of fluoride in toothpastes or professional fluoride treatments. They occur in areas with naturally occurring fluoride levels far in excess of what is safe, and are rare in the United States. In these areas, a defluoridation process must be undertaken to return the water concentration of fluoride to safe and optimal levels.

So what is a safe and optimal level of fluoride?

Great question! I’m glad you asked.

For decades the optimal level of fluoride in drinking water fell in the range between 0.7 parts per million (ppm) and 1.2 ppm, according to the American Dental Association (ADA). This has been adjusted according to region and was affected by temperature (less fluoride in hotter areas), water hardness, and other factors. But trends in water intake, and significant increases in bottled beverage consumption, have led to a recent recommendation to decrease fluoride levels in community water supplies to 0.7 ppm across the board.

How much water people drink these days depends less on regional temperature variations, and the intake of bottled beverages that contain fluoride has increased dramatically. If a product is made with fluoridated water, it’s no different than drinking fluoridated water from your tap. So in many areas without fluoride in the community water, more kids are getting some in other ways and this has equalized the relative risk somewhat when comparing communities. If not taken into account, this might make the benefit of a community water fluoridation program seem less impressive.

Not all ingested fluoride comes in the form of water or water based products. There is also fluoride-containing toothpaste, and then supplement drops that have historically been used in children living in areas with low levels in the drinking water. In an individual kid under the age of 8 years, it is recommended that the daily intake of fluoride be in the 0.05 to 0.07 mg/kg. That seems to be the sweet spot between too much fluorosis and too many cavities. Research has shown that these levels are extremely safe, minimize any untoward side effects such as fluorosis, and maximize the protective benefits of fluoride in tooth enamel.

Fluoride drops have gone out of favor for the most part. They require a prescription, are more expensive than fluoride-containing toothpastes and don’t provide the benefit of topical fluoride once teeth have erupted. They also increase the likelihood of developing fluorosis. In many countries, including the United States, fluoride toothpaste is recommended in young children, although how young it should be initiated has been debated.

Current recommendations in the US are to begin using a fluoride toothpaste to brush with the first tooth in high risk children, and to start at age 2 years when the risk of caries is low. Most experts recommend an amount equal to a grain of rice in young children with an increase to a pea sized amount from 2 years on with each brushing. In reality, starting all children in infancy would be fine considering that the amount of fluoride in a smear the size of a grain of rice would be below the level that would cause fluorosis even if completely swallowed twice a day.

Another recommendation, and one which I’ve found surprises many people, is to not have children rinse after brushing. But it makes perfect sense once explained. Young children don’t know how to rinse and spit anyway, so will actually swallow more of the toothpaste if an attempt is made. And when a child is old enough to do so, the act nullifies the benefit of having topical fluoride in the first place. If you must rinse, it is best to use a fluoride containing product, but many of these contain less than what is in a pea sized amount of toothpaste so the fluoride will still be diluted.

Does it really work?

The American Academy of Pediatric Dentistry published their Guideline on Fluoride Therapy, an excellent document summarizing the current research and recommendations on fluoride use. Their conclusions are as follows:

1. There is confirmation from evidence-based reviews that fluoride use for the prevention and control of caries is both safe and highly effective in reducing dental caries prevalence.

2. There is evidence from randomized clinical trials and evidence-based reviews that fluoride dietary supplements are effective in reducing dental caries and should be considered for children at caries risk who drink fluoride-deficient (less than 0.6 ppm) water.

3. There is evidence from randomized controlled trials and meta-analyses that professionally applied topical fluoride treatments as five percent NaFV or 1.23 percent F gel preparations are efficacious in reducing caries in children at caries risk.

4. There is evidence from meta-analyses that fluoridated toothpaste is effective in reducing dental caries in children with the effect increased in children with higher baseline level of caries, higher concentration of fluoride in the toothpaste, greater frequency in use, and supervision.

5. There is evidence from randomized clinical trials that 0.2 percent NaF mouthrinse and 1.1 percentNaF brush-on gels/pastes also are effective in reducing dental caries in children.

The fluoride controversy

Despite its 50+ years of study, and positive track record of proven benefits, there remains a strong anti-fluoride sentiment in many people. Won’t go into it too much here, as Steve Novella wrote an excellent article on the subject; however, suffice it to say that there is a small but active movement in the US and worldwide to put forth their agenda of the evils of fluoride. Evidently, Big Fluoride is attempting to sap and impurify our precious bodily fluids.

Their concerns primarily come down to four claims, all of which are unfounded:

1. Fluoride is a potent toxin. It’s even on the warning labels on toothpaste to call poison control if ingested while brushing!

2. Adding fluoride to community water sources amounts to forcing a medication on the public!

3. Individual choice is not taken into account. People who want it can just take a supplement!

4. Adding fluoride to community water leads to a variety of ill health effects, including lowering IQ, broken bones, joint problems, dementia and cancer!

Fluoride is a naturally-occurring substance in water everywhere, often at levels much higher than what is recommended in community programs. And it isn’t unique among many beneficial substances in the fact that excessive amounts can be harmful. But to compare the adverse effects of fluoride to these other substances, many of which have no safe level of consumption, is absurd. The safety data is abundantly clear. There is no credible evidence to suggest that fluoride lowers IQ, causes intellectual impairment, or increases the incidence of any cancer. The benefit far outweighs the risk of fluorosis.

Fluoride also isn’t being used as a medication to treat a disease but as a means of prevention on a population level. There is little difference between putting fluoride in the water and folic acid in bread. And yes, there is even potential toxicity from too much of that too. Relying on people who want to take fluoride to do so would be a disaster. Many people would be unable to obtain it and it doesn’t work as well as topical fluoride once the teeth have erupted.

What can non-dental health care providers do? (Jones)

I grew up in Baton Rouge, the capital of Louisiana and home of the LSU Fighting Tigers. I don’t live there anymore but I’m proud to call the state my home. I’m also very thankful for the existence of Mississippi and Arkansas, bordering states which do a great job preventing us from being the worst state in the union when it comes to health. Louisiana is behind in a number of parameters, not the least of which is the overall state of pediatric oral health. Oral health in general is abysmal in the Sportsman’s Paradise. An assessment by the Louisiana Department of Health in 2010 revealed that we met essentially none of the goals set out by the CDC’s Healthy People 2010 objectives for improving oral health.

Focusing on pediatric concerns, the numbers really do look bad. For instance, a full two thirds of third graders in Louisiana have had dental decay, with a little over 40% being untreated. Both of these issues are more than 10% more prevalent compared to the national average. This jibes with my personal experience practicing medicine in Baton Rouge for four years before my recent move to the Northeast. There are a lot of rotten teeth in Baton Rouge children, because Baton Rouge has yet to develop a community program to bring fluoride levels in drinking water up to the recommended amount. That and roughly 70% of the children are on Medicaid.

Pediatric dentists have several fluoride-containing options to address cavity prevention and treatment in individual patients. There are foams, gels, rinses and toothpastes containing higher amounts of fluoride than the OTC variety. Historically non-dentist providers did their best counseling parents and children on good oral hygiene and trying to make referrals. Now, in places like Baton Rouge and Houston, where a majority of children have dental caries and access to a pediatric dentist is spotty at best, some offices are beginning to apply fluoride varnishes in high risk kids.

Fluoride varnish is highly concentrated and applied like paint with a special brush. The coating releases fluoride when plaque is present and an acidic environment begins to develop. There is very good data showing this to be highly effective in children of any age. All they need is a tooth and no special preparation is necessary. It is also very easy to apply, doesn’t taste bad, is portable and well-tolerated. So it is perfect for use in clinics, even schools perhaps. Insurance, even Medicaid, will pay non-dentists for the application in many, but not all states. Hopefully this will change.

Fluoride varnish is technically off-label at this time when used to prevent caries, but is approved for use as a desensitizing agent and cavity lining. But it has been used effectively in many other countries for years. And there is good evidence in support of the current recommendations to apply the varnish at least twice yearly in high risk children. Of note, in England varnish is recommended twice yearly in every child, and three to four times per hear in those at high risk. So varnish works, but is it cost effective? There is the rub.

From available data, it does not appear that the application of fluoride varnish is cost effective if done in every child. This is unfortunate because even low risk children receiving optimal daily fluoride exposure still can get cavities, and varnish is extremely safe. But when an appropriate risk stratification is performed, and varnish applied to only those who are at high risk for caries, it very likely would be cost effective. There isn’t data to support that assumption that I could find at this time, however.

Another intervention, this time at the community level, is the implementation of classroom-based toothbrushing programs. There is actually very good evidence from other countries that this is effective, but none in the US so far. Supervised brushing is part of our Head Start programs by the way.


Tooth decay is extremely common and much more than a simply nuisance. There are significant possible downstream effects. All children are at risk for developing caries, but some are at high risk for a variety of reasons, many of which are likely genetic. Having someone assign risk early in life, when true primary prevention is a possibility, is ideal and the non-dentist pediatric health care professional is well suited to do just that.

In a perfect world, every kid would see a pediatric dentist around their first birthday, or earlier if they are high risk, but there are huge gaps in access. This is particularly a problem in children living below the federal poverty line. Pediatricians are great at educating parents on how to improve oral hygiene but that isn’t always enough. The application of fluoride varnish in the clinic is a great possible intervention in high risk kids, although it is unclear if it is a cost effective one. At the community level, supervised brushing with fluoride containing toothpaste in the classroom is almost certainly another great means of decreasing rates of tooth decay.

Finally, don’t be afraid of fluoride. It is one of the best public health measures every devised and is extremely safe. Despite the vocal minority of anti-fluoridation folks, and numerous websites touting all manner of bogus adverse effects, there is no evidence to support fluoride as a cause of cognitive impairment, dementia, or cancer.

Posted in: Dentistry

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112 thoughts on “Preventing Tooth Decay in Kids: Fluoride and the Role of Non-Dentist Health Care Providers

  1. nyscof says:

    Fluoridation is based more on unproven theories than scientific
    evidence, according to a revised dental textbook by leaders in the

    According to “Dentist, Dental Practice, and the Community,”
    1999, by prominent researchers and dental university professors, Burt,
    Eklund, et al. and based on pages of scientific references:

    * Fluoride is not an essential nutrient. It isn’t even a nutrient
    * Fluoride incorporated into developing teeth does NOT reduce tooth
    decay but does increase fluorosis. Alleged beneficial effects occur

    * There is no evidence that “optimal” intake inhibits cavities. In
    fact, the authors suggest “optimum intake” of fluoride be dropped from
    common usage.

    * Near universal fluoridation in the U.S.A. hasn’t leveled out tooth
    decay rates, instead fluorosis has spread and increased.

    * Not every possible hypothesis regarding fluoride and human health was
    tested before beginning fluoridation.

    More from the dental textbook:

    * “No clear reasons for the caries (cavities) decline (in the U.S.)
    have been identified”

    * At between 3 and 4 times “optimal,” fluoride causes tooth decay

    * A 1943 estimation that .05 mg ingested fluoride per kilogram of body
    weight could reduce cavities was misinterpreted, over time, as the
    “optimal” fluoride dose, a level never scientifically verified.

    * “Dental fluorosis cannot be classed as a public health problem in the
    United States … It would be a mistake, however, to assume that it
    could not become so.”

    Burt et al write, “Fluoridation proponents have also made honest
    mistakes in promoting it. What can appear to some, in retrospect, as
    arrogance and complacency in past years can still present problems in
    promoting fluoridation today.”

    1. Clay Jones says:

      That’s odd, because his own research concludes that there is an optimal fluoride level: and that fluoride is effective at reducing the incidence of decay. I bet those quotes are taken out of context, not actually from the textbook or from Burt, the lead editor of the textbook, or just made up. Regardless, the near totality of the evidence shows a clear picture that fluoride is effective and extremely safe.

      1. Clay Jones says:

        Furthermore, it’s a little hard to swallow that the APHA would give an award to a guy so vehemently opposed to something they support wholeheartedly:

    2. WilliamLawrenceUtridge says:

      Two questions:

      1) Why quote from a 15 year old textbook? Why not something more recent?

      2) What do the majority of textbooks and public health statements say? One can always find one person who dissents – but if they are the only one, then it’s quite possible they’re merely wrong. If they can’t convince their peers, why would we listen to them?

      I will never understand the frothing lunacy that attaches itself to fluoride. Clearly, clearly if it does have pernicious health effects at 0.7ppm, they are subtle. Clearly, clearly at that level they are good for tooth health. Given such tenuous claims of harm, why do people glom onto the idea that it’s liquid poison?

      1. WilliamLawrenceUtridge says:

        Also, Nyscof, you should learn about the wonders of google books, which has features like the search inside option. Quite clearly, this book discusses, at length, the extensive evidence and research behind the benefits of fluoridation, its safety and effectiveness as a dental intervention.

        This is the 2005 edition, perhaps in the six years between editions, the authors learned to read? Or perhaps, as Dr. Jones suggests, you are simply a liar Nyscof, or accept anothers’ lies wholesale without doing your own research.

      2. Sawyer says:

        “I will never understand the frothing lunacy that attaches itself to fluoride. Clearly, clearly if it does have pernicious health effects at 0.7ppm, they are subtle.”

        You answered your own question. Subtlety does not exist in their world. If fluoride hasn’t cured cancer it is useless.

        They also have an incredibly cynical attitude towards anyone in public service, and it’s inconceivable to them that the local water treatment plant is even mildly competent at monitoring water chemistry. There’s some pretty obvious political motivators going on there, but let’s leave it at that.

        1. windriven says:

          ““I will never understand the frothing lunacy that attaches itself to fluoride. ”

          It had occurred to me when I read Dr. Jones’ post this early this morning to post a wise-a$$ comment:

          “This is where fluoride comes in.”

          To which I would add where fluoride goes the wackaloons are sure to follow.

    3. Sawyer says:

      I’m going to recommend no one even bother responding to this nonsense. I’ve seen the NYSCOF show up on several other science blogs about this topic. Despite offering a few interesting talking points, they ultimately rely on the tactics that every other quack employs when talking about complex medical topics: conspiracy mongering, misinterpreting basic research, misuse of statistics, Gish Galloping, moving the goalposts, etc. I’ve seen people with far more patience than most of us here try to engage them. It never works.

      And it’s too bad. While I’m generally pro-fluoride, I am intrigued by fluoride’s relatively narrow safety margin. The issue of “optimal” levels of fluoride is actually a super complicated topic, and many dentists probably don’t appreciate the underlying chemistry involved. I’d even wager that somewhere in the US there are kids getting a bit more than they need, but the anti-fluoride groups are so terrible at basic science and honest communication that they’ll never get the message.

      1. WilliamLawrenceUtridge says:

        I never reply to the crazies with any intent to convert the crazies. I reply for the fence-sitters and reasonable people, to show them that the crazies are also liars.

        Plus, it’s fun. This is my hobby!

    4. AngoraRabbit says:

      “Fluoride is not an essential nutrient. It isn’t even a nutrient”

      That’s a mare’s nest and not relevant to the discussion. Minerals can have biological effects and not be an “essential nutrient.” The point about fluoride is that its interactions with hydroxyapatite strengthen bone mineral structure in the tooth. However, given it’s strong cariostatic effect, an adequate intake has been established.

      Funny how the sCAM folk whinge about fluoride not being a nutrient and then happily dose themselves with unnecessarily excessive intakes of micronutrients for which there is farless evidence of benefit. Anyone for chromium?

      1. WilliamLawrenceUtridge says:

        I have never, ever heard the expression “mare’s nest” before today. Turns out it is a pretty old expression:

        But what I would really like from you, Angora Rabbit, is a guest post discussing it. Or anything, really

        Guest post! Guest post!

        1. Sawyer says:

          Her absolute favorite author in the whole wide world, Michael Pollan, was on the Inquiring Minds podcast this week. I’m going to assume that everything he said is scientifically vetted until I hear otherwise.

          (It was actually a fairly benign interview that doesn’t require much critique, but I’m just trying to provoke Rabbit’s wrath.)

          1. WilliamLawrenceUtridge says:

            Sarcasm? Because AR hates Pollan?

            I loved, I mean, really, really enjoyed The Omnivore’s Dilemma, but every single thing I’ve read since then where he touches on genetic modification has turned me off of him. It just seems like the kind of entitled, white upper-middle class douchebaggery, wrapped in naturalistic fallacy, with a considerable sprinkling of paranoia and anticapitalist rhetoric that sets my teeth on edge. His starting point is so obviously and strongly that GMO is an inherent evil, and so evidence-free, it just makes me want to shove a cup full of golden rice down his damned foodie throat (or alternately, give him a bowlful after he was deprived him of beta-carotene until he enters end-stage deficiency) until he chokes on it.

            I’ve got a lot of rage.

      2. Thor says:

        Totally off topic, but: I second WLU’s ‘motion’. Your comments leave us wanting more. We’re just greedy. So—Guest post! Guest post! (Not to put any pressure on you or anything, lol.)

        1. Calli Arcale says:

          Can I third the motion? I learn a lot every time you post, Angora!

    5. nyudds says:

      The posting is bogus. I think it is a disservice to supply a print resource without attributing the origin. In this case, the entire post is pulled from a customer’s review of June 2006, not from the book he references. It poisons the entire thread. Here’s the link:

      I might also add that excerpts from the book are online, as are reviews. They paint an entirely different picture.

  2. Great article. Possible typo here though >

    “Fluoride is a naturally substance”

  3. Chris Hickie says:

    Great article! I wish I could get CME for your articles as they are much more informative and better written then what is offered.

    1. rork says:

      Nice observation, and I second it (though math police don’t need CME credit).
      It was getting long, but I did like how broad the view taken was. Worth it. Thanks to authors.

      1. Calli Arcale says:

        OT: rork, that looks like a truly awesome morel there in your avatar. It’s making me hungry. ;-)

    2. Sawyer says:

      Mark’s podcasts used to mention CME credit and I could never figure exactly why it was dropped. Besides the obvious time commitment required, I suppose it’s one of those things that doesn’t end up engaging the target audience you want to reach out to. Everyone here is going to read these articles regardless of formal education credit because we already have a deep personal interest in the topics. Every CAM fan will have no shortage of other CME sources that are less critical of their practices. Does CME actually draw in the fence sitters?

  4. Rick says:

    Thank you for a most interesting essay. I’ve gotten into a few debates regarding the topic of fluoride and usually refer to Dr. Novella’s excellent “Antifluoridation Bad Science” post. However, the anti-fluoride crowd says it is the Sodium (synthetic) fluoride that is bad and Calcium (natural) fluoride is ok. Is really a difference between the two or is this a case of appeal to nature. Thanks.

    1. Clay Jones says:

      From the CDC website discussing fluoride regulation and safety:

      “Fluoride Additives Are Not Different From Natural Fluoride

      Some consumers have questioned whether fluoride from natural groundwater sources, such as calcium fluoride, is better than fluorides added “artificially,” such as FSA or sodium fluoride. Two recent scientific studies listed below demonstrate that the same fluoride ion is present in naturally occurring fluoride or fluoride drinking water additives and that no intermediates or other products were observed at pH levels as low as 3.5. In addition, fluoride metabolism is not affected differently by the chemical compounds nor are they affected by whether the fluoride is present naturally or artificially.

      -The ionic speciation study conducted in 2006 mentioned previously (Finney WF, Wilson E, Callender A, Morris MD, Beck LW. Re-examination of hexafluorosilicate hydrolysis by fluoride NMR and pH measurement. Environ Sci Technol 2006;40:8:2572)

      -The pharmacokinetics of ingested fluoride was studied by a 2008 study (G.M. Whitford, F.C. Sampaio, C.S. Pinto, A.G. Maria, V.E.S. Cardoso, M.A.R. Buzalaf, Pharmacokinetics of ingested fluoride: Lack of effect of chemical compound, Archives of Oral Biology, 53 (2008) 1037–1041).”

  5. Well now I feel bad because my youngest who is 19 months old still has not been to the dentist and my 5 year has only been once. I will be making an appointment starting next week to get them checked. Now one thing that I have always heard is that children who take antibiotics a lot are more prone to cavities due to the development of the enamel. In my case I was plagued by ear infections at a young age and even today have tubes in my ears. I have also have had a very significant amount of cavities and now in my mid 20’s I have had now 3 root canals. I have always wondered if my issues tied back to all the antibiotics that I took.

    1. AngoraRabbit says:

      Impossible to know if there is a relationship between antibiotic use and decay risk in a single individual. But consider this – antibiotics do affect the microbial ecosystem including in the oral cavity. Could antibiotics alter that balance to affect dental carie risk? Remember that an important part of toothbrushing isn’t just to remove the food debris, but to remove the microbial biofilm that contributes to carie formation (as well as bad odor, etc). I’m not following that literature, but dollars to donuts someone is sampling the oral microbiome with a goal of identifying cariogenic vs. carioprotective microbes.

      I remember reading once that, in Europe, foods like cheese are permitted to be labeled as carioprotective. What I don’t know is how good the science is behind those claims. Maybe one of our European readers can comment?

      1. Matthew E says:

        Yeah, researchers have a handle on what microbes are good/bad for teeth.
        Streptococcus mutans is the common culprit. Review article: : “treatment strategies which interfere with the colonization of S. mutans may have a profound effect on the incidence of dental decay in human populations.” – markets probiotic treatments

    2. Grant Ritchey says:


      We often see discoloration of teeth that can be attributed to high and/or frequent antibiotic use in children, but as far as I know, it doesn’t render the teeth more susceptible to tooth decay. I might be mistaken, but I haven’t seen research to that effect.

      Thanks for your comments!

  6. Frederick says:

    Good nes for once.
    In my city, they have stopped fluoride in 2008, because of water cleaning/filtering supplu sation were getting totally rebuild, Now that all this is done since 1 years and half, they tried to resume It, of course fear mongers of scared people and the town council who vote a moratorium, because they wanted to “know more” ( even if fluoridation was part of water for decade before that and of course, there was no problems with it. Of course some person who oppose are just people who think the money is better spend elsewhere, or that it is a old method. Or mayor in a old timer guy of normally don,t care about public heath, or the reality, he cared more about jobs and taxes, I hate this guy, BUT for once in his 12 years as mayor, he said a intelligent thing: ” There’s is some people saying it is a good way to help teeth health in kid, other said this is a poison. The first are the public heath ( my wife work in that and there are pushing for it), doctor and dentist. people with professional ethics and have to give accounts to people/goverments. the others are a old gymnastic professior and a naturopath ( those two are the leaders of a coalition of citizen who thing they are expert on health) . My decision, for me his already taken. ” I like that for once he taken credibility Of real professional into account, he most of the time fall in fallacies and “old” thinking. The town council gonna vote on it and it seem it gonna pass. majority of councillors did not fall for the pseudo-science. Hurry for humanity for once. And doing that of city gonna be the biggest on to re-fluorize water, Yes Montreal and Quebec city do not do it. So it mihgt influence other to take the step!
    the provincal gouvernement decided not to make it mandatory, they encourage thought. So pseudo-science and fear mongers have kind of infiltrated the mind anyway.

  7. Paul de Boer says:

    Supernumerary teeth may be rare (“In a survey of 2,000 schoolchildren, Brook found that supernumerary teeth were present in 0.8% of primary dentitions and in 2.1% of permanent dentitions.”), but my brother had one and I had one right in between the roots of my maxillary central incisors. They shifted and one pointed in, one pointed out. I could eat an apple through a tennis racket. Haha. The supernumerary tooth had to be surgically removed. Then I got braces and now I’m AOK.

    I’m not sure if this is a hereditary factor that was considered when evaluating how many problems occur because of genetics, but “A small number of supernumerary teeth may be a common developmental dental anomaly, while multiple supernumerary teeth usually have a genetic component.” So, while me and my brother’s problem may have been developmental, some people may be affected because of genetics.

    1. nancy brownlee says:

      Hmmm… I had 6 wisdom teeth and another 2 extra molars. And no crowding; I have very straight teeth. Odd.

    2. Clay Jones says:

      I had one as well.

    3. Heh.

      I, for one, scored the genetic jackpot. No “wisdom” teeth, and I’m “missing” a tooth on the front – I have three bottom front teeth rather than four.

      The dentist was all like 0.o

      1. mho says:

        speaking of missing teeth,
        The wikipedia article on hypodontia references a 2008 JAMA article : “The preliminary data suggest a statistical association between hypodontia of the permanent dentition and EOC [epithelial ovarian cancer].”
        Please make sure your female relatives are aware of the symptoms of ovarian cancer.

        1. BillyJoe says:

          I dunno, mho.

          Just because there is preliminary data showing a statistical association doesn’t mean it’s worth taking into account in health prevention. Cost/ benefit and all that. And the symptoms of ovarian cancer are pretty vague. So, is it worth doing regular tests for ovarian cancer in these individuals? And what test. The antigen is pretty useless as a test. Which leaves intravaginal pelvic scans. Who’s for that. And how often?

          I guess what I’m trying to say is:

          Please don’t offer suggestions regarding health, based on every little tidbit that you read. Think it through first. More importantly, leave it to the experts to come to a consensus.

  8. stanmrak says:

    Although there are assumptions made here that the studies that conclude fluoride is safe and effective are valid and definitive — and dissenting studies are somehow invalid, there is really no reason to believe this story line. All these studies have flaws that one could use to discredit the conclusions. It just depends on what you want to believe. Who really knows what ingesting fluoride for 40 years does to you? Where is this study?

    1. WilliamLawrenceUtridge says:

      Stan, if fluoride is the dramatic poison you are claiming it to be, why are there no dramatic side effects witnessed? Why do we have to get into the 4-10x the safety levels before we see even minor side effects that are more inconvenient than critical? Why do we not see increased rates of these horrible adverse events in communities with groundwater that is naturally high in fluoride, at several times the dose recommended to prevent cavities?

      Since you point to no actual studies, there is nothing for us to evaluate. I’m personally going to simply take the word of the ADA and other educated, trained professionals over the word of someone who is in marketing has shown no history of critical thinking skills – merely ongoing and continuous beliefs in conspiracy theories.

      Also, your request for a “magic bullet” study is misplaced. There generally aren’t single studies that conclusively disprove a hypothesis – the totality of evidence is assessed and the convergence of answers is taken as stronger proof than any single study could be. For fluoride, the contrary evidence simply doesn’t appear to be very strong. I’ve looked into some of the studies cited as evidence of the dangers of fluoridation, and they’re not convincing. For instance – noting that elderly Chinese women experience greater hip fractures than peers in areas where the groundwater has a fluoride level of 20-50ppm is meaningless when discussing US cities, where fluoride is removed from the drinking water if it is as little as a tenth that level.

      So…any specifics?

      1. windriven says:

        “So…any specifics?”

        Fluorides are the one true cause of autism. Also of bullying in schools. And maybe global warming but stan is still investigating that.

      2. Sawyer says:

        Damn, I didn’t realize you had already give stan some hints as to why there aren’t more long term studies. I was hoping to see what absurd explanations he would generate on his own.

    2. Chris says:

      And you know all of this because of your credentials in marketing? A field that uses lies without remorse. Stan, seriously work on learning some basic chemistry, though a community college may have you take and English comprehension and basic math classes first.

    3. Sawyer says:

      Stan why don’t you provide us with a list of the main reasons why there aren’t more “40 year studies” on things like fluoride, vaccinations, or GMOs. I just came up with five reasons off the top of my head and I’ll be impressed if your list even remotely resembles my own.

    4. MadisonMD says:

      Who really knows what ingesting fluoride for 40 years does to you?

      Is that the standard, Stan? If so, who knows the effect of ingesting your swill for 40 years? 40 years of Selenium? Also resveratrol, ginko milk thistle, bilberry, and quercetin?

  9. Art Malernee Dvm says:

    Is the switch away from stannous fluoride in some brands of toothpaste only cosmetic or are other forms cheaper than stannous?

    1. SteveJ says:

      According to this article, sodium fluoride is “better-tasting and less expensive” than stannous.

    2. Grant Ritchey says:

      In general, the trend away from stannous fluoride was due to taste issues, problems with staining of teeth (it could look like the patient started smoking a pipe), and that newer fluorides had more desirable properties.

      1. WilliamLawrenceUtridge says:

        Anecdotal evidence here, I used a stannous fluoride rinse for a while on the recommendation of my dentist (I was a test case, since they could no longer get my usual fluoride rinse from Oral B; I now use Listerine Zero). They specifically wanted to know what my opinion on it was, to see if they would recommend it to others. It was in a concentrated pump form, I had to mix it with water twice per day to swish. The taste wasn’t that bad, faintly sour and astringent, but it smelled vaguely of methane – raw chicken and farts. Plus, it turned my teeth green, specifically on the plaques that built up on my teeth. Mrs. Utridge complained, and I switched.

  10. Stephanie G says:

    This was wonderful, thank you! Nighttime breastfeeding can also contribute. I’d only ever heard of “bottle-mouth”, and did not realize that nursing would obviously have he same effect. My son ended up with cavities very young because of this, and I’m sure bad luck/genetics too. Working on now preventing the same problem in our baby girl. We’re regulars at our pediatric dentist for sure :)

    1. brewandferment says:

      Not necessarily. There are immune system elements in breast milk that are actually cariopreventive, and when a child is actively suckling, the mother’s nipple is far enough back in the baby’s throat that there is minimal backwash. I used to have the citations at hand but do not follow the literature closely at present so I will admit there may be more current data, but AFAIR, the studies analyzing the issue were pretty well done.

      Also, breastfeeding past 1 year is recommended by WHO and other public health organizations, so there’s a conflict among the recommendations. Interestingly, the concentration of immune factors in breastmilk rises as the nutritive needs from breastmilk decreases (as babies eat more solid foods and need less breastmilk, the level of immune factors rises per unit of milk.) Given that most toddlers have so many more sources for germs, it’s a good thing to have a little more assistance from mom’s immune system!

      Sorry I don’t have a reference handy, haven’t gotten smart about PubMed yet. Perhaps it might be time to dust off my lactation textbooks soon…but first I have to get through some boxes of other stuff that badly needs sorting and purging.

  11. dh says:

    Many apparently incurable cases of cancer have remitted following adoption of healing meditation techniques and plant-based diets. Of course we in science are very threatened by this phenomena, so we dismiss it as “anecdotal” and “might have happened anyway”. But when a patient is told they have a fatal, terminal malignancy, and then lives for 30 or 40 more years following self-directed interventions aimed at diet and the mind-body (psyche-“soma”), there is something more to this story than can be readily dismissed out of hand by the reductionists. Yes very rarely spontaneous remissions of advanced, metastatic disease do occur, but I am reading that the body can actually be coaxed into this phenomenon after all conventional modalities have failed.

    What do you think?

    1. Vicki says:

      I think that this is hopelessly off-topic, as well as completely without any actual evidence, even on the anecdotal level. Over and over, what we find is that some patients recover from cancer after surgery and the adoption of plant-based diets, or sometimes chemotherapy and meditation. Which is like arguing that I can get from Seattle to New York by putting on a pair of tie-dyed socks…and then I have to admit that this “works” only in the sense that I wore those socks to walk downstairs, get in a taxi, ride to the airport, and climb into an Alaska Air jet.

    2. Scottynuke says:

      “Of course we in science are very threatened by this phenomena, so we dismiss it…”

      I think you might benefit from a refresher on pronouns, as it’s a little presumptuous to so freely claim such an association.

    3. brewandferment says:

      what I think is that your comment is utterly off topic for the issue of fluoride and cavities. There are lots of other articles at SBM dealing with your questions, just use the search bar.

    4. madisonMD says:

      What do I think? I think “…we in science…” is a very odd thing for you to say. If you were in science, you would realize that, well…


      Also, I think that you might pay attention to the subject of this post. It would be more polite for keeping your screed on topic.

      Thank you for asking what I think, by the way,

    5. WilliamLawrenceUtridge says:

      1) I think you are off-topic.

      2) I think everyone who tried a plant-based diet and died isn’t available to comment on this fact. It’s easy to cite unusual instances, they are extremely salient. “Dog bites man” isn’t a news story – but “man bites dog” is. We remember things like “switched to a plant-based diet, died at the age of 90 after an aggressive cancer underwent spontaneous remission”. What we don’t remember is “developed an aggressive cancer, died” unless they were a relative or friend – because dying of cancer is unremarkable.

      Also note, if you’re a fan of anecdotes, that Steve Jobs was a vegan, or near-vegan. He developed cancer. And he died. And for that matter, when actually tested, it turns out people trying a high vegetable diet (along with a host of other quackery) as a treatment for cancer – they simply die quicker, and in more misery.

      1. BillyJoe says:

        WLU, you are off topic!

        1. WilliamLawrenceUtridge says:

          Better me than them?

  12. LindaRosaRN says:

    NYSCOF got the title of the book wrong. It’s “DENTRISTRY, Dental Practice, and the Community.” She undoubtedly got the contents all wrong, as well, as is her annoying habit.

    Here, for example, is the abstract of an article written in 2007 by Brian A. Burt BDS, MPH, PhD, one of the book’s two authors, indicating his strong support for fluoridation:

    “Fluoridation and Social Equity”


    The overall reduction in caries prevalence and severity in the United States over recent decades is largely due to widespread exposure to fluoride, most notably from the fluoridation of drinking waters. Despite this overall reduction, however, caries distribution today remains skewed, with the poor and deprived carrying a disproportionate share of the disease burden. Dental caries, like many other diseases, is directly related to low socioeconomic status (SES). In some communities, however, caries experience has now diminished to the point where the need for continuing water fluoridation is being questioned. This paper argues that water fluoridation is still needed because it is the most effective and practical method of reducing the SES-based disparities in the burden of dental caries. There is no practical alternative to water fluoridation for reducing these disparities in the United States. For example, a school dental service, like those in many other high-income countries, would require the allocation of substantial public resources, and as such is not likely to occur soon. But studies in the United States, Britain, Australia, and New Zealand have demonstrated that fluoridation not only reduces the overall prevalence and severity of caries, but also reduces the disparities between SES groups. Water fluoridation has been named as one of the 10 major public health achievements of the 20th century by the Centers for Disease Control and Prevention, and promoting it is a Healthy People objective for the year 2010. Within the social context of the United States, water fluoridation is probably the most significant step we can take toward reducing the disparities in dental caries. It therefore should remain as a public health priority.

  13. lagaya1 says:

    Here in Hawaii, a 3 year old girl died (from anesthesia) after a dentist visit . I was shocked to hear that they were doing 4 root canals on a 3 year old. I’ve never heard of root canals on a child that young. I’m not sure about Honolulu, but here on Maui our water is not fluoridated. Smiles full of cavities are very common.

    1. Calli Arcale says:

      A friend of mine has a daughter who has had root canals and extractions already, and she’s just five. She was also adopted out of an overseas orphanage at the age of two, with very poor hygiene and diet prior to the adoption. They think they’ve got her oral problems under control now. Poor kid.

      Terrible to hear of a three-year-old dying under anesthesia! That could be a good topic for another post — use of anesthesia in dental clinics.

      1. nyudds says:

        Agree. There is no database to chart mortality/morbidity for dental anesthesia. Evidence of safety for pediatric dental sedation is scarce. My guess, from 40 years of hospital practice, institutional practice, US Air Force and private practice, is that it is very safe. Tens of millions of events/doses, both local and general, are encountered every day in dental clinics, hospitals and offices. But my opinion has no real statistical validation. This is a PubMed study that summarizes the problem. The conclusion is clear:

        What is also clear is that dental anesthesiologists keep working to introduce standards of care in each state. State law still trumps all. If the state says you can do something (acupuncture, chiropractic , etc.,) then you can do it. Period. If you follow Jann Bellamy’s posts, it will be painfully obvious that legislators and their collective deliberative bodies mirror the lack of math and science education and sophistication we wish for our education system.

        This is what people remember, with a few good reasons:

  14. scedastic says:

    I have a question.
    My children (aged 8 and 10) do not drink fluoridated water regularly, since we live in a rural area with well water.
    They don’t eat many sweets and almost never have anything to drink except water (sugared beverages or juices only for special events).
    I monitor their twice daily (if they are at home they also brush after lunch) brushing to make sure it is thorough. We use fluoride toothpaste.
    My kids have never had cavities and have had a coating put on their teeth to prevent decay in the ones they already have.

    Question: my pediatrician recommended fluoride tablets. I haven’t started them on the tablets yet, because I’m skeptical on whether they really need extra fluoride, and whether there isn’t a risk of too much.

    Any good science out there to back up either taking them or not taking fluoride pills for children who don’t drink fluoridated water?

    1. mousethatroared says:

      @scedastic – Have you had your well water tested for flouride? Flouride is naturally occurring, some well water has too little, some sufficient flouride, in fact some well water has too much flouride. Here’s a CDC link on flouride and well water.

      Good luck figuring things out.

    2. Andrey Pavlov says:

      Mouse has a good point. I am by no means an expert on this specific question, but it seems that your kids are more likely than not just fine. Low risk group with daily brushing with fluoride. The only question would be about the fluoride tabs to help their adult teeth as they grow in. I would do as mouse suggests and have your tap water actually tested. That could very easily settle the question for you. If there really is no fluoride in your water that may be a reason to do the tabs, but I don’t know that I would say it is absolutely imperative.

      Perhaps a dentist around here could comment?

    3. WilliamLawrenceUtridge says:

      Why don’t you ask your dentist what they think, and the specific reasoning of your pediatrician for recommending fluoride tablets given the information you have listed here? It’s possible your pediatrician has a more interventionist approach, is more risk-averse than you, and when asked for clarification will recognize your preference for a less intrusive approach. Or perhaps s/he appreciates something about your children’s situation that you don’t, which warrants fluoridation.

      But the main thing for me is, fluoride appears to be a relatively safe intervention. Given the first adverse event is fluorosis, which is purely aesthetic (and accompanied by teeth hard enough to chew through a chain link fence – a borderline superpower!) I don’t think I would worry about it.

      Full disclosure, I went through a woo-ey period in my 20s and avoided fluoridated toothpaste (fuck you Thomson’s of Maine, fuck you right in the ear). When I saw a dentist after several years, I had a good half-dozen cavities that needed filling. I actually chipped a tooth on a piece of fruit.

      1. nyudds says:

        Your concerns are justified. First, you need samples of your drinking water tested for fluoride concentration. The optimum level for fluoride in drinking water in the US, as of 2011, is 0.7 ppm. It was once much higher but the Dept. of Health and Human Services of the US constantly monitors levels vs. untoward results.

        The lower concentration reflects the increased availability of fluoride in water, rinses, school programs, toothpaste and common foods and drink, plus the increased number of dental visits for children for cleanings, polishing, fluoride treatments and varnishes. Parents today are very watchful of their children’s teeth.

        Limiting sweets and sugar drinks is a good practice; dental decay however, is dependent on many factors, from genetics to the oral biofilm and the bacterial colonization of the mouth, particularly with S. mutans and L. acidophilus. I’m sure you are aware that sugar is hidden in many foods and that bacteria are opportunistic enough to take advantage of many substrates to do their damage. At this time, there is no vaccine against tooth decay, although a molecule, named Keep 32 ( I guess it’s short for “Keep your 32 teeth.”) was found by Yale researchers that kills Streptococcus mutans:

        It’s tough to monitor brushing unless you use a disclosing tablet (messy.) A better way is with a power toothbrush, ultrasonic or Oral B type. These get to places that only a contortionist with a hand brush can manage and massages your gingival (gum) tissue as well. The other factor is that toothpaste has a shelf life and ages. It is printed on the box. Some brands hold their fluoride concentration better than others. A suggested sequence of brushing is: after rising (only if you find that personally necessary,) after breakfast, after lunch and after dinner. The thorough job should be before retiring, when mouth-breathing is common, saliva (a magical fluid!) is reduced and the membranes are dried a bit. And your partner will be thankful! Floss has not been mentioned much, but frequent, almost religious, flossing drastically limits decay between teeth. It’s indispensable. These cavities, when restored, almost always compromise the tooth and some researchers think this type of cavity is the initial insult that leads to fracture, crowns, root canals and implants. This is the area where fluoride is most helpful. The biofilm and bacterial colonies are well-protected here and the damage is serious.

        The coatings ( “sealants”) are different and much more effective than the cavity varnishes referred to earlier. Sealants are placed in an uncontaminated field on each tooth after determining that no decay is present. Sealant placement is very technique-sensitive. We always placed them under rubber dam (Actually, we did everything under rubber dam when possible, including preparing teeth for crowns.)

        I can’t know your pediatrician’s reason for the fluoride tabs, but generally speaking, pediatricians are well-versed in fluoride dosage. The tabs are a supplement to bring the daily dose (again, the benefit/risk is in the dose) up to 0.7 ppm. He may know the approximate concentration of fluoride in the area and routinely prescribes the pills with no subsequent fluorosis clinically evident in his patients. We use a similar approach in our area because we are on solid granite with only a trace amount of fluoride present
        (our water is tested every year.) All teeth form crown first, then root, so it is important to get the fluoride to the crown as it forms. That’s why a child takes fluoride pills, because the teeth are forming in the jaws and they continue to form until around age 14. This is an easy chart to understand from gestation to permanent molars:

        Finally, yes, there is a huge amount of evidence showing that fluoride supplements dramatically reduce caries in permanent teeth. I’m already too long on this topic so I’ll close, but I hope this helps.

        1. WilliamLawrenceUtridge says:

          Nyudds, I’ve a question then. My normal regimen is the following order:

          – floss
          – gum stimulator (around the front and back base of the teeth, as well as wiggling between the teeth)
          – brush with an electric toothbrush
          – rinse with Listerine Total Zero
          – mouth guard (I grind my teeth)

          That’s at night, in the morning it’s just brush and rinse.

          Should I adjust the order?

          I’ve a standing joke with my dentist that if she adds anything else to my oral hygiene regimen, all I’m going to do all day is take care of my teeth. A great epitaph, “Here lies William Utridge – starved to death, but flawless teeth!”

          1. nyudds says:

            Sounds good to me! I assume you have a fluoride toothpaste on that electric toothbrush and I always gave my patients an extra hand brush for after-lunch use. We always counseled our kids to treat their teeth like their hands: when they are dirty, clean them, so after a noon meal……..floss comes in small but effective packages.
            Hopefully, you will never fall under the old Jewish curse: May you live long enough to lose every tooth in your mouth…except one. And may that tooth give you a toothache! And as a scientist, I hope you find it impossible to make your own one molar solution: Your last molar in a glass of water (bad dental joke.)

            1. WilliamLawrenceUtridge says:

              Sensodyne for sensitivity. Speaking of which, how does that work?

              1. nyuddds says:

                We used various materials/methods for sensitivity, which usually was of exposed root origin. Various “sealants” were applied, from fluoride paste, liquid and gels to exotic coatings (balsamic Azul) and citrate etching with adhesive(?) and acrylics (unfilled.) coatings and actual cutting and preparation of the roots. When I left practice (2004) we had great success with dentinal bonding agents placed on lightly-etched root surfaces. Thank God for inventive chemists!

                Sensodyne and Thermodent hit the market and had an obvious impact. The short version is that the active ingredient plugged the dentinal tubule and stopped any stimuli from creating a release of substance P. This is the manufacturer’s explanation:
                This is more on the chemistry and physiology of dental pain, esp Substance P:
                Many other preparations have been tried with mixed results. One interesting preparation used De Sapientia Veterum (The wisdom of the ancients.) It was a mercury ointment called Unguentum Hydrargyri Ammoniati dilutum. I’m not sure it worked on sensitivity, but it healed the “cracks” in the fingertip that applied it!

      2. Vicki says:

        Tangential, but most Tom’s of Maine toothpastes are properly fluoridated. I buy them because that company makes a couple of flavors I find at least tolerable–most toothpastes are very minty, because apparently it hasn’t occurred to the toothpaste industry that not everyone likes mint.

        I appreciate a company that actually labels the toothpaste with the flavor, as well as the active ingredient (fluoride) and the assorted inactive ones other than flavoring.

  15. Ali says:

    Hmm. Did my comment look like spam?

    I was just saying that thanks to Ellie Phillips DDS bringing it to my awareness, xylitol had a big hand in arresting my tooth decay and remineralizing my teeth. (Fluoride was helpful as well.)

  16. nyudds says:

    Dental hygienists and dental assistants are perfectly capable of performing tasks that contribute greatly to reduced dental insults. Teeth can be cleaned and polished. They can examine, place sealants under rubber dam on non-carious teeth, remove plaque and stain, assess oral conditions and needs and educate and advise patients on all aspects of oral health. All this can be done cheaply and very effectively if paired with fluoride programs, water to rinses and everything in between. In Massachusetts, the Mass Dental Society and the Commonwealth of Massachusetts sponsored a mobile clinic that travelled to schools doing just this. A dentist was present to satisfy the law and to resolve any more serious issues. Nothing is cheaper than fluoride in the water supply, but expanded duty auxiliaries can do an lot of good when used properly.

  17. Lizzy says:

    Although anecdotal only I will say I trust fluoride. I have a bunch of anti fluoridation friends who swear fluoride is brain poison stating “why do you think you have to call poison control if you swallow toothpaste?”

    My brother who brushed his teeth infrequently as a kid but drank a lot of tap water had zero cavities and excellent teeth even with half assed oral hygiene.

    I am not wise about science. I trust scientists because they have background and knowledge I just do not have. I think science is interesting and am not paranoid enough to believe scientists are reincarnated Hitlers looking for a crazy scheme to end us all.

    And yes I have anti science fruitcakes as friends who believe science is a secret ploy to commit genocide.


    1. Sawyer says:

      There’s a Parks and Recreation episode where Amy Poehler’s character decides to get the city water fluoridated. She has a terrible time convincing anyone it’s safe until someone suggests they rename fluoridated water “H2Flow” because it sounds awesome.

      If scientists were involved in a massive conspiracy to kill people, they would not be stupid enough to keep calling it fluoride.

    2. WilliamLawrenceUtridge says:

      You might ask your friends why on earth anyone would want to use fluoride to commit genocide. You might also point out that there is a difference between using toothpaste over the course of months versus eating all of its minty goodness at once (similar to the difference between a child eating a Flintstone Vitamin once per day versus the whole bottle in a day). You could also point out that many municipalities in the United States actually remove fluoride from their water if the source is too high in fluoride naturally.

      1. Bryan says:

        In the seventies pressure groups succeeded in preventing water fluoridation in The Netherlands, but of course that didn’t stop those genocidal dentists from inflicting untold suffering on their patients. Apparently they poison them with articaine, a local anesthetic with thiophene in it, a well known insecticide…

        Fortunately we have the Bosscher Foundation to warn us against these atrocities:

        Marthe Bosscher is a natural healer, who can detect articaine poisoning using the Dr Voll method of electro-acupuncture. She was recently convicted for convincing a breast cancer patient she didn’t really have cancer but was suffering form articaine poisoning instead, causing her to refuse conventional medical treatment.

        1. WilliamLawrenceUtridge says:

          Hi Brian,

          I can’t tell if you’re genuinely over-the-top crazy, or pulling an Andy Kaufman. Thank you for demonstrating Poe’s law.

          Note that in sufficient concentrations, both menthol and caffeine are insecticides (and lethal to humans). Also, humans aren’t insects.

          1. Bryan says:

            Hi WLU, forgot to wink ;)

            1. WilliamLawrenceUtridge says:

              Oh thank the FSM.

        2. Frederick says:

          At least you have a good news in you piece of craziness, That person was convicted for convincing a person to let herself die.
          And why dentist will want to kill their patient client?
          Of course that faith healer probably did not do it for free.

    3. Calli Arcale says:

      Well, part of the reason not to swallow toothpaste is because it contains surfactants. Not very pleasant on the tummy, though calling poison control is probably excessive unless it was a LOT of toothpaste. Like, the whole tube.

  18. Bryan says:

    EFSA, the food safety watchdog of the European Union, in its recent Scientific Opinion on fluoride, about the available evidence regarding fluoride supplements (p. 26):

    “The consumption of fluoride supplements (tablets, drops/lozenges, up to 2 mg fluoride/day) by children reduced in the majority of systematically reviewed studies the caries increment in permanent teeth (by about 25%) (Espelid, 2009), and in one randomized controlled trial (RCT) in children with cleft lip and/or palate with 50-70% (Lin and Tsai, 2000), whilst the effect on deciduous teeth was inconsistant or questionable.”

    1. WilliamLawrenceUtridge says:

      Hi again Bryan,

      Note that the EFSA actually recommended an “adequate intake” of 0.05 mg/kg. Far from recommending against fluoride, the Scientific Opinion recommends people consume a minimum amount of fluoride.

      How do you feel about lying to people, do you do it deliberately or did you genuinely not bother to even skim the executive summary of the sources you cite. Is it perhaps that you don’t think people have access to google, even though you’re reading this on the internet?

      1. Bryan says:

        Actually, WLU (and Frederick), I cited the EFSA Scientific Opinion in response of nyudds’ remark:

        “Finally, yes, there is a huge amount of evidence showing that fluoride supplements dramatically reduce caries in permanent teeth. I’m already too long on this topic so I’ll close, but I hope this helps.”

        Didn’t show up in the right place… And forgot to include the link to the EFSA Opininon – no need to thank me for demonstrating Murphy’ Law ;)

        1. nyuddds says:

          Reputable studies on fluoridationare typically published in peer-reviewedjournals and other vehicles that are easily obtainablethrough a medical/dental library or throughPubMed, a service of the National Library ofMedicine which can be accessed via the Internet

          There are literally thousands of positive studies. This link lists 359 of them:

          Here are two additional ones that are scientific and supportive:

          especially Reference #6:

          I’m biased because I had the privilege of speaking with members of WHO at NYU in 1965.

    2. nyudds says:

      The reason that results on deciduous teeth are questionable, even though fluoride, stannous fluoride or the fluoride ion crosses the placental barrier, is taken up by developing teeth and bone and the remainder excreted, is largely unknown. One well-designed study in 1997 showed no clear benefit for prenatal ingestion of fluoride. There has been very little research in this area because baby teeth are lost only after being exposed to fluoride during life. The teeth assayed are lost teeth not newly-erupted teeth. Decay reduction in baby teeth has been accomplished by other means: early dental visits, cleanings, mothers’ home care, fluoride toothpaste, applied pastes, rinses and treatments etc. The supplements a child receives are not incorporated into baby teeth. Those teeth are already formed in the jaw. In this case, it is the topical effect of fluoride that benefits the child, from swish and spit/ swallow to chewing a tablet, which has both a topical and systemic benefit.
      This is the best discussion I could find about prenatal fluoride and baby teeth:

  19. So that white spot on my tooth is because I ate too much toothpaste as a kid?

    1. nyudds says:

      Probably not. The most common cause of the single white spot is enamel hypoplasia, a wastebasket term that includes many causes resulting in abnormal enamel formation. This is a good discussion of hypoplasia in baby teeth:
      This is an article that includes permanent teeth:

  20. Calli Arcale says:

    Clay Jones, you’ll be happy to know that my kids’ pediatrician is basically practicing as you recommend with respect to dental care. On every well-child visit, I am asked how often they see a dentist, and I have been given information about proper dental care. Since my kids see a dentist every six months, she doesn’t spend a lot of time examining their teeth, just as we skip the eye exam based on the fact that my kids see an optician annually. (Nearsightedness runs strongly in both sides of the family. The eldest has been wearing glasses for several years, while the youngest is getting close to needing them; optician advised waiting as long as she can still read the blackboard and isn’t getting headaches or anything. She’s a little farsighted, but has an astigmatism which almost exactly cancels that out. For now.)

  21. alison says:

    Many thanks for this post :) I’ve linked to and quoted from it in a blog post and on the Making Sense of Fluoride FB page – not that I expect that those strongly opposed to community water fluoridation will take your message on board, but those genuinely interested in finding out more will find it very helpful.

  22. tjohnson_nb says:

    You people really need an attitude adjustment. Even if you were correct in most of these blogs, which you are not, there is so much anger and sarcasm here that it discourages any productive discussion. It’s too bad you are wasting a good platform for intellectual exchange and would rather just stroke each other’s egos in this mutual admiration society.

    1. MadisonMD says:

      TJ: I would love to hear something substantive that would change my thinking– I’m open to new ideas. Have anything?

      If not, and if you simply don’t like the tone, then it might be best to find a blog that is more to your liking. The internet is a big place.

    2. windriven says:

      My friend Madison is such a gentleman*. He gives you the benefit of the doubt and addresses you as if you were a rational actor in search of meaningful discourse. But you and I, we know better don’t we? Because if you were you wouldn’t just toss a soft, wet little ball of sh|t on the table and walk away, would you? No, you’d offer some meaningful argument as a starting point and engage from there. Instead you come into this house criticizing our manners, telling us we’re wrong without telling us how, accusing us of mutual masturbation, and then flouncing.

      I have two words for you but Dr. Gorski likes to keep this place PG-13 and you aren’t worth my risking a week in moderation.

      *I realized as I wrote this that I have no idea if you are male or female. I wonder if you’ve said something that gave the impression that you’re male or if I’m a sexist ass for presuming it?

      1. MadisonMD says:

        English does require commitment on gender for pronouns. Male is appropriate.

    3. Chris says:

      Please tell us how we should have answered your question here, where you asked why mortality declined starting from the early 1800s?

      First, it was the different disease. Second it was a century of data. And then it was mortality not incidence.

      If you don’t like the attitude on the blog then either go elsewhere, or bring us actual relevant data that shows the articles have errors. Complaining about tone in no way provides relevant information in a discussion.

      If you have information about fluoride, the please provide it. Make sure it is verifiable scientific evidence, and not a badly done graph from a biased author. Trust me, that graph on pertussis mortality over a century did not make me angry, it was just exasperating with its blatant deception.

    4. MadisonMD says:

      I see, Chris. Looks like this tjohnson_nb dude likes to post up BS and flounce off. Cool, TJ. Your behavior contributes wonderfully to this platform for intellectual exchange. (Is that too sarcastic for you? Tough nuggies.)

    5. Sawyer says:

      So far the only plausible suggestion I’ve ever seen to eliminate the sarcasm and anger is to flat-out censor the most absurd comments. These are what ultimately spawn 99% of the fights here, and I refuse to pull my punches as they deserve every ounce of derision possible. Cutting down the frequency of pro-quackery posts would make things a lot cheerier.

      So what direction to go? Continue with the current cynical trend, or go the anti-free speech route?

    6. weing says:

      “Even if you were correct in most of these blogs, which you are not,”
      I’m from Missouri, show me.

      “there is so much anger and sarcasm here that it discourages any productive discussion.”
      Oh. We made you angry? What do you want discussion to produce? Some bullsh*t or clarification?

      “It’s too bad you are wasting a good platform for intellectual exchange”
      First, you have to bring in something intelligent to exchange. Otherwise you are trying to rip us off.

      “and would rather just stroke each other’s egos in this mutual admiration society.”
      I hope I didn’t stroke your ego. You made a mistake thinking this is a mutual admiration society, like those other societies you are a member of, where you admire each other’s fluff. You are free to join those mutual admiration societies. I’m not stopping you.

  23. Fiona Dobson says:

    Thank you SBM for this article on fluoride. There is a battle raging in middle class communities amongst the worried well, all around the world about the imagined harms cause by fluoride. Your very own countryman – Paul Connett is coming to New Zealand and Australia in February to spread the message about the ‘evils ‘of fluoride. I’m just sad that he couldn’t bring his BFF Alex Jones along with him to add veracity and validity to his fluoride pilgrimage/ conspiracy tour. Anyway, can you please just keep him in the USA because we have enough problems over here with the likes of Meryl Dorey, an expat American who is leading the charge against vaccination. Oh but hang on, you got Ken Ham the founder of the Creation Museum, so I guess it’s a fair trade.

  24. We’ve always believed that flouride is detrimental to our health and have taken steps to eliminate flouride altogether. Well done on highlighting the poison that water companies insist on using, you can bet some corporate company is making a lot of money through this.

    We recommend Structured Water over normal flouride ridden tap water.

    1. WilliamLawrenceUtridge says:

      Fluoride is certainly detrimental to your health, at levels 10x the recommended dosage. Of course, that’s why most North American municipalities with fluoride levels that high remove it from their water supply.

      For that matter, water would be far more dangerous when consumed at 10 times the “recommended’ level of 8 glasses per day (yeah, I know, that’s a myth, but it’s a reasonable starting point).

      I find it amusing that Nature Consensus is so critical of corporate companies making money…while charging €100 for…whatever it is they’re selling. I can’t even tell, that’s some good Engrish.

  25. Sawyer says:

    you can bet some corporate company is making a lot of money through this.

    I agree with you 100% that someone is making money off of the idea that fluoride is poison. Thanks for providing a link to their website.

    I would advise everyone here to check out the Nature Consensus website. Its products have already brightened my day and put a smile on my face, just by reading the descriptions.

  26. I was more comfortable with pediatrician than a dentist when I was a child. Now, I am much comfortable with the dentist only recently since technology is much convenient for me. Fluoride varnish is basically new since I only have heard of fluoride toothpaste. I have not tried Paleo diet but I already avoid sugar and carbonated drinks just to be safe.

    1. WilliamLawrenceUtridge says:

      I already avoid sugar and carbonated drinks just to be safe.

      What, just like dentists, doctors and dieticians recommend? Good for you.

  27. High Care says:

    Can’t wait for this all to come into massage and wellbeing industry.

  28. Frederick says:

    Happy News, My city just voted FOR putting fluoride back into the water, In fact our water was fluorides for 40 years, they stopped in 2008 because there were rebuilding the whole water filtering system, The anti-fluoridation were strongy present and despite that, the vote pass 9 vs 7 .
    in Quebec only 3 % of water as fluoride, and kid dental health is of course subpar compare to Ontario and even USA.
    the argumentation against it were all pathetic, “not our responsibility” “chemical” etc etc other city stopped doing it, fluoridation doe not work etc etc!
    finally a good news!

  29. Tooth decay in children is preventable. Even if your child already has signs of some tooth decay, you may actually be able to reverse it through nutrition, according to clinical research by Drs. Edward and Edward Mellanby and Weston A. Price, D.D.S. Even so, prevention is better than cure, and the best time to prevent tooth decay in your child begins when she get her first tooth. Thanks for sharing oral health care article with us.

    1. WilliamLawrenceUtridge says:

      Weston Price was a nutjob, and both Mellanby and Price died more than five decades ago. Call me crazy, but I like my research to be a little more recent than that.

  30. nyscof says:

    Fluoride Newly Identified as Dangerous to Brains

    NEW YORK, Feb. 20, 2014 /PRNewswire-USNewswire/ — Fluoride joins lead, arsenic, methylmercury, toluene, tetrachloroethylene, and other chemicals known to cause harm to brains, reports the Fluoride Action Network (FAN).

    Fluoride is newly classified as a developmental neurotoxin by medical authorities in the March 2014 journal Lancet Neurology. The authors are Dr. Philippe Grandjean of the Harvard School of Public Health and Dr. Philip Landrigan of the Icahn School of Medicine.

    The authors write “A meta-analysis of 27 cross-sectional studies of children exposed to fluoride in drinking water, mainly from China, suggests an average IQ decrement of about seven points in children exposed to raised fluoride concentrations.” The majority of these 27 studies had water fluoride levels which the US Environmental Protection Agency currently allows in the US – less than 4 milligrams per liter.

    Developmental neurotoxins are capable of causing widespread brain disorders such as autism, attention deficit hyperactivity disorder, learning disabilities, and other cognitive impairments. The harm is often untreatable and permanent.

    Grandjean and Landrigan write, “Our very great concern is that children worldwide are being exposed to unrecognized toxic chemicals that are silently eroding intelligence, disrupting behaviors, truncating future achievements, and damaging societies, perhaps most seriously in developing countries.”

    The authors say it’s crucial to control the use of all harmful chemicals to protect children’s brain development. They propose mandatory testing of these chemicals and the urgent formation of a new international clearinghouse to evaluate them for potential neurotoxicity.

    “Fluoride seems to fit in with lead, mercury, and other poisons that cause chemical brain drain,” Grandjean says. “The effect of each toxicant may seem small, but the combined damage on a population scale can be serious, especially because the brain power of the next generation is crucial to all of us.”

    Paul Connett, PhD, FAN Executive Director says, “In light of the new classification of fluoride as a dangerous neurotoxin, adding more fluoride to American’s already excessive intake no longer has any conceivable justification. We should follow the evidence and try to reduce fluoride intake, not increase it.”

    The US Centers for Disease Control (CDC) reports 276 million Americans are consuming fluoridated drinking water, largely as a result of the CDC’s vigorous advocacy to maintain and increase those numbers.

    But The CDC’s own evidence reveals Americans already show signs of fluoride-overexposure and reports that 41% of American teenagers have dental fluorosis, a physical marker that they ingested too much fluoride while their teeth were forming. Evidence also shows these markers in the US are not decreasing over time, but are increasing.

    Connett asks, “Why would the CDC persist in going against the tide of evidence to promote higher fluoride intake. Sadly, it seems, health agencies in fluoridated countries seem to be more intent on protecting the fluoridation program than protecting children’s brains.”

    More information about how fluoride affects the brain can be found here: http://www.FluorideAction.Net/issues/health/brain

    SOURCE Fluoride Action Network

    1. Chris says:

      One last bit of spamming before comments are closed on a month old press release? A press release that looks like it misrepresents Neurobehavioural effects of developmental toxicity.

      One hint is that the abstract shows it is not just about fluoride:

      Neurodevelopmental disabilities, including autism, attention-deficit hyperactivity disorder, dyslexia, and other cognitive impairments, affect millions of children worldwide, and some diagnoses seem to be increasing in frequency. Industrial chemicals that injure the developing brain are among the known causes for this rise in prevalence. In 2006, we did a systematic review and identified five industrial chemicals as developmental neurotoxicants: lead, methylmercury, polychlorinated biphenyls, arsenic, and toluene. Since 2006, epidemiological studies have documented six additional developmental neurotoxicants-manganese, fluoride, chlorpyrifos, dichlorodiphenyltrichloroethane, tetrachloroethylene, and the polybrominated diphenyl ethers. We postulate that even more neurotoxicants remain undiscovered. To control the pandemic of developmental neurotoxicity, we propose a global prevention strategy. Untested chemicals should not be presumed to be safe to brain development, and chemicals in existing use and all new chemicals must therefore be tested for developmental neurotoxicity. To coordinate these efforts and to accelerate translation of science into prevention, we propose the urgent formation of a new international clearinghouse.

      1. WilliamLawrenceUtridge says:

        Got a copy of the paper (google scholar sometimes turns up full versions of papers unexpectedly when you plug in the title). The whole thing is based on a 2012 meta-analysis “Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis“. It’s less than perfect, and looking at the money shot table (table 1) you can see it’s not really comparable. Their “high fluoride” groups had different definitions, some of which included exposure to fluoride through coal burning (no idea how to rate that). But looking at the “fluoride in water” groups, the lowest “high fluoride” is 0.88 mg/L (which is above what is used in municipal drinking water for preventing cavities) and is confounded by low levels of iodine (in both high and low fluoride). The rest of the “high” groups varies from questionable (2.7mg/L) to more than twice the EPA maximum upper limit (11mg/L) – which is 11 times what you would get from drinking municipal fluoridated water. Many of these studies report levels at which fluoride would be removed from the drinking water. Some don’t report actual levels, merely the existence of fluorosis (which kind, tiny white spot fluorosis, or brown teeth fluorosis? There’s a substantial difference) and all but two of the studies were conducted in China (the two were from Iran) – presumably because it’s impossible to find fluoride levels this high in the United States or most other first world countries.

        And anyways, shouldn’t the anti-fluoride nutters be happy about how fluoride is currently managed in the US? It’s systematically monitored to ensure it doesn’t breach 1mg/mL – it’s kept lower than what you would see in many communities. The danger threshold is four times what is considered appropriate. If you applied that to water, you get similar results – if you get four times the 64 ounces recommended in a day (yes, I know, from food and straight-up water, let’s assume the remaining 192 ounces are provided in purely liquid form) you would die of hyponatremia and hypokalemia.

        Also, that section that this press release cites? It’s the sole mention of fluoride in the whole paper.

        I love the honesty of fluoride opponents.

  31. Billy says:

    All I can say is that when it comes to tooth decay, I strongly suggest that brushing and flossing every day is the basics to avoid tooth decay. Though some kids hate these stuff, but brushing and flossing is a MUST so we need to develop these things and became a daily habit for our children. Don’t you agree?

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