Fluoride Fears: Why Your Client May Say ‘No’ to This Decades-old Treatment

In the dental industry, there is no older friend than fluoride. This naturally occurring mineral has been widely researched as an additive in drinking water and dental products and is considered a linchpin of oral health. Not only does it strengthen the enamel, but it has also been shown to be effective in preventing gum disease.^1,2It’s no surprise then that The American Dental Association (ADA) recommends that toothpaste should contain fluoride in the range of 1,000-1,500 parts per million (ppm) to provide maximum protection against tooth decay. As for mouthwash, the ADA recommends the use of fluoride mouthwash with a concentration of 0.05% sodium fluoride.

While most dental clients understand the clinical benefits of incorporating fluoride into their oral health routines, you may see more and more clients questioning the need for in-office fluoride treatments or the use of these products at home. Here’s what you need to know to answer client questions about the safety of fluoride and what alternatives may exist.

Researching the Side Effects

As a naturopathic doctor, I can tell you that my clients are often seeking the most natural path to optimal health. And that approach may come with a healthy dose of skepticism regarding accepted treatments. There is a genuine concern among clients regarding the potential side effects of consuming fluoride.

Some people worry about fluorosis, a condition where excessive fluoride causes white spots or streaks on the teeth, or they fear other adverse health effects. A study published in the Journal of Epidemiology and Community Health found an association between high fluoride exposure in utero and decreased IQ in children between the ages of 6 and 12.³ Some individuals also oppose the use of fluoride because of water fluoridation: “If fluoride is added to the water supply, it’s not necessary to add it to my dental regime as well,” they suggest.

There has been evidence to indicate that high fluoride levels pose some additional health risks. A study published in the journal Fluoride found an association between high levels of fluoride exposure and an increase in hip fracture risk in older women.⁴ And a study published in the Journal of the American Dental Association found that excessive fluoride intake during childhood could lead to dental fluorosis.⁵

Are We at Risk?

The safety of fluoride depends on the level of exposure. The American Dental Association recommends that individuals receive a daily dose of fluoride of no more than 0.7 milligrams per day. Furthermore, it recommends that everyone, regardless of whether their water is fluoridated or not, use fluoride toothpaste to prevent decay.⁶

The Centers for Disease Control and Prevention (CDC) states that the amount of fluoride that most people are exposed to from drinking fluoridated water and using fluoride toothpaste is safe and does not pose a health risk if these products are used as directed.⁷ The ADA recommends that children under 6-years-old use no more than a pea-sized amount of fluoride toothpaste, and that they be supervised while brushing to prevent swallowing to increase the safety of its use.⁸

When you consider that the average adult ingests only 0.25 milligrams of fluoride per brushing when using a fluoride toothpaste,⁹ and takes in 0.67 mg/day from drinking fluoridated water, guidelines suggests that drinking fluoridated water and using fluoride toothpaste correctly will most likely not lead to negative side effects and will promote healthy teeth and gums.¹⁰

The likelihood of being overexposed to fluoride in North America is relatively low. In fact, according to the CDC, most people in the United States receive the optimal amount of fluoride to prevent tooth decay through community water fluoridation, toothpaste, and other dental care products. However, some populations, such as those who consume well water with naturally occurring high levels of fluoride or ground water with high fluoride, may be at risk of overexposure.¹¹

The Evidence on Thyroid Function

There has been some debate and research on the potential link between fluoride exposure and thyroid function. While some studies have suggested a potential association between high fluoride exposure and reduced thyroid function, the evidence is not conclusive. A review of the literature by the ADA concluded that “There is no strong evidence to suggest an association between fluoride exposure and thyroid function in humans.”¹²

Furthermore, the fluoride concentrations used in dental treatments are typically much lower than the concentrations associated with potential adverse effects on thyroid function. The ADA recommends the use of fluoride treatments to prevent dental caries, noting that “the benefits of fluoride in caries prevention far outweigh any potential risks.”¹³

What’s the Alternative?

Some individuals prefer to use a natural alternative to fluoride. For example, tea tree oil is a natural antiseptic that has been shown to reduce plaque and gum inflammation. A study published in the Australian Dental Journal found that a tea tree oil-containing mouthwash was effective in reducing plaque and gingivitis in clients with chronic periodontitis.¹⁴

Another popular alternative is oil pulling. Coconut oil pulling involves swishing coconut oil in the mouth for several minutes, which is believed to remove bacteria and improve oral health. A study published in the Nigerian Medical Journal found that coconut oil pulling was effective in reducing plaque and improving gingival health in clients with plaque-induced gingivitis.¹⁵

Your Responsibility

It’s important for our clients to understand that fluoride is a safe and effective tool in maintaining oral health. It has been proven to reduce the incidence of dental caries and gum disease, which are essential for optimal oral and overall health. While there is some evidence to indicate that high levels of fluoride exposure can pose a risk, when used as directed, fluoride toothpaste and water fluoridation are safe and promote healthy teeth and gums. Ultimately, the decision of whether or not to use fluoride is a personal one, but it’s important to share the available evidence and recommendations with your clients so they can make an informed decision.

References:

Walsh T, W. H. (2010). Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents. Journal of Dental Research, 1232-9.
Charles CH, S. N. (2001). Comparative efficacy of an antiseptic mouthrinse and an antiplaque/antigingivitis dentrifice: A six-month clinical trial. Journal of Periodontology, 200-5.
Bashash M, T. D. (2017). Prenatal Fluoride Exposure and Cognitive Outcomes in Children at 4 and 6–12 Years of Age in Mexico. Environmental Health Perspective, 125-134.
Li Y, L. C. (2001). Effect of long-term exposure to fluoride in drinking water on risks of hip fracture: a cohort study. Journal of Bone and Mineral Research, 932-939.
Leverett, D. H. (1994). The Iowa Fluoride Study: Fluoride Content of Public Water Supplies, Fluoride Intake, and Dental Fluorosis. Journal of the American Dental Association, 162-169.
American Dental Association. (2023). Retrieved from American Dental Association: https://www.mouthhealthy.org/en/all-topics-a-z/fluoridation
Marinho VC, H. J. (2003). Fluoride mouthrinses for preventing dental caries in children and adolescents. COchrane Database of Systematic Reviews, Issue 3.
Association Reports (2014). Fluoride toothpaste use for young children. Journal of the American Dental Association, Issue 2.
Group, E. W. (2020). Environmental Working Group. Retrieved from Environmental Working Group: https://www.ewg.org/tapwater/flouride.php
Levy SM, G.-C. N. (1999). Total fluoride intake and implications for dietary fluoride supplementation. Journal of Public Health Dental, 211-223.
11. Li, P. D. (2011, January). Chronic Fluoride Toxicity: Dental Fluorosis. Oral Science, 81-96. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/fluoridation/index.html
American Dental Association. (2018). Fluoridation Facts.
American Dental Association. (2023, March 31). American Dental Association. Retrieved from https://www.ada.org/en/member-center/oral-health-topics/fluoride-topical-and-systemic-supplements
S. Soukoulis, P. H. (2005). Efficacy of an Australian tea tree oil mouthwash for the treatment of gingivitis: a randomized clinical trial,. Australian Dental Journal, 290-297.
Oyedemi SO, A. L. (2016). Coconut oil pulling: A potential preventive adjunct to maintain oral hygiene. Nigerian Medical Journal, 143-147.

About the Author

Dr. Annie Savage is a naturopathic doctor with a special focus in women’s health. She is the co-founder of Bay Wellness Centre, where she has been practising for the past six years. With her expertise in naturopathic medicine, Dr. Savage has helped countless women achieve optimal health and wellness. Her dedication to her clients and passion for holistic healthcare has made her a respected figure in her field.