A lot has changed since we last blogged about the changing fluoride landscape.
Utah and Florida have both banned fluoridation. Health and Human Services head Robert F. Kennedy, Jr., has said he will tell the CDC to stop recommending the practice. And just this month, the FDA started the process to remove children’s fluoride supplements from the market.
Unlike toothpaste with fluoride or fluoride rinses, these products are swallowed and ingested by infants and toddlers. They have also never been approved by the FDA. Ingested fluoride has been shown to alter the gut microbiome, which is of magnified concern given the early development of the gut microbiome in childhood. Other studies have suggested an association between fluoride and thyroid disorders, weight gain and possibly decreased IQ.
What ingested fluoride hasn’t been shown to do is actually prevent cavities. Any dental benefit from fluoride comes from its direct contact with the teeth, and those benefits are rather modest. Topical fluoride may slow down the decay process, not stop it.
Meantime, science continues to highlight the risks that fluoride exposure poses. One of the most recent papers appeared last month in the Annual Review of Public Health.
The review sets out to examine the evidence on water fluoridation, weighing its benefits against the risks, particularly for pregnant women and young children. Those benefits, write the authors, appear to be much smaller than many once thought. Among the recent studies they cite are those we looked at before on this blog:
- The latest Cochrane review which found that fluoridation may reduce decay by only about one-quarter tooth per child.
- The UK study which showed that the number of decayed, missing, and filled teeth was just 2% lower among those with fluoridated water.
Suffice it to say, this contrasts sharply with claims that fluoridation reduces decay by as much as two-thirds!
The authors weigh such evidence against a number of documented health concerns, starting with dental fluorosis. This is the discoloration and sometimes pitting of tooth enamel that can happen from overexposure to fluoride. According to NHANES data, up to 69% of all American youth now have it – almost double what it was just a few decades ago.
More concerning are the potential neurodevelopmental effects, as highlighted by the National Toxicology Program’s systematic analysis of the science. As the review authors note,
Among 59 studies reviewed by the NTP, 52 (88%) reported a link between early-life exposure to fluoride and diminished intellectual abilities in children. On average, IQ scores were seven points lower among children living in areas with high versus low fluoride exposure levels.
There’s also evidence that fluoride may impact thyroid function. One Canadian study included in the review, for instance, found that pregnant women living where water fluoride levels were higher had greater odds of having hypothyroidism. This is particularly concerning since low maternal thyroid levels can interfere with fetal brain development.
Fluoridation once “played a significant role in reducing dental caries and improving oral health when it was first introduced over 75 years ago,” the review notes in conclusion. “However, as time passed, the landscape of dentistry and public health has evolved.”
While some countries continue to endorse community-wide fluoridation, its risks and benefits have come under scrutiny in recent years, driven by a growing body of evidence. The benefits of systemic fluorides must be counterbalanced against the potential for adverse health impacts, particularly in vulnerable populations. Given that fluoride offers minimal benefit to the fetus and infant, health organizations and regulatory bodies should urgently review their recommendations and regulations to ensure they protect the most vulnerable.
And to that, we can only say, “Amen.”
