Fluoride: The Tooth, The Whole Tooth, and Nothing But The Tooth?
🦷 What you need to know about this (innocuous?) little element.
Hello, health heroes! I hope you had a great Christmas.
Today, let’s talk fluoride—a tiny element that has managed to spark debates as big as a root canal feels. For most of us, fluoride is like that boring side character in a movie: always there, never really noticed.
It became a nationwide practice in the 1950s, significantly reducing dental cavities in children. About 63% of us in the U.S. have fluoride in our water system. It's now in our toothpaste, tap water, and some of our fondest dental memories (like when the hygienist shoves a fluoride foam tray in your mouth and asks about your weekend).
But in recent years, some—including RFK Jr.—have opposed fluoride. Suddenly, something we didn’t consider has become a hot health topic. Welcome to my world, where I pursue hot health topics and get into the details to inform people of facts, not fear. This is not comprehensive, but it is a starting point for you to continue to consider how you want to approach fluoride.
So, what’s the truth about fluoride? Is it a dental superhero, or is it causing mayhem in other parts of our bodies? Let’s dive in, tooth first.
The Big Fluoride Debate: Why the Fuss?
Fluoride’s biggest fans are dentists.
According to the American Dental Association (ADA), fluoride is a game-changer for cavity prevention. It strengthens enamel, fights decay, and makes pearly whites more resilient.
The U.S. Public Health Service recommends drinking water levels for fluoride remain below 0.7 milligrams per liter. In contrast, levels above 1.5 mg/L are known to increase health risks such as bone fractures, thyroid disease, and nervous system damage. So, there is such a thing as too much. It’s like Goldilocks – maybe it’s a matter of getting it just right.
Although most fluoridated water supplies in the U.S. are regulated to safe levels around 0.7 mg/L, what about overexposure from adding fluoride toothpaste, mouth rinses, and other products, especially in children who swallow toothpaste? I don’t see much mention of this risk in my research.
Others have raised concerns about fluoride in drinking water, questioning whether it's doing more harm than good. Critics argue that fluoride might be linked to issues like bone health problems, thyroid dysfunction, and even cognitive effects. These concerns stem from studies suggesting potential risks at high exposure levels. However, the science isn’t exactly unanimous, and most studies focus on areas with very high fluoride levels, far beyond what’s in your average glass of tap water.
I found this article helpful in breaking the controversy down. Ultimately, they view ingested fluoride and orally applied fluoride in this way: Ingested fluoride has an inherently higher risk, while orally applied fluoride has a lower risk (unless you’re a kid who eats toothpaste). They make a case to de-fluorinate water in India to potential fluoride toxicity. Should the U.S. consider that action, too?
Where Does Fluoride Come From?
Fluoride, the ion form of the element fluorine, is extremely reactive and readily forms compounds with almost every other element on the periodic table. Thus, it is never found in its pure elemental state in nature.
The fluoride added to toothpaste and water supplies typically comes from naturally occurring minerals, which are then processed.
The fluoride in toothpaste often comes from compounds like sodium fluoride (NaF), stannous fluoride (SnF₂), or sodium monofluorophosphate (Na₂PO₃F). These compounds are synthesized in labs from naturally occurring fluoride minerals. In the water supply, fluoride comes from fluorosilicic acid (H₂SiF₆), sodium fluorosilicate (Na₂SiF₆), or sodium fluoride (NaF).
These compounds are by-products of industrial processes, such as the manufacture of phosphate fertilizer. When phosphate rock is processed to make fertilizer, fluoride compounds are released and captured to be reused, including in fluoride toothpaste.
One interesting thing I found in my digging into fluoride is that it is also seen as aluminum fluoride (AlF3), which is used as an additive for producing aluminium by electrolysis. Together with cryolite, it lowers the melting point to below 1000 °C and increases the conductivity of the solution. It is into this molten salt that aluminium oxide is dissolved and then electrolyzed to give bulk aluminum metal. Aluminum fluoride was nominated by the Environmental Protection Agency (EPA) and the National Institute of Environmental Health Sciences as a “high health research priority” due to its “known neurotoxicity.”
In my last article, I discussed the controversial use of aluminum in antiperspirants, so I thought it would be interesting to mention it again here in light of the information in that article.
While the industrial origins of water fluoridation compounds might raise your eyebrows, many things we take for granted, like phthalates in our cosmetics (that topic is coming next), will likely do the same.
What Do the Experts Say?
While the ADA firmly supports water fluoridation, the American Medical Association (AMA) says, ”Our American Medical Association urges state health departments to consider the value of requiring statewide fluoridation (preferably a comprehensive program of fluoridation of all public water supplies, where these are fluoride deficient), and to initiate such action as deemed appropriate.”
The American Dietetic Association (ADA), who makes says, “The American Dietetic Association strongly reaffirms its endorsement of the appropriate use of systemic and topical fluorides, including water fluoridation, at appropriate levels as an important public health measure throughout the life span.” However, I couldn’t find a more recent statement than this one from 2005, although I didn’t spend a lot of time searching.
What Are Other Countries Up To?
Most Western European countries have rejected water fluoridation, including Austria, Belgium, Denmark, Finland, France, Germany, Iceland, Italy, Luxembourg, the Netherlands, Norway, Sweden, and Switzerland. The only three Western European countries that still practice water fluoridation are Ireland (100%), Spain (10%), and the United Kingdom (11%). And in Canada? They’re split. Some provinces fluoridate their water; others leave it au naturel. Interestingly, tooth decay rates in non-fluoridated countries haven’t skyrocketed, making you wonder: Is fluoride really the linchpin of dental health, or are other factors at play (like diet and dental care)?
What’s the Real Concern with Fluoride?
Activists advocating for removing fluoride from public water supplies and dental products often highlight concerns about the potential health risks of overexposure.
One commonly cited issue is dental fluorosis, a condition manifesting as visible white or brown spots on teeth caused by excessive fluoride intake during childhood. In more severe cases, prolonged high levels of fluoride exposure can lead to skeletal fluorosis, a rare condition causing bone and joint problems. Another significant concern is neurotoxicity, with studies suggesting that high fluoride exposure may negatively impact brain development, including potential links to reduced IQ in children.
Critics also point to thyroid dysfunction, claiming that fluoride may interfere with iodine absorption, potentially contributing to hypothyroidism. Additionally, some research raises questions about bone health, indicating that excessive fluoride might weaken bones or increase the risk of fractures. These concerns form the basis of much opposition to fluoridation efforts, with activists calling for further research and reconsidering its widespread use.
If you’re interested in learning more about fluoride's downside, you may want to read The Case Against Fluoride: How Hazardous Waste Ended Up in Our Drinking Water and the Bad Science and Powerful Politics That Keep It There by Paul Connett, PhD, James Beck, MD, and H. Spedding Micklem, DPhil.
What this yes or no to fluoride feels like is a never-ending balance between public and individual health. It is a classic case of trying to fix one thing and accidentally creating new problems. When we focus on helping one part of the body—like strengthening teeth with fluoride—it’s easy to overlook how it might affect the rest of the body. And, as a culture, we’ve gotten pretty good at zooming in on solutions for the masses, but sometimes, that means forgetting about the unique needs of individuals.
Going Fluoride-Free or Switching to Natural Fluoride
If you’re thinking, “Okay, I don’t want lab-manufactured fluoride in my life anymore,” here’s the lowdown:
Toothpaste: Fluoride-free toothpaste is widely available. Look for natural brands that proudly advertise their fluoride-free status or look for “naturally derived fluoride” if you still want fluoride, but one that is naturally sourced. But I’ve got to pause and give you a little more insight into the naturally derived fluoride claims because, after all —all fluoride originates from natural sources! Fluoride is a naturally occurring mineral in the Earth's crust, rocks, soil, and water. However, how fluoride is processed and incorporated into products like toothpaste or water supplies influences whether labeled as "natural" or "synthetic."
Case Study: Navigating Toothpastes That Claim to Be “Natural” While Containing Fluoride
The term “natural” is being used to appeal to consumers seeking healthier, less processed products. Brands like Tom’s of Maine market themselves as natural while including ingredients like fluoride, specifically sodium monofluorophosphate. But what does “natural” really mean in this context, and does the claim hold up to scrutiny?
The term “natural” is famously ambiguous. While it evokes images of ingredients straight from the earth, there is no universal or regulatory definition of “natural” in consumer products, including toothpaste. For some brands, “natural” means:
Ingredients derived from naturally occurring substances, even if processed in a lab
Avoidance of synthetic dyes, fragrances, and additives
Transparency about sourcing and sustainability practices
In the case of sodium monofluorophosphate, found in Tom’s ‘Wicked Fresh!’ Fluoride is technically a synthesized compound that combines natural minerals—fluoride and phosphate—but is processed in a lab to create a stable, safe formulation. This fits a broad, marketing-driven interpretation of "natural," though it may not align with a purist’s view.
What does this mean? Who knows? It could mean products free from potentially harmful chemicals. If they use responsibly sourced and sustainable ingredients, maybe this matters. But what does that look like? Do they have a process whereby natural minerals are gently extracted from the earth?
This kind of marketing still isn’t very transparent. Unless laws require consumer product manufacturers to be transparent, we, the consumer, are at a disadvantage. Packaging with claims like “natural” work because we don’t have the time or patience to investigate the details. Including lab-synthesized compounds like sodium monofluorophosphate that challenge the perceptions of “natural,” too. While such formulations are likely effective and safe, their “natural” status hinges on how the term is interpreted.
But wait, there’s more. Sweeteners: No Artificial Ingredients? Many natural toothpastes, including Tom’s, also claim to avoid artificial sweeteners. Instead, they use alternatives like xylitol, often labeled a "natural sweetener." But is it genuinely natural?
What is Xylitol?
Xylitol is a sugar alcohol derived from natural sources like corn cobs or birch bark, but it undergoes significant chemical processing to extract and refine it. This makes xylitol more of a “naturally derived” ingredient than a raw natural substance. But honestly, anything at this point could be naturally derived – all elements used in chemistry are from the Earth.
In marketing terms, "artificial sweeteners" often refer to chemically created synthetic compounds like aspartame or saccharin. However, xylitol sidesteps this definition because it starts with a natural source, even though it’s heavily processed.
For consumers, the distinction between “natural” and “naturally derived” may not always be clear, raising questions about transparency in labeling. Honestly, this angers me because it feels like consumers are being lied to. How do we know what is healthful and what isn’t when no clear definition exists? It makes me want to make my own toothpaste, lotion, and everything else. But again, who has time for that?!
The Takeaway is…
Toothpaste like Tom’s of Maine highlights a growing tension in the natural products market: balancing consumer expectations for simplicity and purity with the realities of effective product formulations. If "natural" to you means minimally processed and untouched by labs, these products may not fit the bill.
However, they might strike the right balance if you seek effective, responsibly sourced ingredients with fewer synthetic additives. This is a good example of why I think marketing claims need to be more transparent. If companies are trying to help their consumers with natural products, then they should define what natural means (naturally!). Okay, now let's go back to how to walk away from fluoride in your water.
Water: Back to fluorinated water; if you have fluoridated water and want to switch to un-fluorinated water, you can invest in reverse osmosis filters to remove fluoride from tap water or switch to non-fluoridated bottled water. But the plastic used for bottled water might be of concern to you. Stay tuned for an article about plastics from me at some point.
Risks: Without fluoride, will you be at risk for more cavities? Perhaps, so keep your eyes on the health of your teeth by visiting your dentist regularly and brushing and flossing like a champ.
Natural Sources of Fluoride and Nutrient Pairings
Did you know fluoride occurs naturally in some foods? It’s found in:
Tea
Grapes and raisins
Potatoes
Fish (especially sardines with bones)
However, it’s improbable that you could consume enough fluoride from food alone to match the levels fluoridated water provides. ☹
The Final Rinse
At the end of the day, fluoride can be ingested or topically applied, and science to date shows that both are important to prevent tooth decay. However, ingesting fluoride might come with other concerns, as mentioned above. Do the benefits outweigh the risks, especially when exposure levels are kept in check? Who really knows how much fluoride we consume if we were to navigate away from fluoride supplementation? And who has time to figure that out?
When deciding whether fluoride aligns with your health goals, applying a personal health philosophy and the CREECS framework—Cost, Risk, Effort, Effectiveness, Commitment, and Support—can bring clarity. Your health philosophy helps you filter decisions based on your core values and priorities, while CREECS provides a structured way to evaluate the trade-offs. By combining these tools, you can navigate the fluoride debate (or any health decision) with confidence, ensuring your choices reflect both your unique needs and the bigger picture.
If you’re concerned about fluoride consumption, you could also ask your doctor or dentist but know that they’ll likely be pro-fluoride because their associations support fluoride supplementation.
Ask holistic health professionals, and you’ll likely get the opposite response.
I think both sides hold an element (fluoride) of truth. Ultimately – it’s your choice. Tell me what you think in the comments!
In good health,
Dr. Alice
A little more about Dr. Alice Burron and The Health Navigator Group:
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