Fluoride: The Controversy

Our healthcare system is becoming more and more geared towards general populations and away from individual analysis.  This is because large organizations such as government and insurance companies are seeking to lower cost and reduce risk and exposure.  The ability to spread costs over large populations is just one way they accomplish this.  Prescribing treatment based on larger population studies, what is now called “evidence-based medicine” is another.

These agencies also look at short term issues and results rather than long-term gain.  Preventive medicine costs more money up front but has been proven to save money in the long term.  This is a problem of mindset, focus and perspective.  It is slowly changing.

Why should YOU wait?

Manhattan Dental Health has a very different philosophy.  We believe that preventing disease and promoting health is the ideal.   We believe that care should be personalized and based on a thorough evaluation of an individuals complex history including environmental and diet (epigentetic factors).  We believe that such care, though perhaps being slightly more costly up front, results in tremendous savings in the long term.

There’s a lot of misinformation about fluoride.  It has been blamed for all kinds of problems such as cancer and autism as well as touted as one of the most miraculous public health successes in history.

Who should you believe?  The Anti-fluoridationists or the Pro-fluoride group?

Well, this is another instance where there is no firm answer.  It all depends on your perspective and risks. 

As in so many areas, I believe that there needs to be thought given to the subject and analysis based on individual factors.

While there are “safe” levels of fluoride, a naturally occurring substance, these safe levels are generalized and NOT based on a particular individuals’ analysis.  What is “safe” for you might NOT be “safe” for me.

Do you believe that an infant should be given the same dose of a drug as a teenager weighing considerably more?

Is there a greater risk of a drug doing damage during certain developmental and growth stages?

I do.

So, despite the fact that fluoride can be beneficial in a program to reduce cavities and provide long-term benefits, I believe a more customized and individualized approach i=s prudent.

Risks to be considered are:

  • Medical issues such as an overstimulated immune system.
  • Dental issues such the risk for developing decay.

Such risks are best assessed on and individual basis.  Public Health looks at a different set of risk parameters.  Their focus is broad.

My focus, as your doctor is to recommend what’s right for you, based on a thorough knowledge of your mouth, overall medical condition including family history, diet, environment and hygiene habits.  We combine current clinical status, genetics and epigenetic factors.   You can see how complicated such a risk analysis can get!

Fluoride, when incorporated into the tooth enamel or dentin makes them more resistant to acid breakdown (decay or erosion).

So, if we’re looking to minimize either decay or erosion, you might want to consider fluoride as part of a preventive regimen.

Decay is more of a problem in the pediatric and geriatric populations.   Erosion is more of an issue in the middle aged population.  Fluoride should be evaluated for use in all populations based on a thorough evaluation and risk analysis.

Here are a few facts.

  • People who keep their teeth live on average 6 1/2 years longer than people who don’t.
  • Teeth are necessary to properly digest food.
  • Proper jaw position, supported by teeth is an important factor in breathing.
  • Fluoride is a natural occurring mineral.  That’s how it was discovered that fluoride prevents cavities.  Certain areas have naturally occurring fluoride in the water.
  • Too much fluoride can actually cause a defect in enamel formation.  It’s another case of “dose dependence”. 
  • Fluoride in the water has NO effect on teeth that are already formed.  It’s only beneficial to children whose teeth are forming (up to 12-16).  After that, fluoride in the water is useless.
  • Fluoride, in the water does not benefit adults.
  • Only toothpastes, rinses and topically applied fluoride provide benefit to adults.
  • The most effective form of fluoride for topical use is fluoride varnish applied immediately after plaque has been removed from the teeth.
  • Fluoride can be an enzyme inhibitor and is dose dependent.  By the way, so is Oxygen at certain levels!
  • 1% of the population is allergic to fluoride.
  • Fluoride in water has been associated with an increase in hip fractures in seniors.
  • Excessive fluoride can cause defects in the enamel of teeth.  This is dose dependent.
  • Fluoride is excreted via the kidneys and should be avoided in people with decreased kidney function.’
  • Reverse osmosis filtration systems can remove 80-90% of fluoride from water

Here are my personal thoughts.

     I do not believe fluoride should be in water systems.  I believe that parents with guidance from healthcare providers should be responsible for making health decisions for their children.

     I believe that “at-risk” child populations should be encouraged to receive fluoride in vitamin form and receive fluoride varnish in school-based programs.

     I do not believe that fluoride should be part of a pregnant woman’s diet.  To me, the risk/benefit analysis is weighted towards risk.

     I believe that fluoride toothpaste should only be used by at-risk children and only when they demonstrate the ability NOT to swallow the toothpaste (around age 5).  And then, only a minimal amount of fluoride paste should be used.

     I believe that decay prevention methods should be instituted so as to minimize the need for fluoride.  These include oral hygiene instruction, diet modification, nasal breathing exercises and saliva promotion methods.


     At Manhattan Dental Health we believe that Knowledge, combined with Action is Power.  We want to empower you to make the right decisions about your health and your care.

To everyone’s excellent health and wellness,