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Fluoride: to use or not to use

Sept. 18, 2009
The fluoride controversy among dentists rages on, and there doesn’t seem to be an end in sight. The research may go on for years, but here are a few samplings of what is currently available online.

By Meg Kaiser, Assistant Editor

The fluoride controversy among dentists rages on, and there doesn’t seem to be an end in sight.Those in favor of fluoride insist it helps strengthen teeth, and they have the research to support it.Those opposed to fluoride believe it not only does not help teeth, but it’s bad for people’s overall health, and they have the research to support it.Simply Google “fluoride controversy,” and a mind-boggling 1,220,000 articles regarding the topic can be found. The research may go on for years, but here are a few samplings of what is currently available online.Dr. Paul G. Rubin wrote a fluoride position paper in March 2008. It states, “Most dentists were taught in dental school that ingested fluoride incorporates into the developing tooth enamel of a child to make the teeth more resistant to decay. Furthermore, topically applied fluoride creates an enamel surface more dense with fluoride ions and more resistant to the decay-causing acids produced by plaque bacteria.“What does research really show? Prominent researchers on fluoride have found that ingested fluoride does not significantly reduce decay, and that fluoride’s primary effect is topical.”“The Fluoride Controversy,” written by Hilary Basile on and supported by Dental Care for Children dental practice, states, “Fluoride helps prevent and even reverse the early stages of tooth decay. It strengthens tooth enamel, the outer layer of our teeth, so it can better resist the acid formed by plaque. Fluoride also allows teeth damaged by acid to remineralize (repair themselves). Fluoride is especially critical to the health of developing teeth in children.“In response to these claims, the National Institutes of Health (NIH) reviewed research on dental cavities prevention and public policy. The NIH agreed with anti-fluoride activists that many studies in this area are of poor quality; however, the NIH panel concluded that the unevenness of research does not invalidate the clear benefits of fluoride. The NIH stated that the dramatic reductions in tooth decay in the past 30 years are due to fluoridation of the water supply, and parents and health professionals should continue to ensure that children receive enough fluoride to prevent cavities.”Many dentists address the controversy on their Web sites. A good example of this is in St. Louis, Mo. Drs. Ronald L. King and Giang T. Pham present both viewpoints on their Web site. Their introduction says, “Fluoride’s intended benefit is to reduce tooth decay on a mass scale in a cost-effective manner. For any drug, chemical, or procedure that is recommended (be it conventional or alternative), the patient should ask two questions before consenting to its use: How effective is it, and what potential or known side effects does it have? The quite differing answers to these questions are basically what this passionate controversy is all about!”They present the pro- and anti-fluoride points of view at Mark A. Breiner, DDS, of Breiner Whole Body Dentistry in Fairfield, Conn., states on his Web site, “Just like with mercury, I was initially tipped off about fluoride by Dr. Hal Huggins. In the mid-’70s I researched fluoride. I came to the conclusion that fluoride was a toxic poison, and it did not decrease tooth decay. I stopped using fluoride in my practice. In my own home we started using bottled water, toothpaste without fluoride, and juices not made from concentrate. The water used to reconstitute juice is almost always fluoridated.”According to, a recent survey by the Wealthy Dentist concluded that 85% of dentists in the United States support water fluoridation, while 15% do not support the practice. There was little difference among dentists in rural, urban, and suburban areas of the United States in their support of water fluoridation. Specifically, according to the data, 82% of dentists in rural areas support water fluoridation, 80% of dentists in urban areas support the practice, and 88% of suburban dentists support fluoridated water. The dentists sent in both pro- and anti-fluoride comments with the survey. An orthodontist in New York commented, "There was a reason it was rated one of the top 10 health policies of the century." A Utah dentist said, "It is a benefit to our society and assists in the prevention of innumerable caries." Another dentist in New Mexico stated, "Water fluoridation is a safe and cost-effective, preventive public health measure." A Florida prosthodontist commented, "Fluoride in excess is linked to several health problems." A dentist from Colorado said, "Fluoride clearly helps prevent tooth decay in developing children, but I think it's wrong to medicate the whole population." A New York dentist said, "Fluoride is unnecessary and downright dangerous to the health of the general population." One of the primary arguments against fluoride involves dental fluorosis. According to New York cosmetic dentist Dr. Thomas Connelly, "Dental fluorosis, a condition characterized by brown stains on teeth, is not simply a cosmetic effect, but the first visible sign of fluoride poisoning. Today there is an increased prevalence of dental fluorosis, ranging from about 15% to 65% in fluoridated areas and 5% to 40% in non-fluoridated areas in North America." In its mild form, which is the most common, fluorosis appears as tiny white streaks or specks that are often not noticeable. Dr. Connelly said some experts link fluoride to more serious health problems, such as bone cancer, kidney and liver problems, and reduced IQ.Concerned people should ask their dentist whether or not they should avoid fluoridated water.