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Should you worry about fluoride in the water?

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Is fluoride in drinking water a cause for concern? The short answer is: there is no significant evidence that fluoridation is a risk. Decades of research have shown that water fluoridation is a safe and effective public health measure that can significantly reduce tooth decay. In fact, it’s considered one of the greatest public health achievements of the 20th century (9). Let’s explore the evidence behind fluoride, its benefits for dental health, and what you need to know about potential risks like fluorosis.

Dental fluorosis is a cosmetic issue that creates white spots or streaks on permanent teeth. It develops in childhood when adult teeth are still forming, and is mainly due to overuse of fluoride-enriched products such as toothpaste rather than water fluoridation (5,8,12,25). 

To prevent dental fluorosis, parents should ensure their child uses the correct amount of fluoride toothpaste for their age and supervise them, as young children can’t properly spit it out until around age 6–8 (10,25). 

Skeletal fluorosis is a rare bone disease caused by excessive fluoride exposure over many years that can lead to joint stiffness, pain, and can weaken bones over time (25). However, it’s unlikely to occur with recommended water fluoride levels (0.7 mg/L), as it usually requires long-term exposure to levels above 4 mg/L (8). 

Fluoridation of drinking water remains a widely supported public health measure to reduce cavities for everyone, especially for communities without easy access to dental care. By understanding the benefits and addressing common misconceptions, we can make informed decisions about this important public health measure.

Sources
  1. Community Water Fluoridation Frequently Asked Questions | CDC
  2. Timeline for Community Water Fluoridation | CDC
  3. Understanding How Fluoride Helps Prevent and Repair Tooth Decay| Early Childhood Learning & Knowledge Center (ECLKC) – U.S. Department of Health & Human Services 
  4. Dental cavities Information | Mount Sinai 
  5. 10 fluoride facts | MyHealth Alberta
  6. Tooth Decay | National Institute of Dental and Craniofacial Research
  7. Cavities | Government of Canada
  8. Water Fluoridation: An Analysis of the Health Benefits and Risks | Institut national de la santé publique du Québec | June 2007
  9. About Community Water Fluoridation | CDC
  10. The Fluoride Debate: The Pros and Cons of Fluoridation | Preventive Nutrition and Food Science on PubMed Central | September 2018
  11. Water Fluoridation in Canada: Past and Present | Canadian Dental Association | July/August 2009
  12. CDC Scientific Statement on Community Water Fluoridation | CDC
  13. The State of Community Water Fluoridation across Canada | Public Health Agency of Canada – Government of Canada | December 2022
  14. Fact sheet – Community water fluoridation | Government of Canada
  15. Economic Evaluation of Community Water Fluoridation: A Community Guide Systematic Review | American Journal of Preventive Medicine on PubMed Central | January 2016
  16. The economic value of Quebec’s water fluoridation program | Zeitschrift fur Gesundheitswissenschaften (Journal of Public Health) on PubMed Central | June 2013
  17. An economic evaluation of community water fluoridation | Journal of Public Health Dentistry on PubMed | 2001
  18. Oral health: A global perspective | Canadian Dental Association
  19. Canadian Health Measures Survey (CHMS) | Government of Canada
  20. Inadequate or excess fluoride – Chemical Safety and Health | World Health Organization
  21. Dental Decay/Caries or Cavities | Health and Social Services – Northwest Territories Government
  22. Dental Care, 2018 | Statistic Canada – Government of Canada | September 2019
  23. Dental costs soaring across Canada as fee guides get updated | The Globe and Mail | August 2023
  24. Cost, lack of insurance keeping Canadians from seeing the dentist: StatCan – National | Globalnews.ca | November 2023
  25. Fluoride and Oral Health | Government of Canada
  26. Fluoride – Health Professional Fact Sheet | National Institutes of Health – Office of Dietary Supplements
  27. Ambient Water Quality Criteria for Fluoride | British Columbia Ministry of Environment 
  28. Fluoride in Drinking-water | World Health Organization | 2004
  29. Chlorinated Drinking-Water | National Library of Medicine | 1991
  30. Page 2: Guidelines for Canadian Drinking Water Quality: Guideline Technical Document – Chlorine | Government of Canada
  31. Labelling requirements for salt | Government of Canada
  32. Goiter | American Thyroid Association
  33. WHO Global Consultation on Public Health Intervention against Early Childhood Caries | Community Dentistry and Oral Epidemiology | December 2017
  34. CDA Position on Water Fluoridation | Canadian Dental Association
  35. Fluoridation | American Academy of Pediatrics 
  36. Implementation of community water fluoridation | Ministry of Health New Zeland 
  37. Position statement on Community Water Fluoridation | Government of Canada | September 2016

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