Fluoride Myths & Facts

Fact 1

Fluoride occurs naturally in water, though usually not at a high enough level to protect teeth.

  • Fluoride is a mineral that exists naturally in all water supplies: lakes, rivers, and groundwater.
  • Some U.S. communities, such as El Paso, Texas and Jacksonville, Florida, have enough natural fluoride in their water to prevent tooth decay. But most communities must add a small amount of fluoride to reach the recommended level.
  • There are proven benefits to our health from having the right amount of fluoride — just enough to protect our teeth — in drinking water.

Fact 2

Fluoride has been recognized as an important nutrient for healthy teeth.

  • Fluoride is a mineral and in the right amount, fluoride in drinking water strengthens teeth. Fluoride is not a medication.
  • Fluoride is one of several examples of everyday products fortified to improve our health — iodine is added to salt, folic acid is added to breads and cereals, and Vitamin D is added to milk.
  • U.S. court decisions have rejected the argument that fluoride is a medication.

Fact 3

Community water fluoridation is the most cost-effective way to protect oral health and advance health equity.

  • Fluoridation is the least expensive way to provide everyone in the same community with a proven form of cavity prevention.
  • A 2021 report by the National Institutes of Health praised water fluoridation “for its effects in reducing socioeconomic disparities” in tooth decay.
  • A 2021 report by Public Health England focused on closing oral health disparities. The report cited four studies that “consistently found that inequalities . . . were less pronounced in fluoridated areas.”

Fact 4

Fluoridation actually saves money by preventing tooth decay.

  • Evidence shows that across the U.S. people in fluoridated communities save an average of $32.19 per person (in 2013 dollars) every year in reduced need for dental treatment compared to those without fluoridation.
  • In Texas, the state saved $24 per child, per year in Medicaid expenditures because of the cavities that were prevented by drinking fluoridated water.
  • Water fluoridation saves the state of Colorado nearly $150 million each year by avoiding unnecessary dental treatment.

Fact 5

Many IQ-related studies were poorly designed, gathered unreliable data, or tested fluoride levels that far exceed those in the U.S.

  • Most of the studies that anti-fluoride activists cite to link fluoride to lower IQ scores in children were conducted in China, India or Iran. In many areas of these countries, the natural fluoride levels in water are many times the level used to fluoridate drinking water in the U.S.
  • British researchers who evaluated these studies from China and other countries found “basic errors.” These researchers pointed out that the lower IQs could be traced to other factors, such as arsenic exposure, the burning of high-fluoride coal inside homes and the eating of contaminated grain.
  • Many experts in psychology and neurology have questioned the design and methods of the Canadian fluoride-IQ study (2019) that is most frequently cited by opponents of fluoridation. These experts questioned the validity of the study’s conclusion given that a number of potential confounding factors (such as mother’s IQ scores) were not available or taken into account. Also, the study’s authors did not explain why there was no link between IQ scores and whether children were born and raised in a fluoridated city.
  • U.S.-based researchers have sought to obtain the original data that was analyzed in the 2019 Canadian study to determine if they can replicate the results. However, the people who manage this set of data have declined to provide it. The replication of research findings is an important way to ensure the integrity of science.

Fact 6

Fluoridation is a public health measure, a modest community-wide investment that benefits everyone.

  • Fluoride exists naturally in water supplies, so it isn’t a question of choosing, but a question of assuring that people receive the right amount to prevent tooth decay.
  • Public health decisions are made based on what benefits the entire community and on sound scientific evidence.
  • Our tax dollars help pay to fix dental problems that result from tooth decay. For example, in New York, Medicaid enrollees in counties where fluoridation was uncommon needed 33% more fillings, root canals, and extractions than those in counties where there was fluoridated water.

Fact 7

Fluoridated water is the best way to protect everyone’s teeth from decay.

  • Fluoridated water benefits both children and adults.
  • Fluoridated water + toothpaste = less tooth decay! The benefits of water fluoridation build on those from fluoride toothpaste. Alone, fluoride toothpaste is not enough, which is why in non-fluoridated areas pediatricians and dentists often prescribe fluoride tablets to protect children’s teeth.
  • After looking at all the ways we get fluoride — including fluoride toothpaste — the U.S. Centers for Disease Control and Prevention (CDC) recommended that communities fluoridate water at 0.7 parts per million. Any less than that puts the health of our teeth at risk.

Fact 8

Very high fluoride concentrations can lead to a condition called fluorosis. Nearly all fluorosis in the U.S. is mild. This condition does not cause pain and does not affect the health or function of the teeth.

  • Dental fluorosis – faint, white specks on the enamel of teeth – occurs during the tooth-forming years (up to age 8) if children are exposed to too much fluoride.
  • Nearly all cases of fluorosis are mild. Mild fluorosis does not cause pain, and it does not affect the health or function of the teeth.
  • A 2020 study shows that as a child approaches adulthood, the fluorosis on their teeth lessens in severity — meaning it becomes even less noticeable than before.
  • In 2015, the U.S. Public Health Service updated its recommended level for fluoridation — 0.7 parts per million — to reduce the likelihood of fluorosis while continuing to protect teeth from decay.

Fact 9

Getting enough fluoride in childhood is critical to strengthening teeth over an entire lifetime.

  • Babies and children need fluoride to strengthen their growing teeth. Fluoridated water benefits developing teeth even before they are fully visible in the mouth.
  • The use of fluoridated water to prevent and control cavities is both effective and safe .
  • Children who drink fluoridated water as their teeth form will have stronger teeth that resist decay better over their lifetime. A 2010 study confirmed that the fluoridated water consumed as a young child makes the loss of teeth due to decay less likely 40 or 50 years later.

Fact 10

Children who swallow toothpaste are at increased risk of mild fluorosis.

  • Fluoride toothpaste is recommended by the American Academy of Pediatrics, the American Academy of Pediatric Dentistry, and the American Dental Association for babies and toddlers as soon as the first teeth come in.
  • The only risk to children of too much fluoride is dental fluorosis, which does not harm the teeth or a child’s health. That is why it is important to follow the guidelines on the proper amount of toothpaste to use, to supervise children when they brush, and to teach them to spit rather than swallow the excess.
  • The warning label on toothpaste reflects the fact that it contains a higher concentration (roughly 1,500 times as much fluoride) per milligram than fluoridated water.

Fact 11

Fluoridated water is safe for babies and young children.

  • In 2020 and 2021, the National Academies of Sciences, Engineering and Medicine (NASEM) reviewed a report that raised concerns about fluoride’s effects on the cognitive ability of preschool-age children. NASEM found this report fell “short of providing a clear and convincing argument.”
  • Several studies have explored the possible link between fluoride and negative cognitive effects, but the findings are not consistent. Studies conducted in Canada and Mexico have reported associations between the two, but studies from New Zealand and Sweden have found no such link. And a study from Spain actually found a link between fluoride and a positive effect on boys’ cognitive performance.
  • The ADA states that doctors “can suggest the continued use of powdered or liquid concentrate infant formulas reconstituted with optimally fluoridated drinking water.” Parents should discuss any questions they may have with their health care providers.

Fact 12

Although Americans’ teeth are healthier than they used to be, many people still suffer from decay and the impact it has on their lives.

  • Tooth decay is the most common health problem in U.S. children, even more common than asthma. Tooth decay affects a child’s ability to sleep, speak, learn and grow.
  • Poor dental health can damage job prospects. In a 2015 national survey, nearly 3 in 10 low-income adults said the appearance of their mouth and teeth “affects my ability to interview for a job.” Health economists found that growing up in a fluoridated community increased women’s earnings by 4%.
  • Untreated decay can delay a soldier’s deployment overseas. This led the U.S. Department of Defense to adopt a rule requiring fluoridation on military bases, recognizing that this practice “improves and sustains the military readiness” of soldiers.

Fact 13

Leading health and medical organizations agree: fluoridated water is both safe and effective.

  • Leading health and medical authorities support water fluoridation as safe. The CDC reports that panels of experts from different health and scientific fields have provided strong evidence that water fluoridation is safe and effective.
  • More than 6,900 studies or reports had been published on the subject of fluoridation, making this one of the most researched topics in public health.
  • Although some opponents have claimed that fluoride exposure causes bone cancer, research has shown no link between the two.

Fact 14

Dozens of studies and 75+ years of experience have consistently shown that fluoridation reduces tooth decay.

  • The CDC recognizes fluoridation’s effectiveness in preventing tooth decay and cited it as one of the “10 great public health achievements of the 20th century.”
  • Research has shown that tooth decay increased significantly in cities that ceased fluoridation.
  • A 2021 study showed that before Calgary ceased fluoridation, the tooth decay rate of its 2nd graders was lower than the rate in Edmonton, a city situated 180 miles to the north. But after fluoridation ended, the study revealed that Calgary’s rate increased significantly, well surpassing the rate in Edmonton, where fluoridation continued.
  • A 2022 study compared dental health in two Alaska cities – Anchorage and Juneau. Five years after Juneau ceased fluoridation, the cost of Medicaid dental treatments for children had jumped by 47%. By contrast, these costs rose only by 5% in fluoridated Anchorage.
  • Adults benefit from fluoride, too. A 2007 review of studies found that fluoride prevents caries (tooth decay) among adults of all ages and that fluoridated water prevents decay by about 27%.

Fact 15

Millions of people living in Europe are receiving the benefits of fluoride.

  • Fluoridated water reaches over 13 million Europeans, mostly residents of Great Britain, Ireland and Spain. Fluoridated milk programs reach millions more people, mostly in Eastern Europe.
  • Salt fluoridation is the most widely used approach in Europe. In fact, at least 70 million Europeans consume fluoridated salt, and this method of fluoridation reaches most of the population in Germany and Switzerland.
  • Technical challenges are a major reason why fluoridated water is not widespread in Europe. In France and Switzerland, for example, water fluoridation is logistically difficult because of the terrain and because there are tens of thousands of separate sources for drinking water. This is why Western Europe relies more on salt fluoridation, fluoride rinse programs and other means to get fluoride to the public.

Fact 16

Water fluoridation has been thoroughly studied, and the evidence shows it is safe and effective.

  • The National Research Council (NRC) raised the possibility of health concerns about areas of the U.S. where the natural fluoride levels in well water or aquifers are unusually high. These natural fluoride levels are three to five times higher than the level used to fluoridate public water systems.
  • Although the NRC itself explained that its report was not an evaluation of the safety of water fluoridation, opponents of fluoridation often cite the NRC report, ignoring its purpose.
  • The CDC reviewed the NRC report and stated, “The report addresses the safety of high levels of fluoride in water that occur naturally and does not question the use of lower levels of fluoride to prevent tooth decay.”