Common questions about fluoride

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6. Isn’t using fluoride toothpaste enough?

  • No. Many years after fluoride toothpaste became widely used, an independent panel of experts examined the specific impact of water fluoridation and determined that fluoridation reduces tooth decay by about 29 percent. Even today, fluoridated water plays a critical role of maximizing protection against decay.
  • The co-author of a 2010 study noted that research has confirmed “the most effective source of fluoride to be water fluoridation.”

7. Exactly how does fluoride work to prevent tooth decay?

  • The fluoride in drinking water works in two ways. For people of all ages, it works topically on tooth surfaces. Fluoride mixes with saliva, and when the saliva neutralizes acids produced by bacteria on teeth, the fluoride joins the enamel crystals on the tooth surfaces, healing and protecting the teeth from further decay.
  • Fluoridated water works systemically when it’s swallowed by young children while teeth are forming. Fluoride combines with the calcium and phosphate of the developing teeth and makes them more resistant to decay, especially during the first few years after they come into the mouth. Research has confirmed that systemic use of fluoride increases the concentration of fluoride in the surface enamel of teeth.

8. If fluoridation is effective, why are people still getting cavities?

  • Fluoride in various forms has reduced tooth decay, but fluoride alone cannot guarantee someone a life without any cavities. Diet and nutrition play a role, and so do other factors — like the frequency with which people get routine dental care. But we know from decades of research that fluoridation does reduce the rate of decay.More than 100 million Americans have a drinking water supply that is not fluoridated to the optimal level that helps prevent decay. Getting fluoridated water to more U.S. residents would help reduce the incidence of decay.

9. Is adding fluoride to water without individual consent acceptable?

  • America has a tradition of fortifying foods and beverages to improve health.  Adjusting fluoride in water is only one example of this. Here are other examples:
    • Vitamin D is added to milk to prevent a disease called rickets.
    • Iodine is added to salt to prevent goiter, which affects the thyroid gland.
    • Folic acid is added to many breads and cereals to strengthen the health of  red blood cells.
  • Our society respects individual rights, but there are certain public health policies we adopt communitywide or nationwide because they are more effective and efficient ways to strengthen health and security. Fluoridation is one good example of this approach.
  • Chlorine is added to drinking water to prevent outbreaks of E. coli or other forms of bacteria. Having a community water system means a city or town cannot pick and choose which households receive chlorinated water and which ones do not. The same is true for fluoride. Adding it to the whole water system is exactly what makes fluoridation so effective and affordable.

10. Is ending fluoridation a way to save tax dollars?

  • No. In fact, ending fluoridation imposes a hidden “tax” on families and taxpayers because it is likely to increase their dental expenses to treat decayed teeth. The evidence proves that fluoridation is inexpensive to maintain and saves money down the road. The typical cost of fluoridating a local water system is between 40 cents and $2.70 per person, per year—less than the cost of medium-sized latte from Starbucks.
  • For most cities, every $1 invested in water fluoridation saves $38 in dental treatment costs. A 2003 study in Fort Collins, Colorado, estimated that if the city discontinued fluoridation, it would cost its residents more than $534,000 per year. In 2003, water fluoridation saved Colorado nearly $149 million by avoiding unnecessary treatment costs. The study found that the average savings in these fluoridated communities were roughly $61 per person.
  • Scientists who testified before Congress in 1995 estimated that national savings from water fluoridation totaled more than $3.8 billion each year.
  • Taxpayers save money because fluoridation reduces Medicaid expenses on dental treatments. Studies in Texas and New York have shown that states save approximately $24 per person, per year in Medicaid expenditures because of the cavities that were prevented by drinking fluoridated water.