Fluoride is a naturally occurring ion of fluorine, an element that is abundant in the Earth’s crust. Calcium fluoride and sodium fluoride compounds occur naturally in water (including most surface and ground water supplies) and air. They are also released as polluting byproducts of many industrial processes, such as aluminum, steel and fertilizer manufacturing, coal-burning power plants and glass and cement production.
Fluoride has been embraced by the medical community and public agencies for its ability to prevent tooth decay. In addition to fluoride toothpastes and supplements, fluoride has been added to the municipal drinking-water supplies of a large proportion of the U.S. population. Safety concerns have made fluoridation of water a controversial topic in some areas of the country.
While low doses of fluoride do protect enamel, fluoride can be toxic at high doses. In fact, fluoride toothpaste tubes bear warnings to avoid ingestion. Overexposure in children has been linked to dental fluorosis, in which teeth are permanently stained or pitted. Excessive fluoride ingestion may also cause bone fragility and tenderness.
Current research does not provide evidence of a link between fluoride and cancer.
The U.S. Environmental Protection Agency, which regulates fluoride levels in water supplies, has set a legal limit of 4 milligrams of fluoride per liter of water (mg/l), warning that some people who drink water containing fluoride in excess of this level over many years could develop bone disease. EPA has also recommended (but does not require) a lower limit of 2 mg/L to protect against dental fluorosis, and advises that children under nine should not drink water that has more than 2 mg/L of fluoride.
A number of towns and cities have resisted fluoridation, including Honolulu, HI and Worcester, MA. Nevertheless, the American Dental Association and the EPA maintain that fluoridated water is safe. Currently, the National Research Council is undertaking a review of the data on fluoride.
In addition to toothpastes, fluoride supplements, and fluoridated drinking water, children ingest fluoride in infant formula and beverages made with fluoridated water. Fluoride may also be present in foods grown in soil containing fluoride or irrigated with fluoridated water and in milk from cows raised on fluoride-containing water and feed. (EHP)
To avoid excessive exposure for children under the age of nine, consider using a non-fluoridated toothpaste if your drinking water is fluoridated. Very young children should not be given fluoride toothpaste, as they are likely to swallow it.
Children are exposed to fluoride through water that has naturally or added fluoride. They are also exposed when consuming products made with fluoridated water. Toothpaste is another source of fluoride, and caregivers should teach children not to swallow toothpaste.
In communities with over 20,000 residents, every $1 invested in fluoridated water resulted in $38 in dental treatment savings.
Cost Savings of Community Water Fluoridation. Centers for Disease Control and Prevention. September 1, 2009.
There is research suggesting it is possible for infants to receive too much fluoride if the primary nutrition is formula reconstituted with fluoridated water. The American Dental Association recommends breast milk, ready-to-feed formula or powdered and concentrated formula mixed with a fluoride-free water source. Purified or demineralized bottled water can be used.
Interim Guidance on Fluoride Intake for Infants and Young Children. American Dental Association. November 8, 2006. http://www.ada.org/1767.aspx.
Bottled water may or may not contain fluoride. Manufacturers are not required to list fluoride content. The only way to know the fluoride level in bottled water is to contact the manufacturer.
Fact Sheet on Questions About Bottled Water and Fluoride. American Dental Association. December 9, 2009.
You can find out if your tap water contains fluoride by contacting your utility company. Water utilities are required to provide customers with a Consumer Confidence Report which gives information on water quality including fluoridation. You can also check the Centers for Disease Control’s My Water’s Fluoride database. If you are on a well or would like to test your tap water for fluoride on your own, you can send a sample of your water to a lab to determine its fluoride content.
National Library of Medicine's Household Products Database
Lists brands of products that contain fluoride.
http://householdproducts.nlm.nih.gov/
U.S. Environmental Protection Agency
Office of Ground Water and Drinking Water
U.S. Centers For Disease Control and Prevention
Fluoridation Fact Sheets
http://www.cdc.gov/fluoridation/fact_sheets/index.htm
Fluoride Action Network
This international coalition maintains that fluoride is toxic and therefore should not be used in public water supplies. They have published numerous documents against fluoridation.
American Dental Association Fluoride Pages
The ADA endorses fluoridation of water to protect the public against tooth decay. The have published a good deal of information on their website in favor of fluoridation.