Everyone knows that fluoride is found in toothpaste and mouthwash, but is it really that important? According to the Center for Disease Control (CDC), water fluoridation is one of our country’s greatest public health achievements.
Why is fluoride so important?
The American Dental Association (ADA) says that fluoridated water reduces tooth decay for adults and children by more than 25%.1 Because it is so effective, cities and townships in the U.S and around the globe have been adding fluoride to community water sources since the mid-20th century.
The most recently available data, published in 2018, says that around 73% of community water sources are fluoridated in the U.S. This delivers fluoridated water to about 63% of all Americans, according to the National Water Fluoridation Statistics, an official source offered by the CDC.
Today we’re going to look at the most common questions people have about fluoride, including what it does, is it safe, where do you actually get it from, both naturally and supplementally.
What Is Fluoride? Where Is It Found?
Fluoride is derived from fluorine, a natural mineral found in the ground all around the world. Scientists found out in the early 1900s that there was a correlation between general oral health and using fluoride. Due to this discovery, cities started adding the mineral to community water supplies to help improve public dental health.
Quick quiz: Which city was the very first to add fluoride to their drinking water in the U.S.? Hint – it’s in the Midwest.2
How Does Fluoride Work?
One of the reasons fluoride helps to prevent tooth decay is because it actually makes teeth resistant to demineralization. Demineralization is what occurs every time acids from foods come in contact with teeth’s enamel. Fluoride also helps to remineralize your teeth. This means it helps repair the damage that’s occurred due to demineralization. So not only will fluoride help teeth resist damage in the first place, it also helps to strengthen and repair damage.
Where Can You Get Fluoride?
Most people get fluoride through their toothpaste and similar oral care products. This can include mouthwash, preventative oral rinses and other dental treatments. Fluoride also comes naturally through some foods, in small amounts, and through drinking water.
Public water supplies
The majority of public water systems through the U.S. are supplemented with fluoride. You can actually check if your local water is fluoridated by using Find Water System Information, a tool provided by the CDC. Just open the link and find your area to learn more about your water supply.
People who have private wells on their property may not know what level of fluoride is naturally contained in their water source. According to the CDC, the optimal amount of fluoride in drinking water should be 0.7 milligrams per liter. You can have your water checked to see what level of fluoride, and other minerals and substances, are in your water. Contact your local health department for information on local water testing.
There are other ways you might be missing out on fluoridation, especially if your home uses bottled water or a water filtration system. The ADA suggests that most bottled waters have no fluoride, or sub-optimal amounts. While there is not a strong link between bottle water and tooth decay, it can reduce how much you receive and limit the positive effects it can have on your teeth.
There are some solid reasons for using bottled water and water-filtration systems. Many people believe it simply tastes better than what comes out of the tap. People also want to protect themselves from drinking some chemicals that filtered water removes. Is it possible, however, that by using filtered water, the benefits of fluoride are being lost in the process.
For those who want to use filtered water because of quality and flavor concerns, there may be options. You can look into filtration options that do not remove fluoride. You can also talk with the filtration-system manufacturer to see if there are ways you can preserve fluoride in your drinking water.
- Reverse osmosis: Reverse osmosis does remove fluoride from water.
- Distillation process: Distilling water does remove fluoride from water.
- Carbon water filters: Carbon filters typically do not remove fluoride. There are some, however, that will. Check with the manufacturer.
- Water softeners: Most water softeners do not remove fluoride from your water.
Those that prefer to drink filtered water, including bottled water, do have plenty of options to get the fluoride they need to protect their teeth.
Toothpaste and mouthwash with fluoride
Toothpaste is probably the top product people use that contains fluoride. Not only does it protect your teeth from decay, it helps remove stains. For this reason, some higher end tooth-brightening products also use fluoride. It is also added to many different products used for oral health, like mouthwash and rinses.
Fluoride is effective at protecting and fortifying teeth enamel and safe to use. Unfortunately, however, there are some myths out there that have scared people away from fluoride. Some parents even worry that their kids will be harmed by being exposed to too much fluoride.
Fluorosis is the term for consuming too much fluoride. Parents should be cautious when their children brush their teeth, helping them learn to not use too much toothpaste or swallow any of it.
Children up to the age of 3 can use toothpaste with 1,000 parts per million (ppm) fluoride, according to Medical News Today. They also say that children between the ages of 3 and 5 can have slightly higher concentrations, ranging from 1,350 to 1,500 ppm. It’s important, however, to seek personal medical advice from a trusted medical professional, such as your family dentist or pediatrician.
Dental treatments with fluoride
Your dentist may recommend fluoride treatments. These are applied to your teeth topically, usually every few months. Some of these in-office dental fluoride treatments come in the form of gels, pastes, varnishes and foam. The costs vary based on provider and location. Dentists recommend these types of treatments for many reasons other than poor oral health. According to the ADA, dentists recommend fluoride treatments for reasons such as:
- Fillings and restorations, including crowns
- Gum problems including recessive gums or exposed dental roots
- Persistent dry mouth
- Eating disorders or poor nutrition problems
- Alcohol or drug abuse
- Radiation therapy in areas around the head and neck
Foods with fluoride
The FDA says that ocean fish and shellfish contain the highest levels of fluoride. This comes from fluoride that naturally occurs within ocean water. There are other sources of fluoride in food, including some breakfast cereals, like oatmeal, and black tea and raisins.
Additionally, you get fluoride when you cook food in fluoridated water. This only happens, however, if you use water that contains fluoride. Parents using infant formula should consult their pediatrician about what water they should use. This includes asking for recommended fluoride levels.
You can find out more about foods with fluoride from the USDA’s National Fluoride Database of Selected Beverages and Foods.
Supplements with fluoride
There are areas where water supplies do not have fluoride. This can leave some people more vulnerable to tooth decay, especially children. In this situation, a dentist may prescribe fluoride supplements. These types of supplements are only available by prescription, through a pharmacy. It is very important that you carefully follow instructions on any fluoride-containing product.
The Truth About Fluoride Myths
There is no end to myths, controversy and theories online. That is just as true when it comes to the topic of fluoride. While it can be hard to find good resources for the truth, the ADA has addressed many fluoride myths in their publication Fluoridation Facts (Practical Guide Series). Some of the myths they address include:
- Fluoride is not toxic to consume.
- Fluoridated water that’s treated to recommended levels is not associated with cancer.
- Fluoridated water does not lead to osteosarcoma, a type of cancer.
- Water with fluoride is safe for infants unless your dentist, or pediatrician, especially says otherwise.
- Fluoride is not known to cause any negative effects on the thyroid.
- No scientific evidence shows that properly fluoridated water leads to any type of birth defects.
- Fluoridated water has not been shown to be associated with an increased risk of cardiovascular disease.
It is always important to use only trusted sources, such as the CDC and ADA, for information instead of social media or internet sources. If you have specific questions about oral health, or fluoride, ask a trusted medical or dental professional.
1- For the trivia-curious, the CDC’s 10 greatest public health achievements, in addition to community water fluoridation in the 20th century are: vaccinations, motor vehicle safety, safer workplaces, control of infectious diseases, decline in deaths from coronary heart disease and stroke, safer and healthier foods, healthier mothers and babies, family planning, and recognition of tobacco use as a health hazard.
2- The first city to add fluoride to the public water supply was Grand Rapids, Michigan, in 1945, according to the CDC.
ADA, Fluoridation Facts (Practical Guide Series), 2018, accessed 2021 Aug. 30.
Ten Great Public Health Achievements — United States, 1900-1999, MMWR Weekly, 1999 April 2, accessed 2021 Aug. 30.CDC,
NIH, Fluoride Fact Sheet for Health Professionals, Office of Dietary Supplements, 2021 March 29, accessed 2021 Aug. 30.
Medical News Today, Why Do We Have Fluoride in Our Drinking Water? 2018 Feb. 21, accessed 2021 Aug. 30.
NIH, Fluoridated Water (Common Cancer Myths and Misconceptions), National Cancer Institute, 2017 May 15, accessed 2021 Aug. 31.