Why We Choose to Be Fluoride-Free

As an Austin pediatric dental practice, we put a lot of emphasis on prevention, especially through nutrition, good home hygiene, and investigating the factors contributing to poor tooth formation and decay. Although there are studies that discuss the benefits of topical fluoride on the teeth, there can also be risks to its use. We limit the use of fluoride but remain receptive to parent’s inquiries about fluoride. Dr. Evy explains the pros and the cons during new patient visits to further educate them about the use of fluoride at home and at the dental office. Some parents choose to make our office their child’s dental home for this reason.

Fluoride is not an essential nutrient, for dental benefits its main benefit is when it is applied topically (on the surface of the tooth), however, it is a neurotoxin, meaning that it’s poisonous to the brain. Children are particularly susceptible, as their brains are still developing. In fact, as one 2017 study showed, it can even affect them while they’re still in the womb. The greater the exposure to fluoride while in the womb, the lower their scores on cognitive testing at 4 and 6 to 12 years old.

Over the years, research has linked fluoride toxicity to a range of chronic health problems, including thyroid disorders, kidney problems, and even some cancers. At best, too much fluoride leads to dental fluorosis, especially in kids. It shows up as stained, pitted, and weakened teeth.

Rates of fluorosis have skyrocketed through recent years. It now affects 57% of youth aged 6 to 19, even as rates of decay have gone up, as well.

And no wonder. Children today are exposed to more fluoride than ever. About two-thirds of the US population receives fluoridated water. Most every toothpaste you find in your local grocery or big box store contains the stuff. So do many mouth rinses. Even dental floss sometimes comes with fluoride.

This is exactly why, several years back, the Department of Health and Human Services recommended that maximum fluoride levels in water should be reduced from 1.0 part per million (ppm) to 0.7ppm.

Still, you have to ask: Do the benefits of fluoride outweigh the costs? Not as much as you might think, according to recent research.

One fascinating study published last year in Chile reviewed a large body of controlled studies on the systemic effects of swallowing fluoride and evaluated the impact of that country’s fluoridation program. Chile is considered “a pioneer in the fluoridation of drinking water,” with more than 80% of the population receiving it.

What did its authors find after reviewing the science?

a) The effects of fluoride intake impose risks of various diseases in the astero-skeletal, neurological, endocrine and skin systems. Dental and skeletal fluorosis are signs of chronic and excessive fluoride intake.

b) Infants, children and adolescents are at high risk of diseases due to over-ingestion of fluorides, through drinking water and / or fluoridated milk, as the deterioration of health is proportional to the dose and time of exposure.

c) The fluoridation of drinking water does not significantly impact the prevention of caries. For its effectiveness is rather, by topical and non-systemic effect, as demonstrated by countries that do not fluoride into drinking water, and do not use milks or fluoride salts, decreasing dental deterioration at the same rate as those that fluoridate drinking water.

Are the results any better when fluoride is applied directly to the teeth? Not necessarily.

For instance, one recent study compared the effects of fluoride treatments on two groups of children, 40 at high risk of early childhood caries and 40 who were similar in all ways except their risk was lower. (“Caries” is the clinical term for decay.) Kids in the high risk group had fluoride varnish applied to their teeth three times over a two week period, and again after one and three months. The other kids received standard care: semi-annual fluoride varnish treatment.

As it turned out, the intensive fluoride treatment didn’t reduce decay in the front teeth. But get this: Kids who received the intensive treatment actually developed more decay on their back teeth.

The authors concluded that there was no practical advantage of using the intensive treatment.

Or consider the study published last summer in the Journal of Dental Research. In this case, over 1200 2- and 3-year olds were split into two groups. One got fluoride treatments every 6 months for three years. They were also given toothbrushes, fluoride toothpaste, and standard dental advice. The other served as a control group and got only advice.

After three years, 39% of kids in the control group had developed caries. The rate was only slightly lower for the kids who got fluoride treatments: 34%. The control group averaged 9.6 decayed surfaces versus. 7.2 in the fluoride group.

The authors thus concluded,

This well-conducted trial failed to demonstrate that the intervention kept children caries free, but there was evidence that once children get caries, it slowed down its progression.

You have to ask, though: Are those modest benefits worth the kinds of risks noted above?

Fluoride in dental sealants – protective coatings placed on the teeth to prevent caries – doesn’t fare much better. A study just published in Caries Research, for instance, compared fluoride and fluoride-free resin sealants placed in a high risk population. Both types of sealants were found to limit decay, whether or not they contained fluoride.

The sealant was what worked. It wasn’t about the fluoride.

In light of such research and our knowledge of the health risks of fluoride, we opt not to use it routinely in our practice. When we place sealants or tooth colored fillings, we use fluoride-free (and BPA-free) composite resins. We don’t recommend fluoride supplements or varnishes. We encourage our patients to drink only non-fluoridated water and to use fluoride-free toothpastes and rinses.

Above all, we encourage taking a holistic approach to your family’s oral health, focusing on hygiene, nutrition*, and keeping a healthy gut – essential to absorb those nutrients properly – as the most productive ways to keep teeth healthy and whole for a lifetime.

* If your child takes medications regularly, ask that they be sweetened with sugar-free alternatives to limit added sugars in their diet.

Faucet image by Steve Johnson, via Flickr;
sealants image Perfect Smile