As more communities and states around the country are removing fluoride from public drinking water, the U.S. Department of Health and Human Services is also moving to take prescription fluoride products for kids off the market. The HHS claimed fluoride tablets and drops can alter kids’ gut microbiome and lead to other health problems, such as reduced IQ, weight gain and thyroid disorders.
But many dentists are decrying the decision and health assertions, saying that parents should be able to choose to give their kids fluoride. The prescriptions are typically written for kids in areas with low fluoride levels in drinking water, putting them at increased risk for cavities, according to the American Dental Association.
Earlier this year, Utah became the first state to ban fluoride in public drinking water supplies, effective this month. On May 15, Florida became the second state do so.
To support the claims about prescription fluoride in its press release, the HHS linked out to five studies, but none actually looked at fluoride tablets and drops, NBC News reported.
Dental health experts also tell TODAY.com that the studies do not show the gut microbiome being harmed by fluoride, nor decreased IQ or weight-gain issues.
In a statement provided to TODAY.com, the American Dental Association president Dr. Brett Kessler said “proposals like this stand to hurt rural America, not make them healthier.”
Dr. Scott Tomar, a public health dentist and oral epidemiologist at the University of Illinois Chicago, agrees, telling TODAY.com that “regrettably, people in important leadership positions are embracing and misrepresenting weak information and formulating health policies that are not supported by credible evidence.”
What does the research really show about the pros and cons of ingestible fluoride? And how can parents still protect their children’s health if supplementation and public water supplies are no longer an option? TODAY.com spoke with six experts in family medicine and dental health to find out.
Is fluoride bad for you?
It’s true that ingesting too much fluoride is dangerous. “Too much of anything, including fluoride, is usually not a good thing,” Dr. Santina Wheat, a family medicine specialist at Northwestern Medicine tells TODAY.com.
Fluoride in high amounts over a long period of time can cause fluorosis, which can affect your teeth, bones and joints, according to the Cleveland Clinic. Symptoms include discoloration of teeth, bone and joint pain, muscle wasting, constipation and diarrhea.
But according to the experts and the studies provided by HHS, such issues are associated with ingesting amounts of fluoride that far exceed the recommended amount in U.S. water supplies — 0.7 milligrams per liter, according to the National Institutes of Health Office of Dietary Supplements — and what’s prescribed by dentists and physicians.
“One of the reviews (shared in the HHS press release) concluded that exposure of even 25 times the recommended levels of fluoride we add to water was ‘harmless,’” Dr. Bruce Dye, a professor at the University of Colorado School of Dental Medicine on the Anschutz Medical Campus, tells TODAY.com.
In fact, the only purported harms that were found in the research shared by HHS came from “very small studies conducted in parts of rural China that have endemic fluorosis due to extremely high levels of fluoride in their water sources, including water contaminated from coal burning,” says Tomar.
In the statement provided to TODAY.com, the ADA agreed, adding: “A review of the studies offered as referenced by U.S. Department of Health and Human Services do not in fact demonstrate any harmful effects for the concentrations of fluoride prescribed by physicians and dentists.”
The co-author of the largest study referenced by the HHS press release similarly told The New York Times that there is “little evidence” in the research that would justify suspending fluoride use in public water supplies or fluoride tablets.
Regarding fluoride’s alleged harms to the gut microbiome, Tomar says any evidence “is extremely limited and has no relevance to the levels of fluoride used in either water fluoridation or fluoride supplements in the United States.”
What’s more, a recent systematic review of 49 studies concluded that recommended doses of fluoride had “harmless effects” on the microbiome.
Tomar also says he’s never seen any credible evidence that fluoride tablets could cause weight gain or diminished IQ. Dye agrees and says it’s “not wise” to make health policy decisions based on limited studies that primarily originate from areas of the world that don’t match conditions of public water supplies or fluoride tablet distribution in the United States.
In short, “there are no known harms from ingestion of fluoride using recommended amounts of fluoride in water, toothpaste and fluoride supplements,” Dr. Howard Pollick, a dental scientist at the University of California, San Francisco, tells TODAY.com.
The benefits of ingestible fluoride
Not only does research show ingestible fluoride is safe in the recommended amounts, it has also found there are health benefits.
“Over a century of research has shown that fluoride is highly effective at preventing tooth decay, the most common chronic disease among children and adults,” Dr. Rhonda Stephens, a dental public health specialist at the UNC Chapel Hill Gillings School of Global Public Health, tells TODAY.com.
Study after study shows that water fluoridation decreases the risk of dental caries, also known as cavities, and associated tooth decay. “It decreases the risk of caries forming and slows down the progression of any that exist,” says Wheat. “On top of that, fluoride helps decrease gum disease.”
When community water fluoridation has been stopped in other countries, “dental caries increase and (so do) associated problems with it, like toothaches, sleepless nights, abscesses, cost of dental treatment, increased general anesthesia for dental treatment in young children, lost time and productivity from school and work,” Pollick explains.
People in low-income communities especially benefit from fluoride tablets and water fluoridation, research shows. Many people in these areas have “poor access to dental care, so water fluoridation has been and remains the most cost-effective way for all people to have access to the cavity-fighting benefits of fluoride,” Stephens says. “Fluoride supplements were always intended to provide that missing benefit in places where water fluoridation isn’t available.”
How to protect your teeth with fluoride
If there is not adequate fluoride in your drinking water, you can still ask your child’s dentist about prescription fluoride tablets or drops. They should be available for several more months, as the HHS has set a goal of completing a safety review and public comment period for these products by Oct. 31.
Other ways to use fluoride to protect teeth include:
Use fluoridated toothpaste
“Fluoridated toothpaste in the appropriate amounts for children will always be a wise practice for parents and anyone else to fight tooth decay,” says Stephens.
Appropriate amounts, according to the U.S. Centers for Disease Control and Prevention (CDC), are a pea-sized amount on the toothbrush for children ages 3-6, and an amount no bigger than a grain of rice for 2-year-olds. Anyone age 7 and older can use the amount recommended on the bottle or toothpaste tube. For kids younger than 2, consult a health care professional.
The CDC recommends brushing with fluoride toothpaste at least twice a day and not to rinse or eat right after to make sure the fluoride sticks to the tooth surface. “Fluoride toothpaste also increases the amount of fluoride in saliva, which helps rebuild the outer enamel layer,” the agency adds.
Reduce sugar intake
Of course, sugar intake also matters.
“Limit any sugar-containing foods and beverages — including milk — to mealtime, and don’t allow children to sip and snack on them throughout the day,” advises Stephens.
See a dentist regularly
“Dentists, dental hygienists, and pediatricians can apply fluoride varnish to your teeth several times per year if you’re at higher risk for developing cavities,” says Tomar.
Wheat adds that seeing a dentist regularly “can help identify any developing dental caries, and they can make individualized recommendations for prevention and treatment.”
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