Why is fluoride added to drinking water?

Why is fluoride added to drinking water?
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What is the purpose of adding fluoride to water? Since many years, fluoride has been added to drinking water in various places. What is the proof for this practice. Image credit: Catherine Falls Commercial by Getty Images

In the United States, more than 200 millions people live in an area where tap water is fluoridated. The most recent 2012 data shows that 24 countries, including Brazil, the United Kingdom and Canada, add fluoride into their drinking water. Many other jurisdictions ingest fluoride through naturally occurring deposits. Why do we add it to the water? Is it effective and safe?

What started water fluoridation

In the early twentieth century, a dentist named Frederick McKay observed a peculiar phenomenon in Colorado Springs. The residents of Colorado Springs had brown, mottled stains all over their teeth. However, further observation showed that despite the stains that appeared on their teeth, those with “Colorado brown stain” had teeth that seemed unusually resistant against decay. Caries, or tooth decay, can cause holes in the teeth.

The researchers traced the source of the stain back to the water supply of the town, which had abnormally high fluoride levels. Dentists were compelled to look into whether fluoridated drinking water could be used to benefit teeth and prevent staining. Grand Rapids in Michigan was the first place to implement a water fluoridation pilot program. Researchers measured the rate of decay of the teeth of the nearly 30,000 children in Grand Rapids over a decade after adding a little fluoride into the water supply. The researchers found that the children born after the water fluoridation program began, had 60% less cavities than their counterparts born before.

Benefits of Fluoridated Water

The American Dental Association, for example, is a strong advocate of water fluoridation. Numerous studies have shown that fluoridated water prevents children from getting cavities. Receive the most exciting discoveries from around the globe delivered to your email. Neil Maniar, professor of public-health practice at Northeastern University told Live Science via email. “Putting [it] in the water supply is a form of passive prevention that can improve oral health.”

While fluoridated toothpaste shares many of the tooth-protecting qualities of fluoridated drinking water, some experts believe that the latter has certain benefits for public health. This is because, by ingesting the fluoride rather than brushing it with, the fluoride levels in your mouth will remain constant throughout the day. It’s especially good for developing children. The fluoridated water provides an additional level of protection to those with lower incomes who might not always have access to fluoridated dental products or toothpaste. Maniar stated. It was the case in years past, but recent studies have raised questions about how effective fluoridated drinking water can be at preventing cavities.

According to a review of more than 150 studies, fluoridating water may no longer be as effective in preventing dental cavities in recent times as it used to be in the 1970s, when fluoridated tooth paste became widely available. Fluoridated toothpaste may have made a significant difference in the way water is treated. It’s also important to remember that this review didn’t include studies conducted in low-income nations, where it may be harder to find fluoridated tooth paste. It is also noted that the challenges of measuring fluoridation program effects make it difficult to measure their benefits over time.

Does fluoridated drinking water have any risks?

The U.S. Centers for Disease Control and Prevention and the American Dental Association (ADA) both maintain that fluoride at levels in public water supplies — around 0.7mg per liter — is good for public dental health and carries little documented risk. Fluoride is still the subject of controversy and much research on safety. The condition that McKay observed in Colorado Springs “Colorado brown stain” is fluorosis, which can be caused by excessive consumption of fluoride. Fluorosis in the mouth is characterized by mottled spots of white, brown or yellow on teeth. It does not affect oral health. Even higher fluoride levels over time may cause skeletal fluorosis, which can compromise the integrity of bones. The excessive fluoride deposits in the skeleton cause the bones to be brittle and hard, increasing their susceptibility to fractures. Dental fluorosis, as well as skeletal fluorosis are more common in areas with high natural fluoride levels that leak into water supplies. Because skeletal fluorosis requires extremely high levels of fluoride exposure, it’s mostly observed in regions with fluoride-contaminated groundwater , but dental fluorosis can occur due to low-level fluoride exposure through artificially fluoridated water .

The initial concerns regarding fluoridated drinking water were centered around whether or not it caused cancer. The belief was based on the idea that a buildup of fluoride in the bone growth plates could cause osteosarcoma. Most studies, while difficult to assess in humans due to the difficulty of evaluating this link, have found no strong evidence that such a connection exists. Recent concerns about fluoride’s neurotoxic potential have also been voiced. The U.S. National Toxicology Program conducted a review in 2024 that found high fluoride levels to be associated with lower IQ among children.

The levels of exposure that were associated with IQ change, however, were about twice as high as the fluoride levels found in the water supply of the U.S. and the U.K. – around 1.5mg per liter. While fluoride concentrations are associated to cognitive differences among children, the authors note that their findings do not prove that fluoride causes cognitive changes. These results collectively point to a toxicological saying: “The dose makes the poison.” A substance may be harmless in small quantities, but dangerous in large amounts. A tablespoon of soysauce is safe to eat, but an entire bottle could cause seizures. Researchers are still investigating how much fluoride is needed to cause neurologic effects. The results so far are mixed. A few dozen studies found a correlation between executive function and IQ, as well as fluoride levels in water that has been artificially fluoridated. However, many other studies failed to confirm this relationship.

Many of the studies that have found negative effects from fluoride are also poor quality. They may be plagued by issues like small sample sizes and inconsistent methods. Studies of high quality were more likely to find a connection between exposure to fluoride and adverse cognitive outcomes. It is also difficult to compare studies when they use different methods, examine different outcomes or focus on populations.

Because different studies have contradictory results, there is no single study which can be used to prove or refute the safety of Fluoride. Many experts believe that more research of high quality is needed before a definitive conclusion can be made about the safety or fluoride. Deborah Dewey, professor of pediatrics at the University of Calgary, and author of the study that investigated fluoride and executive functions in preschoolers, spoke to Live Science. “I don’t think there’s a right or wrong answer right now.”

Fluoride, oral equity and equity of access

Maniar says that the discussion on fluoride should be about oral equity. Maniar stated that

“Rather than focusing on fluoridation, we should be talking about the disparities that exist in oral health care, the cost burden of routine oral health care, and the significant gaps that exist related to education on oral health,” . He said

“The linkage between oral health and a range of serious health issues is becoming more clear every day,” in reference to studies that link poor oral hygiene with conditions such as heart disease and pneumonia. “It’s critical that we deploy all available tools to address oral health in the same manner that we would address physical and mental health.”

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