This Is What Could Happen To Americans’ Teeth If They Take Fluoride Out Of The Water

Water fluoridation has arguably never been a hotter topic in US political and scientific circles. Since first being introduced in Michigan in 1945, the addition of fluoride to public drinking water has been celebrated as a big win for oral health, but has also attracted fierce criticism. Now, with moves being made to ban fluoridation, scientists have projected the potential impact that could have on the nation’s teeth – and it’s not great news. 

Fluoridation: the arguments against

Earlier this year, US Health and Human Services Secretary Robert F. Kennedy Jr reportedly said he was planning to rescind the Centers for Disease Control and Prevention (CDC) recommendation to add fluoride to drinking water. At the same time, the Environmental Protection Agency (EPA) announced plans to review the scientific evidence around the potential health risks of fluoride. 

For the fluoride skeptics, this was a dream come true. Campaigners have fought for the cessation of water fluoridation for years due to fears that excessive fluoride exposure could have neurotoxic effects.

It’s true that high-dose fluoride is a neurotoxin for humans – that’s why your toothpaste carries warnings about swallowing too much. Children’s bodies can handle even less than adults’, so we need to take extra care to avoid overexposure in kids. But fluoridated water conforming to the EPA’s current recommendations shouldn’t get anywhere near dangerous levels.

And there’s a reason why fluoride was added in the first place.

Fluoride and oral health

“Fluoride prevents tooth decay through two mechanisms: by converting hydroxyapatite in tooth enamel to the more acid-resistant fluorhydroxyapatite and by inhibiting some bacterial enzymes,” explain Sung Eun Choi of Harvard School of Dental Medicine and Lisa Simon of Brigham and Women’s Hospital, co-authors of a new study.

So important is the role of fluoride in preventing dental disease, they point out, it’s been recommended that children without access to fluoridated water receive either oral fluoride supplements or topical fluoride applied straight to their teeth.

In Windsor, Ontario, an experiment to stop adding fluoride to the water supply was rapidly rolled back after only five years due to soaring levels of tooth decay. Comparisons of two other Canadian cities in the province of Alberta, Calgary and Edmonton, found that children’s dental health declined after fluoridation was stopped in Calgary, whereas Edmonton – with fluoridation ongoing – saw much better outcomes. In the US, analysis of health data from Juneau, Alaska, saw an increase in children getting treated for dental caries when fluoridation was stopped in 2007.

Choi and Simon wanted to simulate a similar experiment for the whole country, predicting what could happen over the next five and 10 years if fluoridation were to be stopped. They used data from 8,484 children included in the US National Health and Nutrition Examination Survey between 2013 and 2016. 

In a scenario with no fluoridation, they projected that dental caries and tooth decay would increase by 7.5 percentage points over five years, adding up to 25.4 million cases. They also noted that the impact would be felt more by families with no health insurance or public health insurance for their children, as opposed to private policies.

They estimated that a total cessation of fluoridation would cost $9.8 billion over five years, increasing to $19.4 billion after 10 years as a result of all the extra cases of tooth decay and associated complications.

“This cost-effectiveness analysis found that cessation of public water fluoridation would increase tooth decay and health system costs in the US,” Choi and Simon concluded. “Despite concerns regarding toxic effects associated with high levels of fluoride, this model demonstrates the substantial ongoing benefits of water fluoridation at safe levels currently recommended by the US [EPA], the National Toxicity Program, and the [CDC].”

The study was limited to dental health, and did not look at other potential effects of fluoridation; however, Choi and Simon point out that over 99 percent of public water fluoridation is within the thresholds set by the EPA, which “are not definitively associated with worse neurobehavioral outcomes.”

When it comes to children’s teeth, the data falls squarely on the side of continuing fluoridation, the analysis concludes.

The study is published in the journal JAMA Health Forum.