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Fluoride in Toothpaste Is Good, But Fluoride in Water Is NOT

Scientists are only now finding out how toxic fluoride is. Time Magazine notes:

What has … changed is how much toxicologists know about the harmful effects of fluoride compounds.

And see this and this.

But everyone agrees on the benefits of water fluoridation in protecting against cavities, right? For example, it is well-known that the number of cavities have plummeted in the U.S. over the last couple of decades, after water fluoridation was introduced.

Maybe, but they have also plummeted in countries which do not fluoridate their water.

Specifically, Science magazine noted in 1982:

The decline in caries prevalence in communities without fluoridated water in various countries is well documented. The cause or causes are, at this time, a matter of speculation.

The Journal of Public Health Dentistry noted in 1985:

Even the most cursory review of the dental literature since 1978 reveals a wealth of data documenting a secular, or long term, generalized decline in dental caries throughout the Western, industrialized world. Reports indicate that this decline has occurred in both fluoridated and fluoride-deficient areas, and in the presence and absence of organized preventive programs.

The prestigious science journal Nature noted in 1986:

[D]uring the period 1979-81, especially in western Europe where there is little fluoridation, a number of dental examinations were made and compared with surveys carried out a decade or so before. It soon became clear that large reductions in caries had been occurring in unfluoridated areas. The magnitudes of these reductions are generally comparable with those observed in fluoridated areas over similar periods of time

The Journal of the American Dental Association noted in 1988:

The current reported decline in caries tooth decay in the US and other Western industrialized countries has been observed in both fluoridated and nonfluoridated communities, with percentage reductions in each community apparently about the same

The Boston Globe reported in 1989:

The debate over fluoridating public water supplies, a measure long credited with producing a dramatic drop in tooth decay in the United States, is being rekindled by new studies suggesting the decline may have more to do with other causes, including other sources of fluoride.

The most exhaustive study ever conducted on the dental health of American children, conducted in 1986-87, has confirmed the great decline in cavities in the last 10 years, but it found much less difference than expected between areas with and without fluoridated water.

The Journal of Public Health Dentistry noted in 1991:

During the past 40 years dental caries h as been declining in the US, as well as in most other developed nations of the world... The decline in dental caries has occurred both in fluoride and in fluoride-deficient communities, lending further credence to the notion that modes other than water fluoridation, especially dentrifices, have made a major contribution.

The Critical Review of Oral Biology and Medicine noted in 2002:

It is remarkable, however, that the dramatic decline in dental caries which we have witnessed in many different parts of the world (for reviews, see Glass, 1982; Fejerskov and Baelum, 1998) has occurred without the dental profession being fully able to explain the relative role of fluoride in this intriguing process. It is a common belief that the wide distribution of fluoride from toothpastes may be a major explanation (Bratthall et al., 1996), but serious attempts to assess the role of fluoridated toothpastes have been able to attribute, at best, about 40-50% of the caries reduction to these fluoride products (Marthaler, 1990; Scheie, 1992). This is not surprising, if one takes into account the fact that dental caries is not the result of fluoride deficiency.

The International Society of Fluoride Research noted in 2005:

Graphs of tooth decay trends for 12 year olds in 24 countries, prepared using the most recent World Health Organization data, show that the decline in dental decay in recent decades has been comparable in 16 nonfluoridated countries and 8 fluoridated countries which met the inclusion criteria of having (i) a mean annual per capita income in the year 2000 of US$10,000 or more, (ii) a population in the year 2000 of greater than 3 million, and (iii) suitable WHO caries data available. The WHO data do not support fluoridation as being a reason for the decline in dental decay in 12 year olds that has been occurring in recent decades.

The British Medical Journal noted in a 2007 paper:

Although the prevalence of caries [i.e. cavities] varies between countries, levels everywhere have fallen greatly in the past three decades, and national rates of caries are now universally low. This trend has occurred regardless of the concentration of fluoride in water or the use of fluoridated salt, and it probably reflects use of fluoridated toothpastes and other factors, including perhaps aspects of nutrition.

Clinical Oral Investigations noted in 2007:

In most European countries, where community water fluoridation has never been adopted, a substantial decline in caries prevalence has been reported in the last decades, with reductions in lifetime caries experience exceeding 75%.

And data published by the World Health Organization shows this dramatic plunge in cavities in virtually all countries (chart courtesy of Chris Neueth, Fluoride Action Network):

Topical Application to Teeth Versus Ingestion in Drinking Water

Much of the confusion about fluoride comes from the fact that dentists assumed for decades that oral ingestion helped get fluoride to the teeth, but it is now understood that topical application – with toothpastes, gels or rinses – works better.

The Centers for Disease Control noted in a 1999 report:

Laboratory and epidemiologic research suggests that fluoride prevents dental caries predominately after eruption of the tooth into the mouth, and its actions primarily are topical for both adults and children.

Dr. Arvid Carlsson – Nobel prize winner in medicine in 2000 – points out (in a brief, must-watch video) that water fluoridation goes against all principles of pharmacology, because fluoride works topically on teeth, not by oral ingestion.

A petition signed by Dr. Carlsson, as well as three members of the prestigious 2006 National Research Council (NRC) panel that reported on fluoride’s toxicology, two officers in the Union representing professionals at EPA headquarters, the President of the International Society of Doctors for the Environment, and hundreds of medical, dental, academic, scientific and environmental professionals, worldwide, states:

The CDC [conceded], in 1999 and 2001, that the predominant benefit of fluoride in reducing tooth decay is TOPICAL and not SYSTEMIC. To the extent fluoride works to reduce tooth decay, it works from the outside of the tooth, not from inside the body. It makes no sense to drink it and expose the rest of the body to the long term risks of fluoride ingestion when fluoridated toothpaste is readily available.

Fluoride’s topical mechanism probably explains the fact that, since the 1980s, there have been many research reports indicating little difference in tooth decay between fluoridated and non-fluoridated communities (Leverett, 1982; Colquhoun, 1984; 1985 and 1987; Diesendorf, 1986; Gray, 1987; Brunelle and Carlos, 1990; Spencer,1996; deLiefde, 1998; Locker, 1999; Armfield and Spencer, 2004; and Pizzo 2007 – see citations). Poverty is the clearest factor associated with tooth decay, not lack of ingested fluoride. According to the World Health Organization, dental health in 12-year olds in non-fluoridated industrialized countries is as good, if not better, than those in fluoridated countries (Neurath, 2005).

Time Magazine notes:

Because toothpaste is designed to be spit out, it’s a more efficient way to get the decay-fighting ingredient where it is needed and nowhere else. Even some dentists, who see firsthand the benefits of fluoridation, wonder whether people who get fluoride from toothpaste should get it in their drinking water as well.

As ABC News’ medical and scientific journalist, Nicholas Regush, writes

The fluoride is in your toothpaste to fight cavities. When it comes into direct contact with teeth, fluoride appears to help. The much bigger questions are whether we need to fluoridate the entire water supply to achieve this and whether water fluoridation, an indirect method to fight cavities, actually works.


What is amazing, however, is that public health policy in this country has allowed water fluoridation to continue in the absence of solid scientific evidence that its benefit is greater than its risk.

When you commit to putting a powerful chemical into the water supply, you’d better have the best of evidence that it is both safe and effective. The required level of evidence is just not there.

Similarly, the Environmental Working Group – a science-based group which has conducted research into and helped publicize many toxic chemical dangers, such as Bisphenol A and drinking water pollution – says:

The Environmental Working Group supports the use of fluoride in toothpaste, where there is strong evidence of its effectiveness. But EWG’s analysis concludes that fluoridation of public water supplies should end, because the risks outweigh possible benefits, especially for infants and young children, because they consume more water than adults relative to their size.

When Fluoridation Is Stopped, Cavities Do Not Increase

Further evidence of the ineffectiveness of water fluoridation is that the scientific literature shows that – when fluoridation of water supplies is stopped – cavities do not increase, but may in some cases actually decrease. See this, this, this, this, this and this.

Scientists have proposed different explanations. See, for example, this:

Factors other than fluoride, such as food additives and antibiotics, may have contributed.


The caries decline is probably caused by a broader availability of fluorides, a high level of individual dental curative and preventive care (fissure sealings) and by changed oral health behaviour and nutritional habits. Reference is made to a possible tangent between a high level of antibiotics consumption and the virulence of oral pathogenic streptococci.

And this:

The causes for the changed caries trend were seen on the one hand in improvements in attitudes towards oral health behaviour and, on the other hand, to the broader availability and application of preventive measures [including fluoride toothpaste].

Top Experts Change Their Mind

Several prominent leaders of the pro-water fluoridation movement have recently admitted publicly that they were wrong, including:

  • John Colquhoun, DDS, Principal Dental Officer for Auckland, New Zealand and chair of that country’s Fluoridation Promotion Committee, reviewed New Zealand’s dental statistics in an effort to convince skeptics that fluoridation was beneficial and found that tooth decay rates were the same in fluoridated and nonfluoridated places, which prompted him to re-examine the classic fluoridation studies. He withdrew his support for it in “Why I Changed my Mind About Water Fluoridation” (Perspectives in Biology and Medicine 1997;41:29—44).
  • And Richard G. Foulkes, MD, a health care administrator and former assistant professor in the Department of Health Care and Epidemiology at the University of British Columbia also switched from pro to anti- water fluoridation after studying the issue.

Bottom Line

While there is evidence that the topical application of fluoridated toothpaste may help prevent cavities, there is substantial evidence that ingesting fluoridated water does not help prevent cavities.

Therefore, fluoridation should be taken out of the water supply. In the meantime, some water filters can remove up to 95% of the fluoride from your drinking water.

For those who do not wish to use fluoride toothpaste, make sure you eat enough calcium-rich foods, as calcium makes enamel more resistant to demineralization and, thus, resistant to decay.

Chewing gum products have recently been developed with friendly bacteria which attack cavity-causing bacteria.

As the BBC noted in 2006:

Scientists have developed a chewing gum containing friendly bacteria which they say can help prevent tooth decay.

The good bugs in the gum prevent other harmful mouth bacteria from sticking to and attacking the teeth.

Toothpastes and mouthwashes containing Lactobacillus anti-caries are also in the pipeline ….

The bacterium responsible for dental cavities, Streptococcus mutans, persistently colonises the surface of the teeth, where it converts sugar into aggressive acids that breaks down the enamel.

L. anti-caries reduces the concentration of this harmful bacterium in the mouth making S. mutans clump together, preventing them from adhering to the teeth.

The BASF scientists say the gum has been tested on large numbers of people and has the ability to significantly reduce bacterial levels.

These “probiotic chewing gums” are now widely available in bigger pharmacies.

In addition, new studies show that xylitol helps to remineralize teeth (my own dentist suggested that I use toothpaste containing xylitol). Preliminary studies also show that compounds in cranberries and licorice root may help to inhibit cavities. As may the tannins in dark chocolate, coffee (add milk to reduce acidity), tea, grapes, persimmons, blueberries, blackberries, apricots, ripe pomegranates, bilberry, the red skin of apples and pears or ripe bananas.

Decongestants, antihistimines and many other medicines dry out your mouth. Reduced saliva means more cavities. So if you’re taking medicines which dry out your mouth, take sips of water frequently to wet your whistle. Chewing sugarless (e.g. xylitol) gum also helps, and pineapple is a natural saliva stimulant.

Obviously, good oral care – including flossing, brushing after meals (and snacks), and getting regular checkups from your dentist – are also important.

View the original article at Washingtons Blog

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