For the first time in 50 years, the U.S. has lowered the recommended fluoride recommendations. As a pediatric dentist focused on prevention, here is a quick run down and my opinion:

The old guidelines: 0.7 ppm to 1.2 ppm depending on the average temperature. (ppm stands for parts per million)

The thought process was those living in hotter climates will drink more water, so they should have the lower lever of fluoride (0.7 ppm). Those living in cooler climates will drink less water, so could use more fluoride concentration (up to 1.2 ppm).

The new guidelines: The recommended guidelines are now a flat 0.7 ppm for all climates.

I think this is a step in the right direction. The thought process is that there are plenty of other sources of fluoride that we swallow. This includes small amounts of toothpaste every night, and the “halo effect” of fluoride, such as buying a product made with fluoridated water elsewhere.

Fluoride has been shown to help reduce the effect of the acid attack by bacteria make on teeth and thereby can potentially help reduce cavities. How it does this, exactly, is up for debate.

I believe most of the evidence leans towards fluoride in the water helping our teeth by rinsing over the enamel, and not by swallowing it. This is admittedly hard to study. However, rinsing enamel with fluoride has less chance of side effects than swallowing it, for obvious reasons.

Getting fluoride at your dentist every six months helps with the “topical” effect of coating the enamel with fluoride. There is less chance of fluorosis with fluoride at your dentist every six months as compared to swallowing too much toothpaste every night. (That is why it is important to use a rice sized amount for small children, and a pea sized amount once children are old enough to spit.)

Like any mineral, vitamin, or drug… too much is bad, but too little can bad as well. An extreme example… salt. Sodium Chloride (salt) is required to live. If you drink extreme amounts of salt, you would die. If you (somehow) were to manage no salt whatsoever, you would die. Both extremes are very difficult to achieve. There is obviously a wide range of safety. The same is true with fluoride.

With fluoride… too little and cavities (big brown holes) can be much easier to achieve. If you double the amount of recommended fluoride and swallow it daily, you run into the range of getting little white spots on your adult teeth (fluorosis.) There is no harm, but it doesn’t look cosmetically pleasing. If you have extreme amounts of fluoride (5-8 times the recommended amount) swallowed daily for years (like in some parts of the world where it occurs naturally in the water supply), then teeth are not formed correctly and other bad things can happen. I wouldn’t worry about these things unless you live in a place like Durango, Mexico.

For some families who are very educated about my philosophy that diet is the best way to prevent cavities and have a better diet than my own family, I would argue that fluoride in the water is not important for that particular family. This is probably a very small percentage of American households who have made the sacrifice to give up most processed foods. Not just sugar, but almost all flour. Also, not eating bananas or oranges all day, and following my other prevention principles and then some.

I still give my kids plenty of processed foods, like ice cream after dinner, macaroni and cheese for lunch, and whole grain breads. I still try to keep crackers reserved for preschool and on the go. But, I give them a small amount of fluoride toothpaste on their tooth brush every night, and I don’t buy bottled water. We drink the fluoridated stuff from the tap.

My only exception is: for infants.

Although my wife was able to exclusively breastfeed our daughters up to age one, I know that can be difficult or not possible with some children. If my child were to exclusively use formula, I would buy non-fluoridated water for formula use under age one.

If my assumption is correct: that fluoride helps more by passing over the teeth than by swallowing it, there is not much of a benefit under age one for fluoridated water in large quantities. Also, an infants weight is so small, they could get a relatively large amount of fluoride concentration from drinking formula, which could potentially increase the risk for spots on the teeth (fluorosis). As a child gains more weight (ages one and up), the risk of this theoretically diminishes.

Most families in America are not even aware that crackers and dry cereal can cause cavities. Unfortunately, there are still a large percentage of parents who may not even bring their child in to the dentist until ages 4 or 5. I still see this every day.

In my opinion, the fluoride is in the water for the children who are not able to see a dentist, and because we are hooked on processed flour.

So, until they put a warning label on all crackers and juice that they can cause cavities (which isn’t happening any time soon), fluoridated water is, in my opinion, a good public health measure.

I would only recommend to cut out fluoridated water if you also cut all all processed food.

Having a newborn baby, my family is not doing that anytime soon, so I happily give my kids normal tap water.

Dr. Lucas