Fluoride: Risks, uses, and side effects (2023)

Fluoride is found naturally in soil, water, and foods. It is also produced synthetically for use in drinking water, toothpaste, mouthwashes and various chemical products.

Water authorities add fluoride to the municipal water supply, because studies have shown that adding it in areas where fluoride levels in the water are low can reduce the prevalence of tooth decay in the local population.

Tooth decay is one of the most common health problems affecting children. Many people worldwide cannot afford the cost of regular dental checks, so adding fluoride can offer savings and benefits to those who need them.

However, concerns have arisen regarding fluoride’s effect on health, including problems with bones, teeth, and neurological development.

Fast facts about fluoride

  • Fluoride comes from fluroine, which is a common, natural, and abundant element.
  • Adding fluoride to the water supply reduces the incidence of tooth decay.
  • Fluoride protects teeth from decay by demineralization and remineralization.
  • Too much fluoride can lead to dental fluorosis or skeletal fluorosis, which can damage bones and joints.

Excessive exposure to fluoride has been linked to a number of health issues.

Dental fluorosis

Fluoride: Risks, uses, and side effects (1)
A fluoride content of 0.7 ppm is now considered best for dental health. A concentration that is above 4.0 ppm could be hazardous.

Exposure to high concentrations of fluoride during childhood, when teeth are developing, can result in mild dental fluorosis. There will be tiny white streaks or specks in the enamel of the tooth.

This does not affect the health of the teeth, but the discoloration may be noticeable.

Breastfeeding infants or making up formula milk with fluoride-free water can help protect small children from fluorosis.

Children below the age of 6 years should not use a mouthwash that contains fluoride. Children should be supervised when brushing their teeth to ensure they do not swallow toothpaste.

(Video) Fluoride: Risks, Uses and Side effects - Is Fluoride Harmful for Health?

Skeletal fluorosis

Excess exposure to fluoride can lead to a bone disease known as skeletal fluorosis. Over many years, this can result in pain and damage to bones and joints.

The bones may become hardened and less elastic, increasing the risk of fractures. If the bones thicken and bone tissue accumulates, this can contribute to impaired joint mobility.

Thyroid problems

In some cases, excess fluoride can damage the parathyroid gland. This can result in hyperparathyroidism, which involves uncontrolled secretion of parathyroid hormones.

This can result in a depletion of calcium in bone structures and higher-than-normal concentrations of calcium in the blood.

Lower calcium concentrations in bones make them more susceptible to fractures.

Neurological problems

In 2017, a report was published suggesting that exposure to fluoride before birth could lead to poorer cognitive outcomes in the future.

The researchers measured fluoride levels in 299 women during pregnancy and in their children between the ages of 6 and 12 years. They tested cognitive ability at the ages of 4 years and between 6 and 12 years. Higher levels of fluoride were associated with lower scores on IQ tests.

In 2014, fluoride was documented as a neurotoxin that could be hazardous to child development, along with 10 other industrial chemicals, including lead, arsenic, toluene, and methylmercury.

Other health problems

According to the International Association of Oral Medicine and Toxicology (IAOMT), an organization that campaigns against the use of added fluoride, it may also contribute to the following health problems:

  • acne and other skin problems
  • cardiovascular problems, including arteriosclerosis and arterial calcification, high blood pressure, myocardial damage, cardiac insufficiency, and heart failure
  • reproductive issues, such as lower fertility and early puberty in girls
  • thyroid dysfunction
  • conditions affecting the joints and bones, such as osteoarthritis, bone cancer, and temporomandibular joint disorder (TMJ)
  • neurological problems, possibly leading to ADHD

One review describes fluoride as an “extreme electron scavenger” with an “insatiable appetite for calcium.” The researchers call for the balance of risks and benefits to be reconsidered.

Fluoride poisoning

Acute, high-level exposure to fluoride can lead to:

  • abdominal pain
  • excessive saliva
  • nausea and vomiting
  • seizures and muscle spasms

This will not result from drinking tap water. It is only likely to happen in cases of accidental contamination of drinking water, due, for example to an industrial fire or explosion.

It is worth remembering that many substances are harmful in large quantities but helpful in small amounts.

Fluoride: Risks, uses, and side effects (2)
Fluoride is added to many dental products.

(Video) Is Fluoride Safe??

Flouride exists in many water supplies, and it is added to drinking water in many countries.

It is also used in the following dental products:

  • toothpaste
  • cements and fillings
  • gels and mouthwashes
  • varnishes
  • some brands of floss
  • fluoride supplements, recommended in areas where water is not fluoridated

Non-dental sources of flouride include:

  • drugs containing perfluorinated compounds
  • food and beverages made with water that contains fluoride
  • pesticides
  • waterproof and stain-resistant items with PFCs

Excess fluoride exposure may come from:

  • public water fluoridation
  • high concentrations of fluoride in natural fresh water
  • fluoridated mouthrinse or toothpaste
  • untested bottled water
  • inappropriate use of fluoride supplements
  • some foods

Not all fluoride exposure is due to adding the chemical to water and dental products.

Some geographical areas have drinking water that is naturally high in fluoride, for example, southern Asia, the eastern Mediterranean, and Africa.

Possible side effects of excessive fluoride intake include:

  • discoloration of teeth
  • bone problems

Other possible side effects are listed under the “risks” section above.

Fluoride: Risks, uses, and side effects (3)
Flouride has been linked to a reduction in tooth decay.

The American Dental Association (ADA) says fluoride in water benefits communities because it:

  • reduces tooth decay by 20 to 40 percent
  • protects against cavities
  • is safe and effective
  • saves money on dental treatment
  • is natural

Fluoride is present in natural water. Adding fluoride, says the ADA, is like fortifying milk with vitamin D, orange juice with calcium, or cereals with B vitamins and folic acid.

(Video) The Dangers of Fluoride on the Brain and IQ with Dr. Mark Burhenne

Studies continue to show that adding fluoride to water supports dental health.

A Cochrane review published in 2015 found that when fluoride was introduced to water:

  • Children had 35 percent fewer decayed, missing, or filled baby teeth.
  • There was a 15-percent increase in children with no decay in their baby teeth.
  • The proportion of children with no decay in their permanent teeth rose by 14 percent.

Applying fluoride on children’s teeth can prevent or slow decay.

How does it work?

Fluoride prevents tooth decay by:

  • changing the structure of the developing enamel in children under the age of 7 years, so that it is more resistant to acid attack
  • providing an environment where better quality enamel is formed, which is more resistant to acid attack
  • reducing the ability of bacteria in plaque to produce acid

This involves the following processes:

Protection from demineralization: When bacteria in the mouth combine with sugars, they produce acid. This acid can erode tooth enamel and damage our teeth. Fluoride can protect teeth from demineralization that is caused by the acid.

Remineralization: If acid has already caused some damage to the teeth, fluoride accumulates in the demineralized areas and begins strengthening the enamel. This is remineralization.

Who benefits the most?

Everyone can benefit from added dental protection, but those who can benefit particularly are people who:

  • enjoy snacking
  • have poor dental hygiene
  • have little or no access to a dentist
  • follow diets that are high in sugars or carbohydrates
  • have had bridges, crowns, braces, and other restorative procedures
  • have a history of tooth decay or cavities

Most public health authorities and medical associations worldwide recommend that children and adults receive some fluoride, to protect their teeth from decay.

Fluoride: Risks, uses, and side effects (4)
Small amounts of fluoride are unlikely to be dangerous.

Here are some facts supporting the use of fluoride:

  • From 2000 to 2004, 125 communities in 36 states of the U.S. voted to adopt fluoridation.
  • In the right amounts, fluoride helps prevent dental decay.
  • It is similar to adding vitamins to foods.
  • Using fluoride in water to protect teeth reduces the need for costly dental procedures.
  • Over 100 national and international health and other organizations recognize the benefits of added fluoride.

Here are some arguments against its use, from the IAOMT:

  • Fluoride is a neurotoxin which, in high doses, can be harmful.
  • Excessive exposure can lead to tooth discoloration and bone problems.
  • There is enough fluoride in the water already, without adding more.
  • People have the right to choose whether or not they take medications.
  • Different people need different amounts of substances such as fluoride.
  • Current levels of fluoride in the water may not be safe.
  • It may be harmful for the environment.


(Video) The Truth About Fluoride | The Good.... And The Bad!

The controversy continues over whether it is a good idea to add fluoride to water or not.

In 2000, German researchers reported that tooth decay fell in cities where fluoride ceased to be added to the water.

However, they called for further investigation into the reasons for this decline, which they said could be due to improved attitudes toward dental health and easier access to dental health products, compared with the years before fluoride was added.

They suggested that their findings might support the argument that caries can continue to fall if the concentration of fluoride is reduced from 1 part per million (ppm) to below 0.2 ppm.

How much fluoride is recommended?

The Department of Health and Human Services (DHHS) sets the optimal level of fluoride for preventing tooth decay at 0.7 ppm, or 0.7 milligrams (mg) in every liter of water.

The previous figure, in force from 1962 to 2015, was 0.7 to 1.2 ppm. In 2015, it was revised to the lower limit.

The aim of this optimal level is to promote public health.

What does the WHO say?

The World Health Organization (WHO) notes that long-term exposure to drinking water that contains more than 1.5 ppm fluoride can lead to health problems. The WHO’s guideline limit is 1.5 ppm.

How much does the EPA allow?

The Environmental Protection Agency (EPA) aims to protect people from over-exposure to toxic chemicals.

It sets the maximum allowable level at 4 ppm, and a secondary maximum level at 2 ppm. People are asked to inform the EPA if levels are above 2 ppm. Levels above 4 ppm could be hazardous.

In areas where water naturally contains higher levels of fluoride, community water systems must ensure that the maximum level is no higher than 4 ppm.

As with any substance, excess intake or exposure can be harmful.

It is important not to use any fluoride supplements without first speaking to a dentist.

(Video) Fluoride in Water - The Good, The Bad & The Ugly

Read the article in Spanish.


What is fluoride used for? ›

Fluoride is used to prevent tooth decay. It is taken up by teeth and helps to strengthen teeth, resist acid, and block the cavity-forming action of bacteria. Fluoride usually is prescribed for children and adults whose homes have water that is not fluoridated (already has fluoride added).

Is fluoride harmful to the body? ›

If someone is exposed to levels higher than this for a long time, it can cause a condition called skeletal fluorosis, in which fluoride builds up in the bones. This can eventually result in joint stiffness and pain, and can also lead to weak bones or fractures in older adults.

What is the use of fluoride toothpaste? ›

It can help prevent tooth decay, which is why it's added to many brands of toothpaste and, in some areas, to the water supply through a process called fluoridation.

What is fluoride made of? ›

Fluoride is created when salts from the element fluorine combine with minerals in soil or rocks. Fluoride is found naturally in soil, water, and many foods, and occurs naturally in the human body in bones and teeth.

What is another name for fluoride? ›

Acidulated Phosphate Fluoride, Atomic number 9, Calcarea Fluorica, F, Fluorophosphate, Fluorure, Fluorure d'Hydrogène, Fluorure de Phosphate Acidulé, Fluorure de Sodium, Fluorure Stanneux, Fluoruro, Hydrogen Fluoride, Monofluorophosphate, MFP, Nombre Atomique 9, Sodium Fluoride, Sodium Monofluorophosphate, ...

Do we need fluoride? ›

yes, fluoride helps prevent tooth decay – in fact, since 1950 the American Dental Association has backed fluoride as “safe, effective and necessary in preventing tooth decay”. By strengthening enamel and slowing its breakdown, fluoride limits the ability for plaque and bacteria to go to work on your teeth.

Does the body need fluoride? ›

Fluoride is not considered an essential nutrient but plays an important role in dental and possibly bone health. A deficiency of fluoride can lead to dental caries and potentially bone problems. See the section on Fluoride and Health.

Do you need fluoride? ›

Research has shown that by adding fluoride to public water supplies, tooth decay-related conditions decline by 25 percent among adults and children. In small doses, fluoride strengthens tooth enamel against acids created by the bacteria in your mouth.

How can you avoid fluoride? ›

Top 10 Ways to Reduce Fluoride Exposure
  1. 1) Stop Drinking Fluoridated Water: ...
  2. 2) Don't Let Your Child Swallow Fluoride Toothpaste. ...
  3. 3) Do NOT Get Fluoride Gel Treatments at the Dentist. ...
  4. 4) Eat Fresh Food, Not Processed Food and Preferably Organic. ...
  5. 5) Buy Organic Grape Juice and Wine.

How much fluoride is too much? ›

Fluoride levels of 2.5 mg/L or higher may increase the risk of skeletal fluorosis (a condition that causes bones to break easily and causes calcium to build up in ligaments and tendons).

Why you shouldn't use fluoride toothpaste? ›

Concerns about Fluoride Toxicity

Excess fluoride ingestion is linked to dental fluorosis, a condition that causes tooth enamel to become discoloured and which when present can indicate that the rest of your body has been overexposed to fluoride as well.

Which fluoride is best for teeth? ›

As a rule of thumb, if you're looking for all-around protection (and not just cavity prevention), then stannous fluoride is the preferred fluoride of choice for your oral health. Sodium fluoride doesn't cut it when considering tooth decay prevention.

What is the disadvantage of fluoride toothpaste? ›

Swallowing fluoride toothpaste can lead to fluorosis, which interferes with the development of tooth enamel and can result in white streaks on the teeth, and gastrointestinal problems if the amount is large enough.

Who invented fluoride? ›

Fluoride research had its beginnings in 1901, when a young dental school graduate named Frederick McKay left the East Coast to open a dental practice in Colorado Springs, Colorado. When he arrived, McKay was astounded to find scores of Colorado Springs natives with grotesque brown stains on their teeth.

How many types of fluoride are there? ›

The three most popular sources of fluoride globally, which are all accepted by the US FDA as clinically effective, are: stannous fluoride (SnF2) sodium fluoride (NaF) sodium monofluorophosphate (Na2PO3F)

Is fluoride naturally found in food? ›

1. Grapes, Raisins, and Wine. Grapes are an excellent natural source of fluoride, which explains why raisins contain one of the highest concentrations of any food. It's also one of the most versatile foods that contain fluoride.

Does fluoride make you tired? ›

Water fluoride levels were not significantly associated with sleeping more than the recommended amount, frequency of trouble sleeping, or frequency of daytime sleepiness.

Can fluoride cause constipation? ›

It is concluded that in an endemic (fluorosis) zone, where the inhabitants are consuming water of high fluoride content, the occurrence of gastrointestinal complaints – viz., loss of appetite, nausea, abdominal pain, flatulence, constipation and intermittent diarrhoea – is one of the early warning signs of fluoride ...

Is fluoride a salt? ›

), whose salts are typically white or colorless. Fluoride salts typically have distinctive bitter tastes, and are odorless. Its salts and minerals are important chemical reagents and industrial chemicals, mainly used in the production of hydrogen fluoride for fluorocarbons.
Other anionsChloride Bromide Iodide
24 more rows

Who needs fluoride? ›

When Is Fluoride Intake Most Critical? It is certainly important for infants and children between the ages of 6 months and 16 years to be exposed to fluoride. This is the timeframe during which the primary and permanent teeth come in. However, adults benefit from fluoride, too.

Do dentists use fluoride? ›

In the dental office, a dentist can apply fluoride varnish or gel, and in some public health programs, children can have fluoride varnish applied to their teeth. Fluoride can prevent tooth decay across the lifespan; both children and adults benefit from it.

Which foods contain fluorine? ›

Fluoride tends to accumulate in a mixture of both healthy and unhealthy foods including tea, coffee, shellfish, grapes (raisins, wine, grape juice), artificial sweeteners, sodas, potatoes, flavored popsicles, baby foods, broths, stews, and hot cereals made with tap water.

What is natural fluoride? ›

The mineral fluoride occurs naturally on earth and is released from rocks into the soil, water, and air. All water contains some fluoride. Usually, the fluoride level in water is not enough to prevent tooth decay; however, some groundwater and natural springs can have naturally high levels of fluoride.

What are the pros and cons of fluoride? ›

The sole purpose of fluoride is to strengthen the enamel of the teeth, which should (so research has shown) prevent cavities and tooth loss. This assumption has been called into question over time. In fact, many studies have shown that fluoride may cause a cosmetically damaging effect called fluorosis.

Why do adults need fluoride? ›

Benefits of Fluoride

As you get older, you become more susceptible to certain dental conditions, such as gum disease or tooth and root decay. Fluoride treatments can help to strengthen and protect your teeth, preventing your need for invasive and expensive procedures in the future.

Does bottled water have fluoride? ›

Does bottled water contain fluoride? Bottled water products may contain fluoride, depending on the source of the water. Fluoride can be naturally present in the original source of the water, and many public water systems add fluoride to their water.

Which is the best toothpaste? ›

The Top Toothpastes
  • Colgate Total. ...
  • Crest Pro-Health. ...
  • Sensodyne ProNamel Gentle Whitening Toothpaste. ...
  • Arm and Hammer Dental Care Advance Cleaning Mint Toothpaste w/Baking Soda. ...
  • Tom's of Maine Natural Anticavity Fluoride Toothpaste. ...
  • Crest Tartar Protection. ...
  • Tom's of Maine Simply White Clean Mint Toothpaste.

How does fluoride enter the body? ›

When swallowed, fluoride is absorbed via the stomach and intestines, and passes rapidly round the body in the bloodstream. Peak blood levels appear in 30-60 minutes after swallowing. The most soluble fluoride compounds, such as sodium fluoride in water, tablets and toothpaste, are almost completely absorbed.

Does green tea have fluoride? ›

The average concentration of infusible fluoride in green tea (1.19 ± 0.22 mg/L) was significantly lower than that of black tea (p < 0.05). The infusible fluoride content in green tea in this study was comparable with that (range, 0.16–3.29 mg/L) reported in the study by Maleki et al.

Is there fluoride in filtered water? ›

However fluoride cannot be filtered via fridge water filters. Instead, a reverse osmosis filter system is one of the most common ways people remove fluoride from their drinking supply.

What is the most common source of fluoride? ›

What accounts for most of the fluoride intake? In the United States, water and processed beverages (e.g., soft drinks and fruit juices) provide approximately 75% of a person's fluoride intake.

How much fluoride is in bottled water? ›

Today the U.S. Food and Drug Administration issued its final rule for added fluoride levels in bottled water titled Beverages: Bottled Water. This final rule amends the allowable level for fluoride in domestically packaged and imported bottled water to which fluoride is added to 0.7 milligrams per liter (mg/L).

What happens if you swallow too much fluoride? ›

Swallowing a large amount of regular toothpaste may cause stomach pain and possible intestinal blockage. These additional symptoms may occur when swallowing a large amount of toothpaste containing fluoride: Convulsions. Diarrhea.

Can you refuse fluoride at the dentist? ›

No Toxic Fluoride

As parents, you have the right to CHOOSE to say no to fluoride. Although some dental offices will allow parents to refuse fluoride treatments, they may not be aware that fluoride may also be found in the prophy paste (the paste the hygienists use to clean patients' teeth).

Should you use fluoride free toothpaste? ›

Are those toothpastes effective? Dr. Okano: In terms of prevention of tooth decay, no. The only benefit that you'll gain is a fresher mouth with the natural toothpaste, but you will not receive any benefit against tooth decay if it doesn't have fluoride within it.

Do adults need fluoride treatments? ›

In general, fluoride treatments are not always necessary for adults, but they can be beneficial to your overall oral hygiene depending on your situation.

What kind of fluoride do dentists use? ›

The most common fluoride compound used in mouthrinse is sodium fluoride. The fluoride from mouthrinse is retained in dental plaque and saliva and helps prevent tooth decay.

Can you use fluoride toothpaste everyday? ›

The CDC and the ADA recommend that frequent exposure to small amounts of fluoride every day is the best for reducing the risk of dental cavities for all ages. For most people, this means drinking tap water with optimal fluoride levels and brushing teeth twice a day with fluoridated toothpaste.

Which toothpaste has highest fluoride? ›

Which Toothpastes Have The Highest Fluoride Content? Colgate® PreviDent® 5000 Booster Plus (1.1% Sodium Fluoride) Prescription Strength Toothpaste is among the highest fluoridated toothpastes available. You can only get it by having your dentist put in a prescription.

Do kids need fluoride treatment? ›

Fluoride treatment is important for both children and adults because it is a preventative treatment that protects tooth enamel. For kids, fluoride is especially important because it helps with proper tooth development. Getting enough fluoride in childhood is essential for strengthening teeth to last a lifetime.

Why do dentists put fluoride on your teeth? ›

Fluoride varnish is a dental treatment that can help prevent tooth decay, slow it down, or stop it from getting worse. Fluoride varnish is made with fluoride, a mineral that can strengthen tooth enamel (outer coating on teeth). Keep in mind that fluoride varnish treatments cannot completely prevent cavities.

What is fluorosis disease? ›

Dental fluorosis is a condition that causes changes in the appearance of tooth enamel. It may result when children regularly consume fluoride during the teeth-forming years, age 8 and younger.

Is fluoride free toothpaste better? ›

When you shop for toothpaste, you'll come across formulas with and without fluoride. Although fluoride-free solutions can scrape off bacteria, fluoride toothpastes are more effective for cavity control.

Is fluoride necessary for teeth? ›

Fluoride is an important treatment if you want to maintain healthy teeth throughout your life. Most toothpaste brands include fluoride as one of the ingredients, so regular brushing habits will result in fluoride treatment for your gums on a daily basis. But, the fluoride content in your toothpaste might not be enough.

Why do people avoid fluoride? ›

The reason for these recommendations is because when too much fluoride is ingested, it is toxic. Excess fluoride ingestion is linked to dental fluorosis, a condition that causes tooth enamel to become discoloured and which when present can indicate that the rest of your body has been overexposed to fluoride as well.

Should you use fluoride toothpaste? ›

Use of a fluoridated toothpaste is very beneficial for tooth decay, but it's all part of total dental health, and seeing your dentist regularly as he or she would recommend would very important to maintaining good dental health.

Are fluoride treatments good for adults? ›

What you need to know as a dental consumer is that studies have shown topical fluoride applications performed by a dental professional create a significant benefit for adults who have moderate to high risk for cavities. There are several circumstances that warrant extra fluoride protection among adults.

What kind of toothpaste is best? ›

The Top Toothpastes
  • Colgate Total. ...
  • Crest Pro-Health. ...
  • Sensodyne ProNamel Gentle Whitening Toothpaste. ...
  • Arm and Hammer Dental Care Advance Cleaning Mint Toothpaste w/Baking Soda. ...
  • Tom's of Maine Natural Anticavity Fluoride Toothpaste. ...
  • Crest Tartar Protection. ...
  • Tom's of Maine Simply White Clean Mint Toothpaste.

Is fluoride necessary for adults? ›

In general, fluoride treatments are not always necessary for adults, but they can be beneficial to your overall oral hygiene depending on your situation.

Are fluoride treatments worth it? ›

Many adults wonder, “Are fluoride treatments beneficial for adults?” The answer is yes. All adults can benefit from a dental fluoride treatment, especially those at a higher risk for tooth decay. Insurance doesn't normally cover fluoride for adults, but the price is usually only around $20-40—well worth the extra cost.

What can you eat after a fluoride treatment? ›

You should avoid frozen foods, crunchy foods, spicy foods, sugary drinks/snacks, and citrus fruits. It's advisable to eat soft foods after a dental cleaning or fluoride treatment. The foods include soups, soft foods, salads, and hard-boiled eggs.

Do water filters remove fluoride? ›

Can a Water Filter Remove Fluoride? A reverse osmosis filtration system is a simple solution for removing fluoride from drinking water. A Reverse Osmosis (RO) system can remove 85-92%* of fluoride in your water.


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