Benefits of Fluoridation in the 21 st Century

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By Jessica A. Rickert

November 17, 2024

Children crying and holding their faces due to dental disease is preventable.

Tooth decay is the most common chronic disease of childhood in the United States. This is an infectious disease caused by bacterial plaque on the tooth surface metabolizing sugars and producing acid, which dissolves the surface of the tooth. If unchecked, this process continues through the tooth and into the nerve. This can lead to local infections, systemic infection, and, in rare cases, death. Dental disease in the United States is responsible for 51 million school hours lost per year.

Fluoride is found in all natural water supplies. Fluoride is a naturally occurring mineral called calcium fluoride ions, and is found in rocks that leach into water. The natural level of fluoride in the water varies depending on the type of rocks the water is in contact with.  The fluoride ions added during municipal fluoridation are identical to the naturally occurring calcium fluoride ions.

All vegetation contains some fluoride, which is absorbed from soil and water.  Some plants concentrate fluoride ions; an example is all tea leaves contain fluoride.

Ocean water contains fluoride at around 1 part per million.

In 1901 Dr.  Frederick McKay, a dentist in Colorado Springs, Colorado, noted these local citizens’ tooth enamel was unusually resistant to decay.  Then, in the early 20th century, scientists linked higher levels of naturally occurring fluoride in Colorado water supplies to low levels of tooth decay.

In 1945, Grand Rapids, Michigan, became the first community in the world to add fluoride to tap water. When subsequent studies showed a significantly lower rate of cavities in schoolchildren, water fluoridation began in other towns and cities.

In North America, fluoride concentrations in groundwater are generally very low, with the exception of some parts of the southwestern United States where the Ogalalla Aquifer results in elevated natural levels of fluoride in the groundwater.

The Center for Disease Control and Prevention (CDC) currently recommends that all public drinking water contain 0.7 milligrams of fluoride per liter of water, to protect against tooth decay.  This very low level of fluoride in water is equal to about 3 drops of water in a 55-gallon barrel.   For more than 75 years, public water systems across the country have adjusted the naturally occurring fluoride levels in tap water to 0.7mg/L level for five key reasons:

1. It prevents tooth decay. Fluoride in water is the most equitable and efficient way to prevent tooth decay. An estimated 51 million school hours and 164 million work hours are lost each year due to dental-related illness.
2. It protects all ages against cavities. Studies show that fluoride in community water systems prevents at least 25 percent of tooth decay in children and adults.
3. It’s safe and effective. For more than 75 years, the most rigorous scientific evidence has consistently shown that fluoridation is safe and effective, so state over 100 health organizations.  
4. It saves money.  $1 invested in water fluoridation saves $38 in dental treatment costs.  Fluoride supplementation is the most equitable way of decreasing dental disease in the general population. 
5. It’s natural. Water fluoridation is the adjustment of natural fluoride levels to the recommended level for preventing tooth decay. It’s similar to fortifying for health benefits such as salt with iodine, milk with vitamin D, orange juice with calcium and bread with folic acid.

How does fluoride in drinking water work? The fluoride crystal in enamel is called fluorapatite.   Fluorapatite is incorporated into developing teeth and makes the tooth more resistant to acid attacks from plaque bacteria and sugars. 

Dental fluorosis can happen when excessive fluoride is consumed while teeth are still forming. Other than the appearance of white spots or mottling on the surface of the teeth, dental fluorosis doesn’t cause any symptoms or harm.

If bottled water is your main source of drinking water, you could be missing the cavity-fighting benefits of fluoride.

Numerous rigorous scientific studies have shown there is no evidence that the fluoride added to local water supplies in the United States causes any health problems.

The National Health and Medical Research Council (NHMRC) strongly recommends community water fluoridation as a safe, effective, and equitable way to reduce tooth decay for children and adults.

The American Academy of Pediatricians (AAP), the American Dental Association (ADA) and numerous health organizations also endorse the fluoridation of community water supplies.

Community water fluoridation has also been hailed by the CDC as one of 10 great public health achievements of the 20th century. 

Let’s control what we can to free our children from disease.

Dr. Jessica A. Rickert is a tribal citizen of the Prairie Band Potawatomi Nation. A graduate of the University of Michigan School of Dentistry, in 1975, she became for the first female Native American dentist.

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