Why do people hate fluoride so much?
As a kid, fluoride was the gold standard in preventing tooth decay and cavities. You had your fluoridated water, fluoride rinse, and bubble gum flavored treatment at the dentist. If your dentist recommended it for you, it was something you would do. For the most part, it’s still just as prevalent today, except for the ever-growing segment of the population that rejects it. It seems like the wisdom of the expert you are face-to-face with is increasingly likely to be evaluated in the uneven quality expert advice of a social media platform. So why do some people reject using fluoride?
Fluorosis is a cosmetic condition affecting teeth that have been overexposed to fluoride within the first 8 years of life when adult teeth are forming. Fluorosis can appear as various changes in the appearance of the tooth enamel, including white or dark spots on the teeth. Nobody wants that.
2. Excessive Intake
It is argued that many children today exceed the recommended level of fluoride intake from toothpaste alone. The anti-fluoride camp argues the dosage for public water supply cannot be controlled, and combined with all the other fluoridated products, they think the risk of overdose is too great. Adding to these concerns, a recent CDC study found that 40% of 3-6 year olds use too much toothpaste when they brush.
3. Crossing the Line
Fluoride is the only chemical added to public water supplies for the purpose of medical treatment. Water fluoridation is argued to cross the line of “informed consent” that is standard practice for any medical treatment by giving a medical treatment to an entire population that has not been specifically diagnosed with a disease. This is the reason 97% of Western Europe has rejected water fluoridation, although they tend to use fluoridated salt to receive the health benefits of fluoride.
4. Imperfect Cure Rates
Because fluoride does not prevent 100% of cavities, some patients misunderstand its effectiveness. They think that if it doesn’t completely prevent all caries, it isn’t preventing any caries at all. They are not educated on the complexity of caries disease and do not understand that treating multiple risk factors is necessary to provide the best outcomes across the population. Just because fluoride isn’t a magic cure, that doesn’t mean it’s not helping.
5. Health Concerns
In many communities with naturally high fluoride levels, we see dental fluorosis in children, and skeletal fluorosis in older adults. There is also evidence that excessive fluoride intake may harm other tissues, including the brain and pineal gland and can interfere with calcium channels in parathyroid gland. A 2017 study linked excess fluoride intake with lower IQ and poorer cognitive outcomes.
6. Unbalanced Information
With the advent of the internet, the amount of information available at everyone’s fingertips has exploded, but the information often lacks context. Fluoride has fallen victim to this, with widespread information about the toxic effects of overexposure without any context offered about when and how overexposure is likely to occur. Studies conducted in areas where naturally occurring fluoride far exceeds the safe limits allowed in municipal water supplies in the United States are used as evidence that municipal water dangerous, even though the exposure levels are not comparable. When reading something on the internet, it’s important not to fall for the dihydrogen monoxide scam, in which a widely forwarded email explained the many true dangers of a substance—dihydrogen monoxide—and calling for it to be banned. The problem, of course, is that dihydrogen monoxide is the chemical name for water, so even though it does kill people every year (mainly through drowning), banning it would be disastrous to human health.
7. Holistic Health
Today we are seeing a huge increase in the number of patients seeking holistic dentistry, which rejects the use of fluoride and unnatural toxic materials like mercury. This trend toward a more natural, whole body approach to oral healthcare represents a paradigm shift in dentistry as we know it. There is certainly value to be found in looking at the whole patient, including lifestyle and diet, when developing a dental care relationship. It’s important, however, to communicate clearly with patients about what treatments are supported by evidence and which may or may not be helping. There is strong evidence for the benefits of fluoride.
Where do you stand?
With the anti-fluoride camp seemingly growing every day, it’s important that you understand both sides of the coin. It is also important to have strategies in place to educate your patients, rather than discard their feelings or opinions. Most patients that are anti-fluoride aren’t trying to be difficult, they are just trying to do what is best for themselves and their families. As a team, know what your approach will be with these patients. Can you provide information on fluoride as an important protective factor? Can you effectively tell them why you think fluoride is important? Can you explain the different recommendations for different ages? Do you offer options for dental products that don’t contain fluoride, but contain other helpful protective factors like xylitol?