Fluoride is known for remineralizing tooth enamel; reducing tooth and gum sensitivity; and preventing cavities, gum disease, and the premature loss of teeth. It is a naturally occurring mineral found in water, soil, rocks, and trace amounts in many foods such as tea and shellfish. Fluoride can be delivered topically -- through toothpastes, mouthwashes, rinses, gels, and foams -- or systemically, typically though drinking water or supplements such as fluoride pills. For the past 70 years, over 70% of publicly-supplied drinking water in the United States has been fluoridated, resulting in a 25% reduction of cavities in both children and adults. But because fluoride is harmful in large quantities, public debates continue to spark controversy about its necessity and sustainability.
The Pros and Cons of Fluoride in Water and Toothpaste
The CDC (Centers for Disease Control and Prevention) includes water fluoridation as one of the ten great public health achievements of the 20th century alongside vaccination, family planning, and more. Although no RDA (Recommended Dietary Allowance) for fluoride has been established, the WHO (World Health Organization) asserts dental health as a major predictor of overall health, and poor oral health can cause a range of health conditions other than cavities, even cardiovascular disease. In areas of the country where dental providers are scarce, fluoridated water is one of the few stopgaps that protects oral health. Our local water district East Bay Municipal Utility District (EBMUD) has added fluoride to its drinking water since 1977 and maintains an average fluoride level of 0.7 mg/L parts. The Contra Costa Water District (CCWD) also fluoridates its water to an average concentration of 0.7 mg/L. These levels of fluoride align with the recommendations of the CDC.
In the late 1970s and early 1980s, Denmark, Sweden, and eventually the Netherlands banned fluoridation when government panels found insufficient evidence for its safety as well as evidence of negative effects in a percentage of the population. Studies from sources such as Science Direct say there is no conclusive evidence of negative health effects from low levels of fluoride exposure but there are concerns about high levels of exposure in early childhood. The most common side effect of ingesting too much fluoride while baby teeth are developing between the ages of birth to eight years is fluorosis, that is, tooth discoloration like white streaks, spots, or stained pitting. To prevent fluorosis, the American Association of Pediatric Dentistry recommends that parents and caregivers use a miniscule amount of toothpaste once the child’s first tooth erupts to prevent cavities, and this amount will not put them at risk for fluorosis even if they accidentally swallow the toothpaste. Opponents of fluoridated water say high fluoride exposure may also cause weakened bones and joints and even cognitive impairment and lower I.Q. According to the Harvard School of Public Health, however, authors of a comprehensive review of epidemiological, animal, and laboratory studies noted various confounding factors may have contributed to cognitive deficits, including low birth weight, socioeconomic status, and exposure to other neurotoxins.
The controversy over fluoride in water is still going strong. Health and Human Services Secretary Robert F. Kennedy Jr. wants local governments to remove fluoride from their water systems. As of May of 2025, Utah and Florida have banned water fluoridation, and states including Kentucky, Massachusetts, and Nebraska have introduced bills to restrict or ban it. According to U.S. News, data from the National Survey of Children’s Health shows that two-thirds or more of third-graders have tooth decay in low-fluoride states like Utah, Hawaii, Idaho, and Louisiana. Moreover, CDC data shows that low income and uninsured Americans as well as Black Americans are more likely to live with untreated cavities.
Natural personal care companies like Tom’s of Maine say most concerns raised about fluoride have stemmed from controversy surrounding the mass fluoridation of municipal drinking water supplies, a separate issue from including fluoride in toothpaste. Tom’s, a certified B-Corp, makes both fluoride and non-fluoride toothpastes and points out that when fluoride toothpaste is not ingested but just applied directly to the surface of the teeth and immediately rinsed out, it delivers a clear benefit to dental health.
The highest safe level of fluoride remains unclear, but natural health advocates express concern about getting fluoride from too many sources, such as from both fluoridated water and fluoridated toothpaste. The United States Food and Drug Administration (FDA) and the European Community (EC) recognize fluoride as a safe and effective anti-cavity agent in oral care products but bear warning language that cautions against accidental ingestion.
Is Fluoride Sustainable?
Fluoride manufacturing is not considered sustainable because of its environmental impacts. Fluoride for toothpaste is not mined as a pure substance but rather extracted, either from the mineral fluorite or phosphate rock deposits. Fluorite is finite, making it an unsustainable mineral resource, and mining operations can lead to soil erosion and the destruction of natural wildlife habitats. The extraction, processing, and transportation of fluorite are energy-intensive and generate significant greenhouse gas emissions. The manufacturing process also releases pollutants like PFAS (man-made “forever chemicals”) into the air, water, and soil.
Fluoride is also chemically processed and purified into compounds like sodium monofluorophosphate, which is not sustainable primarily because it is not biodegradable. It can accumulate in the environment, water, and soil, potentially harming aquatic life and causing plant damage through pollution from industrial sources and wastewater discharges. Hopefully, good competition will come up with a better, more sustainable, product.
What’s the Bottom Line?
Proponents of water fluoridation may be criticized for overstating its benefits, while opponents of fluoridated water, fluoride toothpaste, and/or fluoride in general may be criticized for understating fluoride’s benefits and overstating its risks. Widespread exposure to fluoride raises questions about whether additional fluoride in toothpaste is always necessary, especially for individuals who already drink fluoridated water regularly. Additionally, the process of manufacturing fluoride is not a sustainable one. Those in the middle may feel that while some fluoride is not harmful, getting it from more than one source may not be necessary. Since most municipalities fluoridate tap water, those who drink their local tap water can’t avoid ingesting fluoride, but deciding to buy fluoride or non-fluoride toothpaste and other over-the-counter dental products is, obviously, a personal choice.
Disclaimer: The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your qualified health provider with any questions with regard to a medical condition.
Sources and Further Reading:
https://www.usnews.com/news/best-states/articles/2024-12-06/map-fluoride-in-drinking-water-by-state
https://my.clevelandclinic.org/health/treatments/11195-fluoride
https://www.medicalnewstoday.com/articles/154164#benefits
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547570/
https://ods.od.nih.gov/factsheets/Fluoride-HealthProfessional/
https://ods.od.nih.gov/factsheets/Fluoride-HealthProfessional/
https://fluoridealert.org/studies/caries01/
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