Fluoride in Drinking Water: What You Need to Know

The Centers for Disease Control and Prevention (CDC) lists water fluoridation as one of the ten greatest public health achievements of the 20th Century.

But not everyone agrees. Critics say that it's not as safe or effective as we've been told. And they say that people should have the right to choose whether their water has fluoride added to it. 

It's been over 60 years since the first public water fluoridation project was launched in Grand Rapids, Michigan. But it's still a subject of debate. For years, most people just took it for granted that water fluoridation was a good thing. Why? Because the government said it was, even though they didn't really have a way to validate their claim.

Then along came the Internet. It gave people the ability to question and verify information and to share knowledge in a way never before possible. A healthy dose of skepticism and the means to find out the facts have fueled the controversy. That's why it's still a hot topic after all these years.

Why is it so controversial? What are the benefits and risks? And what - if anything - should we do about it?

History of Water Fluoridation in the United States

First, it's helpful to know a little about how we got to where we are today.

It all started in the early 1900's when a dentist in Colorado noticed that the kids in his town had ugly brown stains on their teeth. This staining became known as the "Colorado Brown Stain." As he studied this, he discovered that the kids in some towns had it, but the kids in other towns didn't. He realized that it was because their water was coming from different sources. It was something in the water, but no one could figure out exactly what it was.

Then in 1931, a chemist working for ALCOA decided to investigate a similar problem in Bauxite, Arkansas, a town owned by the company.  He conducted an in-depth study and discovered that there was fluoride in the water. Fluoride was the culprit. That's when the condition became known as "dental fluorosis".

Around the same time, someone working for the U.S. Public Health Service was looking into the problem. He noticed that children with dental fluorosis had less tooth decay than average. The fluorosis didn't seem to cause any harm; it was just unattractive. He became more interested in preventing tooth decay than in solving the fluorosis problem.

Someone in the scientific community suggested, "Maybe we should put fluoride in the water."

The idea went public in 1942 when Colliers magazine published an article called The Town Without a Toothache. The story was about a town in Texas that was supposed to have the lowest rate of tooth decay in the country. Scientists conducted a study and concluded that the reason for the low decay rate was the high level of natural fluoride in the water. The study made no mention of the people's brown mottled teeth, by the way.

Soon there was public pressure to conduct a trial to see if fluoridating the public water supply would help prevent tooth decay. In 1945, Grand Rapids, Michigan was selected for the trial. Nearby Muskegon was the control city, for comparison.

After several years, there was a definite decline in the rate of tooth decay in Grand Rapids. The trial was supposed to last for fifteen years, but it ended after only six years. Muskegon decided that they wanted to fluoridate their water, too, so that was the end of that.

The idea caught on, and many cities throughout the U.S. decided to start fluoridating their water. This wasn't without controversy and some strong opposition, though.

Today, about 70% of the drinking water in the U.S. is fluoridated. Most of that comes from municipal water supplies.

Facts About Fluoride You Should Know

So, what exactly are the arguments against water fluoridation? Following are ten facts about fluoride that most people don't know, but should.

1. Most of the developed countries in the world don't add fluoride to their drinking water.

There are more Americans drinking fluoridated water than the rest of the entire world. 97% of the countries in western Europe don't fluoridate. They considered it, but they decided against it. Not that this in itself is a good reason to not fluoridate our water.

But it ought to make us stop and ask, "Why?"

(For statistics on the extent of fluoridation throughout the world, click here.)

2. Countries that don't fluoridate their water do NOT have more tooth decay than the ones that do.

Does this surprise you? It sure surprised me!

In 2013, the World Health Organization (WHO) published a study about dental health throughout the world. They found that since 1970, the rate of tooth decay for the entire world was the same as the rate for the United States. In other words, there was no difference between the small number of countries that fluoridate and those that don't.

They've seen the same decrease in tooth decay in the non-fluoridated countries. But here in the U.S. they say that it must be because of fluoridation. If fluoridation were the reason, you would expect the countries that fluoridate to have a greater decline in tooth decay.

But that's not the case.

In fact, according to WHO, the U.S. ranks at number 12 in the DMFT (Decayed, Missing & Filled Teeth) Status for 12 year olds. Eight of the countries ranking higher than the U.S. have no fluoridation at all.

(See statistics from WHO's Oral Health Country/Area Profile Project here.)

3. Teeth are not the only tissues in the body that fluoride affects.

When you're taking any kind of medication, you need to be aware of the side effects.

Take ibuprofen, for example. It's effective for inflammation and pain relief, but it can also cause liver damage if you take it for too long. It enters your bloodstream and circulates throughout your body. It doesn't just go directly to your head or back or wherever it is you're having pain. It passes through all your organs. It does good in inflamed areas, but it can do harm in others.

It's the same thing with fluoride. It doesn't only affect the teeth, but it can have a negative impact on other parts of the body.

The National Research Council published a report in 2006 about a study on fluoride's toxicity. They determined that fluoride is an endocrine disruptor that can affect the brain, pineal gland, thyroid gland, blood sugar levels, and bones.

Even before this study, fluoride was known to reduce thyroid function. Up through the 1950's, doctors in Europe and South America prescribed fluoride to patients who had overactive thyroid glands. They were able to reduce thyroid function by taking 2-5 mg of fluoride per day.

2-5 mg per day - it's not a stretch to say that a lot of Americans are ingesting that amount through their drinking water, diet, and toothpaste.

Millions of people in the U.S. suffer from hypothyroidism (underactive thyroid). Is it possible that fluoridation is a contributing factor?

It very well could be. The National Academy of Sciences posed the question in 2006, and they called for a scientific study on whether fluoridation is contributing to chronic health problems in this country.

I think it's time for a serious study of the long-term effects of fluoridation on health. We deserve to know the truth.

(Read Fluoride in Drinking Water: A Scientific Review of EPA's Standards (2006) here.)

4. Water fluoridation is not a "natural" means of adding fluoride to the diet.

People who advocate fluoridating drinking water like to say, "Nature thought of it first!"

Yes, well, nature thought of arsenic and lead first, too. Does that mean that they're safe? Of course not!

The normal level of fluoride in fresh water is about 0.1 ppm (parts per million). That's much less than the amount in artificially fluoridated water. Municipal water suppliers bring the level up to 0.7 to 1.2 ppm.

Some water supplies do have a high level of naturally occurring fluoride. That's how those kids in Colorado ended up with the "Colorado Brown Stain". But in some areas where the natural fluoride levels are as high as artificially fluoridated water, wildlife and humans have serious health problems like bone disease, arthritis, and blindness.

Read the BBC article Indian Villagers Crippled by Fluoride if you want to see what high levels of even naturally occurring fluoride can do to the human body. It's heartbreaking!

You won't find this extreme level of natural fluoride anywhere in the U.S., but we are getting fluoride from other sources. We get it from toothpaste, processed foods and beverages, tea, and some pharmaceuticals. Cooking with Teflon also adds a significant amount of fluoride to food. When you put that all together, that's a lot of fluoride - especially if your water is fluoridated, too.

And, speaking of toothpaste -

When fluoridation started, American toothpastes did not have fluoride in them. That didn't happen until Procter and Gamble introduced Crest toothpaste in 1956. Fluoride toothpaste proved to greatly reduce tooth decay, and yet water fluoridation continued.

There's another problem with this notion that fluoride is "natural", so it's safe. The fluoride that's added to our drinking water is not the same compound that you find in natural water supplies. The fluoride compounds are fluorosilicic acid, sodium fluorosilicate, and sodium fluoride. Of those three, only sodium fluoride is in toothpaste. And none of them are pharmaceutical grade.

According to the CDC, fluorosilicic acid (FSA) is the compound that's used in most of the fluoridation programs in the U.S. today. 

What is fluorosilicic acid and where does it come from? Well, let me tell you.

Fluorosilicic acid is a corrosive acid. It's a by-product of the phosphate fertilizer industry. Here's a direct quote from the CDC about the process:

"Most fluoride additives used in the United States are produced from phosphorite rock. Phosphorite is mainly used for manufacturing phosphate fertilizer. Phosphorite contains calcium phosphate mixed with limestone (calcium carbonates) minerals and apatite—a mineral with high phosphate and fluoride content. It is refluxed (heated) with sulfuric acid to produce a phosphoric acid-gypsum (calcium sulfate-CaSO4) slurry.

The heating process releases hydrogen fluoride (HF) and silicon tetrafluoride (SiF4) gases, which are captured by vacuum evaporators. These gases are then condensed to a water-based solution of approximately 23% FSA."

Hydrogen fluoride and silicon tetrafluoride are toxic gases that the phosphate industry used to just let out into the air. When they realized that this pollution was causing serious damage to the environment and to people's health, the EPA required them to capture the fluoride gases in liquid form.

Not wanting anything to go to waste, someone got the idea to send it off to municipal water departments to add fluoride to the drinking water.

An EPA official stated in a 1983 letter:

“In regard to the use of fluorosilicic acid as the source of fluoride for fluoridation, this agency regards such use as an ideal solution to a long standing problem. By recovering by-product fluorosilicic acid from fertilizer manufacturing, water and air pollution are minimized, and water authorities have a low-cost source of fluoride available to them.”

But not everyone agrees that this is an "ideal solution". Dr. William Hirzy, of the EPA's Union of Scientists and Professionals said this at a U.S. Senate Environment and Public Works Committee hearing in 2000:

"If this stuff (fluorosilicic acid) gets out into the air, it’s a pollutant. If it gets into the river, it’s a pollutant. If it gets into the lake it’s a pollutant. But if it goes right into your drinking water system, it’s not a pollutant… There’s got to be a better way to manage this stuff."

Yet the CDC maintains that "fluoride additives are not different from natural fluoride."

5. 40% of American teenagers have dental fluorosis.

What exactly is dental fluorosis, anyway?

It's a defect of the tooth enamel. It happens when fluoride interferes with tooth-forming cells. It usually shows up as white spots and streaks on the teeth. In severe cases, it results in brown stains and even tooth erosion.

According to a 2010 CDC brief, 40.6% of 12-15 year-olds in the U.S. showed visible signs of dental fluorosis. They also said that "Children aged 12–15 in 1999–2004 had higher prevalence of dental fluorosis compared with the same aged children in 1986–1987."

The rate was going up.

That's why the Department of Health and Human Services recommended lowering the acceptable limit of fluoride from 1.2 ppm to 0.7 ppm in 2015.

6. There is no benefit - only risks - in giving fluoridated water to infants.

In 2012, the CDC said they are unaware of any benefit resulting from babies getting more than 10 micrograms a day of fluoride.

The Institute of Medicine (IOM) recommends that babies ingest no more than 10 micrograms of fluoride per day. That's about equal to what they would get from breast milk.

But, babies drinking formula made with fluoridated water take in up to 700-1200 micrograms per day. That's 100 times more than the IOM recommendation!

And babies who drink fluoridated water have higher incidence of fluorosis in their front teeth. No surprise there.

Several years ago, the American Dental Association (ADA) recommended parents not use fluoridated water for infant formula because of the risk of fluorosis. But this information has not reached the public. Even a lot of pediatricians aren't aware of the ADA recommendation.

Fluoride also impacts neurological development in children.

In 2012, the Harvard School of Public Health published a paper that showed a connection between high levels of fluoride and lower IQ. The studies were conducted in China, where the children get more fluoride than American children do. But not much more.

The research scientists at Harvard made this statement:

"All but one of the 27 studies documented an IQ deficit associated with increased fluoride exposure. These results do not allow us to make any judgment regarding possible levels of risk at levels of exposure typical for water fluoridation in the U.S. On the other hand, neither can it be concluded that no risk is present. We therefore recommend further research to clarify what role fluoride exposure levels may play in possible adverse effects on brain development, so that future risk assessments can properly take into regard this possible hazard."

I'd say that it's time for the U.S. to study the effects of fluoride on the IQ and neurological development of American children. If it hasn't been studied, how can they say with confidence that the fluoridation program is safe?

7. The Food & Drug Administration (FDA) has never approved fluoride supplements.

Unlike dietary supplements, you can't buy fluoride supplements over the counter. You need a prescription.

So that must mean that fluoride supplements are FDA-approved, right?

Wrong.

Oral fluoride supplements need a prescription, but "to date, FDA has approved no fluoride-containing supplements as prescription or over-the-counter drugs." (source Food & Drug Administration, 2007)

Isn't that odd?

In fact, the only fluoride supplements that the FDA has ever reviewed have been rejected. So, by fluoridating water, we're adding a prescription strength dosage of a drug that has never been approved by the FDA.

8. Fluoride is the only medicine deliberately added to public water supplies.

Fluoride isn't put in the water to treat the water itself. It's added to treat us.

We add chlorine to kill bacteria so we don't get sick when we drink it. But we add fluoride as a medical treatment for a disease that isn't caused by the water.

By definition, a nutrient is "a food or other substance that provides energy or building material for the survival and growth of a living organism." [Dorland's Medical Dictionary for Health Consumers. (2007)]

Carbohydrates and fats are nutrients. Iron and Vitamin D are nutrients. Our bodies need them to live.

Fluoride is not a nutrient. We don't need it to survive.

The FDA states that:

"FDA does not list fluorine as an essential nutrient. The National Research Council, the source from which FDA received data on essential nutrients, indicated that there was no justification to classify fluorine as an essential nutrient."

Further:

"Fluoride, when used in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or animal, is a drug that is subject to Food and Drug Administration (FDA) regulation."

Got that?

The FDA classifies fluoride as a drug because it's used to treat or prevent dental caries (tooth decay), which is a disease. 

According to the FDA, it's a drug when it's in supplements, and it's a drug when it's in toothpaste.

So, it only makes sense to conclude that adding fluoride to water to prevent tooth decay is a form of medication.

Fluoride = drug. So, adding fluoride to water = adding a drug to the water.

And here you have one of the main reasons that most of Europe rejects fluoridation - Because adding a drug to the public water supply is not an appropriate way to administer medication.

Fluoridation deprives people of the basic right to decide whether they will be medicated. That's a huge violation of individual freedom.

Another big problem with this is the one-size-fits-all mentality. It treats everyone as if they're the same. It doesn't matter your age or what health issues you might have.

Everybody gets the same dose and it assumes that everybody will respond the same way to the drug.

That just goes against all common sense. We don't do that with other toxic medical substances. Doctors always prescribe dosages that are appropriate to individual needs.

Dr. Arvid Carlsson, a Swedish doctor and 2000 Noble Prize winner in Medicine who led the campaign to end fluoridation in Sweden had this to say about fluoridation:

"It is against all principles of modern pharmacology. It's really obsolete. There's no doubt about that. I think that those nations that are using it should feel ashamed of themselves. It's against science, actually."

9. Teeth do not benefit from ingesting fluoride.

When fluoridation started in the 1940's, doctors thought that people needed to ingest fluoride in order for it to prevent cavities. Experts don't believe that anymore.

According to the CDC, teeth benefit most from topical application like toothpaste and fluoride rinses:

"...fluoride's predominant effect is posteruptive and topical and ... the effect depends on fluoride being in the right amount in the right place at the right time."

So when we fluoridate water, we're not just adding a medicine to the water. We're adding a medicine that doesn't need to be swallowed to be effective.

10. Fluoride puts low income communities at risk for more serious health problems.

Here's another problem with using fluoridation to deliver the same dosage of fluoride to everyone -

What's "safe" for a healthy person might be harmful to someone who is not in good health. It's more likely that children with poor nutrition will suffer more harm from fluoride than children with good nutrition.

A CDC survey found that black children have a much higher rate of dental fluorosis - and more severe damage - than children of other races. The cause isn't clear, but it could be either a "biological susceptibility or greater fluoride intake", according to the CDC.

Other risk factors are at play too, including heavy use of baby formula, lower milk consumption, poor nutrition, and other health conditions. Low income families aren't likely to buy bottled water or water filtration systems, either.

So their only choice is to drink fluoridated tap water, which only adds to the problem.

Dental decay is a huge problem in low income communities across the country. If you google "dental health crisis", you'll find page after page of articles addressing the issue. Decades of fluoridation hasn't solved the problem.

What people need is good dental care, but they're not getting it because they can't afford it. Medicaid doesn't help, either. Most dentists won't accept Medicaid patients because they can't make a profit. (See Frontline article "America's Dental Care Crisis")

Maybe we should stop spending millions of dollars adding cheap industrial chemicals to the water. Instead, we could direct funds to making sure that people have access to real dental care.

But that makes too much sense, doesn't it?

What Can I Do?

The first thing you should do is to find out if your water is fluoridated. There are three ways to do this:

1. Go to the CDC My Water's Fluoride website and search for your water supplier by state and county. If your state participates in the program, you'll be able to get information about your water.
2. Call your water service provider and ask them.
3. If you're on a well, you should have your water tested or test it yourself.  Just make sure that they test for fluoride.

If your water is fluoridated, you have a few options.

1. Drink bottled water. Sometimes there is fluoride in bottled water, though. It depends on where it comes from. Spring water normally has little - if any - fluoride in it. But some bottled water comes from municipal water supplies, so you need to do your research.
2. Drink distilled water. Just be aware that distillation removes all the beneficial minerals from the water. It may not be a problem since you can get minerals through your diet. There are water distillation units available for home use.
3. Get a water filtration system for your home. But be sure to get the right kind of filter. The only types that are effective in removing fluoride are reverse osmosis, activated alumina, and bone char. Carbon filters like Pur and Brita won't work.

Beyond protecting yourself and your family, you can help by getting the word out. So many people just aren't aware of the facts.

If you're the activist type, you can work to educate and influence decision makers in your community. There are many cities that have reversed their fluoridation policies. Maybe yours could be next!

The Fluoride Action Network was a valuable source of information in writing this article.

Thank you for taking the time to read this article. If you think it's important information, please share it with your family and friends. And feel free to share your thoughts in the comments.

Read my Best Fluoride Filters Buyers Guide for more information.