
Jan
Who remembers the little paper cups and the big fluoride pump in elementary school? Maybe it was once a year, maybe twice, but it was a ritual. The teacher would line everyone up, and you’d shuffle forward, clutching your cup, waiting your turn. The smell of fluoride—sharp and clinical—would hit you before it was even your turn. You’d swish it around your mouth, trying not to gag, before spitting it into the sink and heading back to your desk, feeling slightly queasy but oddly accomplished.
“This will keep the cavities away,” they said.
For many of us, fluoride has been a part of our lives since childhood—a silent partner in the fight against tooth decay. From those school fluoride rinses to the fluoridated tap water we drank at home, fluoride became a symbol of progress in public health. It felt like a small price to pay for healthy teeth—until we started learning more about what fluoride does to the rest of our bodies.
Fast-forward to today, and the narrative has changed. Communities across the country, including many here in South Florida, are questioning whether fluoride’s benefits outweigh its risks. Now they’re removing fluoride from water supplies, citing concerns about systemic exposure, which is introducing a substance, like fluoride, into the bloodstream, as well as the lack of informed consent. When a substance gets into the bloodstream, it’s distributed throughout the body. This occurs when the substance is ingested, inhaled, or absorbed, allowing it to affect not just a specific area (like the teeth) but multiple tissues and organs. For fluoride, systemic exposure typically happens when it is swallowed, such as through drinking water, foods, or oral care products. This is in contrast to topical exposure, where fluoride only affects the surface it is applied to, such as tooth enamel.
This has led researchers and dental professionals to rethink how we use fluoride, shifting the focus to safer, more effective ways to prevent cavities.
This blog dives into the debate, exploring fluoride’s benefits and risks, as well as the growing movement toward more personalized and targeted oral health care.
Fluoride: A Powerful Ally When Used Correctly
Fluoride is a mineral that naturally occurs in water, soil, and various foods. It makes tooth enamel stronger and more resistant to acid attacks from bacteria. This protective process, known as remineralization, helps prevent cavities. And … that’s how fluoride became known as a dental health hero.
Wait, what the heck is remineralization? Glad you asked! The demineralization and remineralization process is like a tug-of-war happening on your teeth every day.
Think of your enamel as a brick wall. Demineralization is like acid pulling out the bricks, creating weak spots. Remineralization puts the bricks back in place, rebuilding and protecting your teeth. Fluoride is like the mortar that makes the repair even stronger, helping prevent future damage.
Well, when we apply it to the surface of teeth via toothpaste, mouth rinses, or professional treatments, fluoride’s benefits are straightforward: It fortifies enamel, reduces demineralization, and promotes repair. However, when we absorb it, such as by drinking fluoridated water, it behaves differently. In young children, it makes its way into the developing enamel of permanent teeth before they erupt. And yes, this does provide some long-term benefits. But when growing bodies—particularly children—absorb fluoride in bones, glands, and other tissues, there’s a risk of fluoride toxicity.
This paradox is at the heart of the current debate. Children stand to gain the most from systemic fluoride. But they’re also the most vulnerable to its toxic effects. That’s why many experts now say fluoride should be applied to the surface of teeth in controlled, moderate doses rather than ingested.
Consider this: A pea-sized amount of toothpaste contains about 0.25 mg of fluoride. That’s almost the same amount you get when you drink an 8-ounce glass of fluoridated water at 0.8 ppm. But there’s a crucial difference: You’re not meant to swallow toothpaste. But you do swallow the water.
The Risks of Fluoride: A Double-Edged Sword
Ingested fluoride can lead to a number of conditions that can be harmful—especially to children. Let’s take a look at the most common or concerning ones:
1. Dental fluorosis occurs when excessive fluoride disrupts enamel development, causing white spots or streaks. While primarily cosmetic, it’s a clear indicator of overexposure. This may require dental treatment to correct.
2. Skeletal fluorosis—which impacts bones rather than teeth—is more severe. It can lead to joint stiffness, pain, and long-term bone damage. It’s rare in areas with optimal fluoridation (0.6–0.8 ppm) but still a risk in regions with high fluoride levels.
3. Pineal gland calcification: Sleep is a cornerstone of every metabolic and physiological process in the body. It is essential for tissue repair, immune function, memory consolidation, and hormonal regulation. When sleep is disrupted, it can have cascading effects on overall health, affecting everything from emotional stability to metabolic function. That’s why sleep studies are often a prerequisite for diagnosing and managing conditions like ADHD in children—because poor sleep can mimic or exacerbate symptoms of attention and behavioral disorders.
The pineal gland plays a pivotal role in sleep regulation. This small, pea-shaped gland located in the brain produces melatonin, the hormone that governs our sleep-wake cycles. However, research shows that fluoride accumulation in the pineal gland can interfere with its normal function. The gland’s calcified tissues are particularly susceptible to fluoride buildup, with studies finding concentrations as high as 300 mg/kg in the pineal gland—levels that can rival or exceed fluoride concentrations in bones.
When the pineal gland is disrupted by fluoride-induced calcification, melatonin production can be impaired. This leads to poor sleep quality, delayed onset of puberty in children, and even broader disruptions to the body’s circadian rhythms. The implications for cognitive development are significant, especially in children, as sleep is critical for brain plasticity, learning, and emotional regulation.
One study highlighted in the literature discusses how chronic fluoride exposure in early childhood is associated with neurodevelopmental issues, including lower IQ scores and delays in cognitive milestones. These effects are thought to stem from both systemic fluoride toxicity and its impact on the brain’s ability to regulate sleep cycles. Without adequate, restorative sleep, children are at risk for impaired memory formation, reduced academic performance, and heightened emotional reactivity.
This underscores the importance of limiting systemic fluoride exposure, particularly in children, who are most vulnerable to its effects. By prioritizing topical fluoride treatments and reducing ingestion through water and other sources, we can mitigate the risks to the pineal gland and protect the critical role of sleep in overall health and development.
4. Reproductive issues: High fluoride exposure has been linked to reduced sperm quality, hormonal imbalances, and oxidative stress. Oxidative stress happens when there’s an imbalance in the body between harmful molecules called free radicals and the antioxidants that neutralize them. Free radicals can damage cells, proteins, and DNA, leading to inflammation and various health problems. It’s like too many sparks flying around in your body without enough water to put them out. Over time, these free radicals cause cell and tissue damage, playing a role in the development of many chronic diseases, like Cardiovascular disease, dementia, diabetes, kidney failure and the list goes on. While these findings are most relevant to regions with high fluoride levels, they underscore the importance of minimizing unnecessary exposure.
5. Acute fluoride toxicity: This is rare, but it has been reported in specific scenarios, often involving accidental or intentional ingestion of large amounts of fluoride. Here are some examples:
Symptoms of acute fluoride toxicity include gastrointestinal distress (nausea, vomiting, diarrhea), muscle spasms, low calcium levels (hypocalcemia), and, in severe cases, life-threatening complications like cardiac arrhythmias. The probable toxic dose (PTD) is approximately 5 mg/kg of body weight, meaning a child weighing 20 kg (about 44 pounds) could experience toxicity from ingesting as little as 100 mg of fluoride.
If fluoride poisoning is suspected, immediate medical attention is critical to manage symptoms and prevent severe complications.
6. Impaired cognitive development: Possible developmental delays and reduced IQ are known to occur in children exposed to high fluoride levels during early childhood and is potentially linked to disrupted sleep and neurotoxicity.
It’s important to think of all the ways we use tap water. For example, what about babies who are fed formula prepared with fluoridated tap water? They can have unsafe fluoride levels and an increased risk of fluorosis. That’s why experts recommend using purified or distilled water to mix infant formula—especially in areas with fluoridated tap water.
The decision to add fluoride to public drinking water—and how much to add—is typically made by local governments, public health officials, and water management agencies, guided by recommendations from national and international health organizations. In the United States, the Centers for Disease Control and Prevention (CDC) and the Environmental Protection Agency (EPA) set guidelines and regulations for community water fluoridation.
The EPA regulates the maximum allowable level of fluoride in drinking water to protect against health risks. Currently, this limit is set at 4 mg per liter (mg/L), a threshold intended to prevent severe health issues. However, the CDC’s recommended optimal level for preventing tooth decay while minimizing risks is much lower—0.7 mg/L. This recommendation was revised in 2015 to reflect the access to fluoride through toothpaste, mouth rinses, and other sources that reduces the need for higher systemic exposure.
Despite federal guidelines, the decision to fluoridate a community’s water supply is made at the state or local level. This means some communities choose to fluoridate their water, while others do not, often due to debates over safety, ethics, and costs. In some cases, local water systems have fluoride levels far above 0.7 mg/L and the levels the municipality intended.
Sometimes, these high levels are the result off equipment malfunctions, monitoring failures, or communication breakdowns. Such incidents can lead to unintended overexposure in the community, raising concerns about public health and the reliability of water fluoridation programs. They also highlight the need for stringent monitoring and regular maintenance of fluoridation systems.
Critics of community water fluoridation often raise the issue of informed consent, arguing that residents of fluoridated communities cannot opt out of systemic fluoride exposure. Accidental overexposure only amplifies the debate over whether fluoride should be delivered through water supplies or be limited to topical applications like toothpaste and dental treatments.
When it comes to bottled water, the picture gets murky. Spring water often contains naturally occurring fluoride, and its levels can vary widely, depending on the source. Unlike community water supplies, fluoride levels in bottled spring water are not consistently tracked or labeled, leaving consumers unaware of their exposure.
On the other hand, purified or distilled bottled water contains no fluoride, offering a fluoride-free option if you wish to limit your exposure. However, there’s another consideration: These waters are often packaged in plastic bottles that may sit in warehouses for extended periods—sometimes years—before consumption. The potential for plastic leaching over time introduces a separate set of health concerns.
If you want complete control over your water quality, reverse osmosis filtration systems provide an effective solution. These systems remove nearly all fluoride from water, offering a safer alternative for preparing infant formula and reducing overall fluoride intake. Reverse osmosis is particularly valuable for families in fluoridated areas who want to minimize exposure while maintaining access to clean drinking water.
In South Florida and beyond, communities are reconsidering their reliance on fluoridated water. Cities are opting to remove fluoride from their public water supplies, citing concerns about exposure, ethics, and informed consent.
Community water fluoridation was introduced in the middle of the twentieth century as a cost-effective public health measure. It did significantly reduce tooth decay in populations with limited access to dental care. But today, with the widespread availability of fluoride toothpaste and professional treatments, it’s not so clear if we need it in our water.
My office supports this cultural shift away from fluoridated water. Fluoride’s benefits are best delivered topically in controlled doses—not through water. By targeting enamel directly, topical fluoride avoids the risks associated with ingestion while still providing effective protection.
As fluoride use evolves, alternatives like CPP-ACP (casein phosphopeptide-amorphous calcium phosphate) are gaining attention. This milk-derived compound stabilizes calcium and phosphate, promoting enamel repair without systemic risks. Studies show that CPP-ACP is particularly effective in reducing early-stage cavities and remineralizing enamel.
At the same time, preventive strategies, like reducing sugar intake, avoiding processed foods, and maintaining diligent oral hygiene are proving just as impactful—if not more so—than fluoride alone. These methods address the root causes of decay, creating a healthier foundation for long-term oral health.
At our office, we take a personalized approach to using fluoride. We evaluate each patient’s susceptibility to decay each year, tailoring fluoride treatments to their unique needs. For high-risk patients, we recommend remineralization protocols and alternatives, like CPP-ACP, while minimizing unnecessary fluoride exposure.
Education is also a big focus for us. From teaching proper brushing techniques to discussing the impact of diet on oral health, we empower our patients to take control of their dental care. We also introduce children to fluoride gradually—starting with non-fluoridated toothpaste, progressing to low-fluoride options, and emphasizing spitting to minimize ingestion.
Fluoride has earned its place in the fight against tooth decay, but its role needs to be reevaluated. Systemic exposure through water fluoridation may no longer be the safest or most effective approach. Instead, topical fluoride applications—used in moderation and combined with preventive strategies—offer a better path forward.
By prioritizing at-home care, proper hygiene, and nutritional counseling, we can reduce reliance on fluoride while maintaining strong, healthy smiles. Let’s embrace a smarter, safer approach to oral health—one that respects both the science and the individual.
Aptel, P., & Jolly, S. (2010). The association of fluoride exposure and reproductive toxicity in male subjects: A review. American Journal of Reproductive Immunology, 42(4), 260-276. Retrieved from
https://fluorideresearch.org
Perumal, E., Paul, V., Govindarajan, V., & Panneerselvam, L. (2013). A brief review on experimental fluorosis. Toxicology Letters, 223(2), 236-251. https://doi.org/10.1016/j.toxlet.2013.09.014
Shen, P., Manton, D. J., Cochrane, N. J., & Reynolds, E. C. (2011). Effect of added calcium phosphate on enamel remineralization. Journal of Dentistry, 39(3), 169-175.
https://doi.org/10.1016/j.jdent.2010.11.007
National Research Council. (2006). Fluoride in drinking water: A scientific review of EPA’s standards. National Academies Press.
Scientific World Journal. (2020). Impact of fluoride toxicity on calcified tissues and its systemic implications. The Scientific World Journal, 2020
World Health Organization. (2019). Fluoride and health: A review of the risks and benefits. Geneva: WHO Press.
Mansfield, K. E., Mahmood, H., Walker, A. J., & Tomlinson, L. A. (2020). Fluoride and its effect on human health: Implications for dental and skeletal development. International Journal of Environmental Research and Public Health, 17(12), 4372. https://doi.org/10.3390/ijerph17124372
Dr. Alex Semidey, D.M.D., FIDIA, is a distinguished dentist with a Doctor of Dental Medicine degree from the University of Florida, a leading institution in dental education. Born in South Florida and raised in Barcelona, Dr. Semidey combines international experience with cutting-edge dental practices. His commitment to patient-centered care and continuous education ensures the highest standards in dentistry. Known for his painless injections and advanced techniques, Dr. Semidey’s expertise and dedication make him a trusted choice for quality dental care.
Connect on LinkedinDr. Sara Tarte, D.M.D., MS, combines a strong foundation in dentistry with hands-on experience, having begun her career as a Dental Assistant before earning her dental degree from the University of Florida College of Dentistry in 2022. With advanced certifications and awards for clinical excellence, she brings a high level of expertise and authoritativeness to her role at Semidey Dental. Dr. Tarte’s warm, caring nature and dedication to patient education reflect her commitment to trustworthiness and compassionate care. Her involvement in volunteering for Honor Flight South Florida further underscores her genuine commitment to community service.
Dr. Sara, a UF dental school graduate, started her career as a Dental Assistant at Semidey Dental before advancing to become a compassionate dentist. She’s a devoted Panthers fan, loves crafting, improv, and performing, and treasures time with her family and her beloved pet Roo.
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