Fluoride Isn’t Controversial in Dentistry—It’s Just Misunderstood
In the lead-up to the 2024 election, Robert F. Kennedy Jr. has revived a long-standing health debate: is fluoride in water safe? His anti-fluoride campaign claims that fluoride is neurotoxic and should be removed from the U.S. water supply. These arguments aren’t new—but in today’s environment of health skepticism, they’re spreading faster.
As dental professionals, we need to be clear: fluoride is safe, effective, and essential to preventing tooth decay. Here’s what the science actually says.
What Is Fluoride and Why Is It in Tap Water?
In the United States, fluoride is added to public drinking water at a level of 0.7 parts per million (ppm). This level was set by the U.S. Public Health Service and is designed to strengthen enamel and reduce dental cavities—without causing harmful side effects.
Fluoride occurs naturally in groundwater in many parts of the world. But when anti-fluoride studies are cited, they often come from regions with unregulated, high fluoride levels—well above 2.0 ppm. That’s nearly three times the amount used in U.S. fluoridation programs and not an apples-to-apples comparison.
What About the Study Linking Fluoride to Lower IQ?
One of the most referenced studies by anti-fluoride advocates is the 2019 Green et al. study, which found a small drop in IQ among boys born to mothers with higher fluoride exposure. But the study has major limitations:
(1) It was observational, meaning it couldn’t prove cause and effect.
(2) It relied on self-reported water intake, not measured fluoride levels.
(3) The IQ difference was small and only showed up in boys—not girls.
(4) No biological explanation was provided for the gender-specific result.
If this study had definitively shown fluoride harms children, public health policies worldwide would have shifted. They haven’t—because the weight of evidence still supports fluoride’s safety and benefit when used appropriately.
Fluoride Works—And the Data Proves It
A 2015 Cochrane Review found that fluoridated water reduces cavities in baby teeth by 35% and in adult teeth by 26%. The CDC ranks water fluoridation among the top ten public health achievements of the 20th century. These aren’t just numbers—they translate into:
- Fewer cavities
- Fewer dental emergencies
- More access to preventive care, especially in underserved communities
In dentistry, there’s no serious debate: fluoride is effective, and removing it would lead to worse health outcomes—especially for children.
What About Hydroxyapatite Toothpaste?
If patients are looking for a fluoride-free option, hydroxyapatite toothpaste is the only alternative with real clinical evidence behind it. Hydroxyapatite is a naturally occurring mineral that makes up about 97% of tooth enamel. Toothpaste with hydroxyapatite has been shown to reduce demineralization, relieve sensitivity, and support enamel repair—without the risk of fluorosis or irritation. For patients at low risk of decay, or those with concerns about fluoride exposure, it’s a valid option that aligns with both science and patient preference.
