Photo: Bryan Goodchild
Fluoride not only strengthens teeth and leads to better health overall but also is one tool communities can use to reduce health disparities, according to Hugh J. Silk, MD, MPH, professor of family medicine & community health.
Yet not every city and town has added fluoride to its water. And the future of public water fluoridation may be in question.
How does fluoride provide health benefits, what are the risks and what should people do to protect their oral health? Dr. Silk explains:
Why does fluoride matter?
“Fluoride first of all strengthens the outer coating of the tooth, the enamel. If you start to get tiny little holes, that aren’t full cavities, it repairs those,” Silk said. “It also kills some of the bacteria in our mouth that lead to cavities. People have good and bad bacteria in their mouth, and the bad bacteria takes sugar from what we eat, turns it into acid, and then the acid eats away at the tooth.”
Silk said that having healthy teeth isn’t important just for a bright smile.
“The mouth has dramatic effects on the rest of the body,” he said. “It could be as straightforward as, if you get an infection in your mouth, that infection could spread, and what was a toothache is now bacteria floating through your whole body, infecting your heart, infecting your joints.” He said many people die each year from such infections.
Similarly, inflammation from gum disease, called gingivitis and periodontitis, drifts into the rest of the body, which can worsen such conditions as diabetes, heart disease, arthritis and Alzheimer’s disease.
In 2022 Silk and his colleagues launched the 100 Million Mouths campaign to train health professionals to integrate oral health into primary care education nationwide.
Medical students are taught how to do a proper oral exam to catch problems early and also address things like oral cancer. Silk said someone is diagnosed with oral cancer every 10 minutes in this country.
Where is fluoride found?
Fluoride is a mineral found naturally in the Earth’s crust and in water, said Silk. But for most communities, the level is so low that it wouldn’t help our teeth, so many communities add fluoride to their public water supply.
Silk said, “Studies over time have shown that if you look at a community that has water fluoridation versus a community that doesn’t, there are fewer cavities and other tooth problems.”
What to do if you don’t have fluoridated water
Silk recommended the website IlikeMyTeeth.org for resources on good oral health as well as facts and myths surrounding fluoride. He said fluoridated water is safe for young children as well as adults.
For those who don’t have access to fluoridated water, the American Academy of Pediatrics says that up until age 16, medical and dental providers should prescribe fluoride once teeth start appearing in the mouth. Fluoride is initially given in drops and then later in chewable form.
It’s also important to brush twice a day with fluoridated toothpaste once teeth begin to erupt and floss every day once the teeth start to come together, usually between ages 3 and 6.
Fluoride varnish, which is painted on children’s teeth, is another tool. It can be done in physicians’ offices, not just by dentists. Silk has overseen the training of more than 600 primary care medical offices in New England to do this.
Risks and benefits of fluoride
Critics of fluoridating community water supplies point to studies that have linked fluoride to lower IQ scores in children. But according to Silk, “Those studies have been really looked upon with a lot of questions about their validity.”
For example, some were conducted in places where people got water with at least double or triple the level of fluoride allowed in the United States. Other environmental factors were also not taken into consideration. The website Ilikemyteeth.org discusses these critiques in depth.
Several studies have shown dramatic public health cost savings from fluoridation. The U.S. Centers for Disease Control and Prevention found that for every $1 invested in fluoridation, most cities saved $32 in costs to treat dental problems.
For Silk, a compelling reason concerns health equity. He said, “When we do things like put fluoride in the water, we make it so that everybody is getting access to something that’s going to help prevent a problem, as opposed to only those who can afford to go to the dentist or who can afford toothpaste.”
Science for Living stories feature the perspectives of UMass Chan Medical School experts on the research behind health news headlines. If you have ideas for topics you’d like to see explored, reach out to susan.spencer1@umassmed.edu.
