Is Fluoride Safe?

The Controversy Over Fluoride

There’s a lot of information online about fluoride and its safety. In Las Vegas, our tap water contains about .3 milligrams per liter. What does that mean for you? I want to all my patients to have evidence-based information about fluoride, what it does, and where alternatives like hydroxyapatite fit in.

What Is Fluoride?

Fluoride is a naturally occurring mineral found in water, soil, and certain foods. In dentistry, fluoride is used because it strengthens tooth enamel and helps prevent cavities. To be clear, the CDC has declared water fluoridation to be one of the 20th century’s greatest public health achievements. 

Your enamel is constantly exposed to acids from food, drinks, and bacteria. Fluoride helps repair early damage by remineralizing enamel, making teeth more resistant to future acid attacks.

Why Dentists Recommend Fluoride

From a clinical standpoint, fluoride is one of the most effective cavity-prevention tools we have. It works by:

• Strengthening enamel
• Slowing down or stopping early cavities
• Reducing acid production from bacteria
• Helping repair microscopic enamel damage before decay forms
  

This is why fluoride is commonly found in toothpaste, professional treatments, and many public water supplies.

Is Fluoride Safe?

Yes!

…When used as directed, of course.

Fluoride has been studied for decades and is supported by organizations like the American Dental Association and the CDC. The levels used in toothpaste and drinking water are carefully regulated to provide benefit without harm. The U.S. Public Health Service recommends an optimal fluoride concentration of 0.7 milligrams per liter. In Las Vegas, the naturally occurring concentration is less than half of that (0.3 mg/L)!

Issues only occur with excessive exposure, such as regularly swallowing large amounts of fluoride over long periods—something that is uncommon with normal use.

What are the Risks of Fluoride?

While some people believe that fluoride may cause a decrease in IQ when ingested by young children, the studies with this suggested conclusion were all done in areas where fluoride was well over the safe concentration of .7 mg per liter. 

The greatest proven risk is dental fluorosis, which can occur if young children consume too much fluoride while teeth are still developing. It is aesthetic only, appearing as faint white spots on teeth, and does not affect tooth strength or function.

To minimize risk, I advise parents to:

• Use a rice-sized amount of toothpaste for children under 3
• Use a pea-sized amount for children ages 3–6
• Supervise brushing and discourage swallowing toothpaste
  

When used appropriately, fluorosis and other health risks associated with fluoride are rare and typically mild.

What Is Hydroxyapatite?

Many patients ask about hydroxyapatite, especially if they’re trying to avoid fluoride. Hydroxyapatite is a naturally occurring mineral in teeth, but our bodies have a difficult time breaking it down if it is ingested.

Proponents of replacing fluoride with hydroxyapatite claim that it works by:

• Bonding to the tooth surface
• Filling in microscopic cracks and weak spots
• Helping smooth and strengthen enamel

However, there’s less evidence on it than fluoride. It has been shown that most nano-hydroxyapatite toothpastes are not formulated well enough for the molecules to be active.

It is possible that nano-hydroxyapatite may be toxic if swallowed.

Fluoride vs. Hydroxyapatite: What’s the Difference?

While there was a lot of hype and popularity around Hydroxyapatite the past few years, newer studies are revealing that it may not be as effective as was previously marketed. 

• Fluoride strengthens existing enamel and makes it more resistant to acid
• Hydroxyapatite is naturally occurring, but in most toothpastes on the market, it has little to no effect on improving tooth structure

Fluoride has more long-term research and stronger evidence for cavity prevention, especially for patients at higher risk for decay. Hydroxyapatite has been heavily marketed in the recent years, but has little to no evidence of improving your oral health.

My Professional Take

Fluoride is completely safe when used properly, and it remains one of the most effective tools we have to prevent tooth decay. There are continued efforts to re-evaluate whether fluoride should continue to be the gold standard; however, the current body of evidence supports that it is the best treatment to remineralize teeth and prevent decay. 

Most nano-hydroxyapatite toothpastes on the market are much more expensive (sometimes two or three times the cost) of the average fluoridated toothpaste that you can find in the drugstore. The people who recommend hydroxyapatite over fluoride generally have something to gain when you as a consumer believe that fluoride is harmful. 

Of course, there’s no one-size-fits-all answer. Your cavity risk, diet, oral hygiene habits, and medical history all matter.

If you’re unsure what’s right for you—or your child—I’m happy to have a conversation and help you make an informed decision.

By Dr. Winna Pham, a general dentist in the Spring Valley / Chinatown area of Las Vegas, Nevada