A new study from the federal Centers for Disease Control and Prevention (CDC) about the toothbrushing habits of young children is nothing to brush aside.
The study, released in February 2019, found that nearly 40 percent of American children ages 3 to 6 used more than the recommended amount of fluoride toothpaste. To come up with that statistic, the CDC surveyed the dental behavior of almost 1,700 children in that age group.
While fluoride helps prevent cavities, overuse of fluoride toothpaste — more than a pea-sized drop on a toothbrush — can lead to tooth discoloration and damage among 3- to 6-year-olds.
“When it comes to fluoride toothpaste, getting the right amount of fluoride is best — not too much and not too little,” the American Dental Association advises.
More than highlighting the use of fluoride toothpaste among young children, the CDC study might raise your overall concerns about fluoride. While critics attack fluoride as a hazardous, toxic chemical, fluoride supporters acknowledge excessive amounts of the chemical may be unsafe but insist normal levels are safe and effective in promoting oral health.
Where can you find fluoride?
For decades, fluoride in toothpaste and tap water has contributed to a historic decline in tooth decay among children and adults in the U.S. its supporters say. However, health authorities in recent years have seen a small uptick in the share of young American children with tooth decay; they pin the blame largely on increased consumption of sugary foods and drinks.
Fluoride occurs naturally in water, soil and foods. Synthetic fluoride is available in drinking water, toothpaste and mouth rinses. The CDC says there’s no difference between natural fluoride and fluoride additives.
Today, fluoride is added to most brands of toothpaste, and about three-fourths of Americans have access to fluoridated drinking water through public water systems. Some brands of toothpaste are made without fluoride, though, and fluoride sometimes shows up in small amounts or not at all in well water and bottled water.
Can toothpaste without fluoride offer any benefits?
Dr. David Okano, a dentist who’s an assistant professor at University of Utah School of Dentistry, answers this question with an unequivocal “no.”
“The only benefit that you’ll gain is a fresher mouth with the natural toothpaste, but you will not receive any benefit against tooth decay if it doesn’t have fluoride within it,” Okano says in an interview with University of Utah Health.
However, some consumers are switching to fluoride-free toothpastes to avoid even low-level exposure to the chemical, despite the fact that these products do not fight tooth decay.
Is fluoridated drinking water bad for you?
More than 50 years of experience with fluoridated drinking water in the U.S. shows it has safely lowered the incidence of tooth decay, Okano says. He cites the stark difference in the better dental health among children in communities with fluoridated water compared with children in communities without fluoridated water.
“Nonetheless, there are some folks who do not believe in it, and they are skeptics for the rest of their lives. But we can’t convince those folks,” Okano says. “But for the masses, where so many people have benefited, people understand the benefits of fluoride to their dental health.”
One of those skeptics is the International Academy of Oral Medicine and Technology. The nonprofit organization says its work combats an “alarming lack” of awareness among health professionals, policymakers and consumers about “dangerous dental products that are harming humans and the environment on a massive scale.” It includes fluoride among those products.
On its website, the organization lists a number of potential problems tied to exposure to fluoride, including cancer, diabetes and heart disease. Here’s the breakdown of the possible relationship between fluoride and those three conditions.
1. Cancer
Today, the “general consensus” among researchers “is that there is no strong evidence of a link between water fluoridation and cancer,” the American Cancer Society says. However, several researchers have noted that further studies are needed to clarify any possible connections, the Cancer Society says.
Dr. Herve Sroussi, a physician who specializes in oral medicine at the Dana-Farber Cancer Institute and Brigham and Women’s Hospital, says research confirms that “there is no reason to believe that fluoride, used in an approved manner, in any way causes disease,” including cancer.
Yet the Fluoride Action Network and a number of other anti-fluoride activists point out research drawing a connection between fluoride and bone, bladder and lung cancer.
“The concern that fluoride can cause cancer has been fueled by evidence linking it to a serious form of bone cancer known as osteosarcoma,” the Fluoride Action Network says.
The American Cancer Society stresses that since osteosarcoma is a rare cancer — only about 400 cases are diagnosed in children and teens each year in the U.S. — it’s difficult to study enough cases to conduct meaningful research about fluoride’s potential connection to osteosarcoma.
2. Diabetes
A study published in 2016 by a researcher at the Case Western University medical school suggested that fluoridation of water supplies was “significantly associated” with spikes in diabetes between 2005 and 2010 across 22 states.
However, the researcher, Kyle Fluegge, stressed that the findings of his study should not be applied “directly to individuals” and that the subject deserves further examination. And, he added, his research indicated that naturally occurring fluoride “has a protective effect from diabetes,” but that this type of fluoride generally isn’t present in water supplies.
In highlighting what it cites as a link between fluoride and diabetes, the Fluoride Action Network notes: “Fluoride has been shown to increase blood glucose levels and impair glucose tolerance, likely by inhibiting insulin production or secretion.”
3. Heart disease
In 2016, an analysis of more than 60 years of scientific research and 3,000 studies done by Australia’s National Health and Medical Research Council indicated there’s “insufficient evidence” to show a correlation between fluoride and heart disease.
Citing several studies, the Fluoride Action Network disagrees. The group maintains that fluoride can accumulate in the cardiovascular system and trigger issues such as high blood pressure, arterial calcification (an early sign of heart disease), arteriosclerosis (hardening and thickening of the arteries) and myocardial damage (which can be a precursor of a heart attack).
