Fluoride is a naturally occurring chemical that can be found in some foods and beverages. It is also used to make fluoride toothpaste and mouthwash to prevent cavities. Fluoride was first introduced into public water supplies as a way to reduce dental decay and improve overall dental health.
There are many misunderstandings about the risks and benefits of fluoride in drinking water.
What is fluoride?
Fluoride is a class of compounds composed mostly of the natural element fluorine. Fluoride exists naturally in water and soil at various levels.
Fluoride can also be found inside our bodies. Approximately 99% of fluoride found inside of the body is within our bones and teeth. 
Over the last hundred years or so it has been found that fluoride prevents or reverses molar tooth decay. It works by inhibiting bacteria that produce acid in the mouth. And also through stimulating the process in which tooth enamel is reconstructed.
What is water fluoridation?
Water fluoridation refers to the addition of fluoride to community water supplies by public health authorities. It is used to adjust the natural fluoride levels in water to concentrations recommended for dental health benefits.
The History of Fluoridation
Water fluoridation was discovered by accident. In 1901, a dentist named Frederick McKay noticed that the town’s people in Colorado Springs had brown stains on their teeth. He believed this indicated high concentrations of fluoride in the water. 
However, he also noted that they did not have much tooth decay compared to other similar communities without the stain. This began the scientific journey of fluoride as a way to prevent cavities.
Community Water Fluoridation
In the 1930s, scientists recommended adding fluoride to water supplies as a public health measure. .
The first experiments were done in Newburgh, New York and Kingston, New Jersey between 1945 and 1956. Scientists observed the effects of drinking fluoridated water in children and compared them to those who didn’t drink it. They noticed a decrease in tooth decay among the children who drank fluoridated water.
Milk fluoridation is an addition of fluoride to milk. Milk fluoridation was first proposed in Switzerland in the 1950s [4a]. Studies show that the children who drink fluoridated milk have fewer cavities than those who do not drink it. Milk fluoridation is also supported by the World Health Organization (WHO) [4b].
Salt fluoridation involves adding fluoride to table salt. It’s considered an effective method for tooth decay prevention.
Adding fluoride to salt was first done in Switzerland and Germany beginning in 1922  and became popular and widely used after World War II.
In Switzerland, 85% of salt is fluoridated, with that number estimated at 67% in Germany. Many scientists believe that salt fluoridation is one of the cheapest and most effective ways of preventing dental caries.
The Benefits of Water Fluoridation
According to the Centers for Disease Control (CDC), more than 75% of Americans drink fluoridated water. 
Along with the CDC, the American Medical Association (AMA), American Dental Association (ADA), and then World Health Organization (WHO) all recognize and support water fluoridation as a safe and effective way to prevent dental decay.
Better Dental Health & Less Tooth Decay
Most people who drink fluoridated water daily experience better oral health. This is because fluoride strengthens teeth and prevents cavities from forming.
Fluoridation of drinking water reduces cavities (tooth decay) by around 25% in children and adults by making teeth stronger. 
Reduced Dental Treatment Costs
According to the CDC, water fluoridation saves about $6.5 billion per year in reduced dental treatment. .
On the other hand, if this water was not treated with fluoride there would be an increased number of people experiencing cavities, thus requiring more dental work leading to higher costs for both patients and insurance providers.
Possible Health Risks of Too Much Fluoride
There are no conclusive studies that prove adding fluoride to community water supplies adversely affects a person’s overall health.
Reduced IQ in children
Some research shows an association between fluoride consumption and reduced IQ scores in young boys. Interestingly the association doesn’t exist for girls.
The study by Green et. al has been questioned by multiple scientists, who found the data to be unreliable and the findings to be borderline rather than meaningful 
There have also been studies by the National Toxicology Program which found some possible negative effects of fluoride exposure at levels higher than 0.7 parts per million on the learning and memory of mice and rates. It’s important to note that these were not considered conclusive, and neither can the results be extrapolated to humans 
Bone Cancer (Osteosarcoma)
Another potential risk of fluoride ingestion revolves around its possible connection to cancer rates. A 2001 study published in Cancer Causes and Control by Elise Bassin  found that boys who drank fluoridated water had an increased chance of suffering from Osteosarcoma, a deadly bone cancer.
The study has some serious limitations, however. A colleague of Bassin’s professor Chester W. Douglass, DMD, Ph.D. noted that the study was conducted on a small subset of people exposed to water fluoridation. Studies that focus on the entire population do not show any link.
Nephrotoxicity and kidney damage
Nephrotoxicity is another possible risk associated with fluoride consumption. A 2015 study in Environmental Health & Preventive Medicne found that a high incidence of kidney damage in Sri Lanka was caused by excess fluoride in drinking water .
However, the same study notes that “there are no known adverse effects associated with relatively low levels of fluoride (1–2 ppm in drinking water)”.
Another potential risk of fluoride ingestion is dental fluorosis . According to the CDC, even though it’s a cosmetic condition, in its advanced stages it can cause major problems for someone who consumers too much fluoride in early childhood.
It’s only a concern for children, and again, is only a risk where fluoride levels in drinking water are higher than 2 parts per million.
The Best Way to Remove Fluoride from Drinking Water
Despite inconclusive evidence, if you are a pregnant person or you have young children you may still want to limit your fluoride exposure.
Fluoride Water Filters
Fortunately, there are many different kinds of filters (both pitcher and faucet-mounted) that can effectively remove fluoride from your tap water.
First, carbon filters are the cheapest option in terms of bringing fluoride down in your drinking water. This means that if you have a large family or you use a lot of drinking water daily, this may be one of the best options for you. Most pitcher-style carbon filters will bring fluoride levels down to about 0.2 ppm.
We also like the Clearly Filtered water filter pitcher, which we reviewed here because it removes more fluoride than any other pitcher we found on the market.
Another option for removing fluoride from tap water is reverse osmosis systems. These systems work by forcing tap water across a membrane containing activated alumina granules that attract fluorine atoms and remove them as wastewater.
Another good choice is a water distiller. This system works by heating the water into steam that then condenses into purified water. Since fluoride is more volatile than other substances, it will leave first as vapor and not be present in your drinking container.
Want to reduce your fluoride intake? Check out our article: 5 Best Fluoride Water Filters Reviewed
Water Fluoridation Facts & Statistics
- According to the CDC, dental cavities are reduced by 25% in areas where fluoride is added to water.
- Grand Rapids, Michigan became the first city to fluoridate water in January 1945 
- Fluoride is toxic for humans when consumed at doses over 5-8 mg/kg of body weight 
- Every $1 spent on water fluoridation saves up to $38 in dental treatment costs 
- There are still no conclusive studies that prove fluoride negatively affects overall health or IQ scores in children
- Reduced dental treatment costs is one of the main reasons why public health officials push for water fluoridation
- More than 9 out of 10 dentists are in favor of water fluoridation 
- Fluoride is found naturally in water, plants, and animals.
- Dental fluorosis is a cosmetic condition of the teeth caused by prolonged exposure to fluoride
- One out of every six children has some form of dental fluorosis.
- Children ages 12-15 are most at risk for dental fluorosis because their teeth are still developing
Frequently Asked Questions About Flouride Drinking Water
Does my drinking water contain fluoride?
To find out if your water supply is fluoridated, you should contact your local government. In some parts of the U.S., fluoride is added to drinking water to meet federal recommendations.
You can also buy a drinking water test kit to determine if your water has fluoride in it.
Why is fluoride added to my drinking water?
The U.S government recommends that public water suppliers add fluoride to their drinking supply to help prevent tooth decay.
What percent of the US has fluoridated water?
As of 2016, more than 200 million people in the US have access to fluoridated drinking water.
What states fluoridate water?
All states fluoridate water, but there are some states where the total population covered is very low.
States with low percentages of people served by community systems getting fluoridated water included: Oregon (27 percent), Montana (31), Idaho (31), Wyoming (36), Louisiana (40), and New Hampshire (43) .
Is fluoride safe?
While some studies have linked fluoride ingestion to health problems, there is no conclusive evidence proving fluoride ingestion affects overall health or IQ scores in children.
Does fluoride whiten teeth?
Currently, fluoride is the only chemical approved by the FDA for tooth discoloration. However, according to The American Dental Association (ADA), it’s not clear whether or not fluoridated water helps teeth become whiter.
Get Optimally Fluoridated Water but Avoid Excessive Fluoride Exposure
While there are a number of ways to remove fluoride from your drinking water, research still suggests that it’s better for your teeth to keep the fluoride in.
However, if you’re worried about high fluoride concentration in your water, the easiest solution may be to get a distiller for your kitchen countertop.
Whatever you choose for your home, make sure that you consult the public health service or your doctor before making any decisions.