Why do people add fluoride to drinking water?
The addition of fluoride to drinking water was once hailed as one of the great achievements of public health, helping to reduce tooth decay on a large scale. But is this measure still necessary in today's modern society?
In the medical field, especially dentistry, Fluoride is famous for its ability to prevent tooth decay. When used in appropriate doses, Fluoride helps strengthen tooth enamel and makes teeth resistant to acid attacks from bacteria in plaque.
Adding fluoride to tap water has been used for a long time, and this measure was once considered a breakthrough in preventing tooth decay and improving public oral health.
However, besides strong support from medical experts, it has also been the focus of criticism many times, especially from those concerned about the long-term effects of fluoride on the brain and development in children.
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In particular, the recent wave of opposition to fluoride in drinking water is showing signs of a strong comeback in the US. The US Secretary of Health and Human Services, Mr. Robert F. Kennedy Jr., is said to be considering canceling the long-standing recommendation of the US Centers for Disease Control and Prevention (CDC) on maintaining fluoride in drinking water.
At the same time, the US Environmental Protection Agency (EPA) has also begun reviewing scientific data related to potential health risks from this compound.
For fluoride skeptics, this is a historic victory. They have long warned that fluoride exposure, especially in children, can lead to neurological damage if the recommended dose is exceeded.
Although it is true that high levels of fluoride can be neurotoxic, the levels in tap water are usually strictly controlled by authorities and are within safe levels according to allowable standards.
Why is fluoride added to drinking water?
The decision to add fluoride to drinking water was not a random one, but was based on clear scientific evidence of its benefits in preventing tooth decay. According to public health experts, it is one of the most effective interventions ever used to improve the oral health of the population.
In a new study published in the JAMA Health Forum (USA), co-authors Sung Eun Choi (Harvard School of Dental Medicine) and Lisa Simon (Brigham and Women's Hospital) pointed out that Fluoride works through two main mechanisms: first, it converts hydroxyapatite - the main component of tooth enamel - into fluorhydroxyapatite, a form that is more resistant to acid, helping to protect teeth from corrosion; second, Fluoride can inhibit the activity of enzymes secreted by bacteria, reducing the formation of plaque and acid that causes tooth decay.
For that reason, health organizations have recommended that in cases where children do not have access to fluoridated water, they should supplement it orally or apply it directly to the teeth.
Fluoride’s protective role is not just theoretical. Choi and Simon cite a series of real-life cases, such as in Windsor, Ontario, Canada, where a decision to stop adding fluoride to water in 2011 was reversed just five years later, when the rate of tooth decay in the community skyrocketed.
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Similarly, Alberta, Canada, which stopped adding fluoride to water, had poorer dental health than Edmonton, which continued adding fluoride. And in Juneau, Alaska, the number of children treated for tooth decay also increased significantly after the government stopped adding fluoride in 2007.
Based on the evidence, Choi and Simon decided to expand their analysis, simulating what might happen if the entire United States stopped supplementing fluoride. Using data from more than 8,400 children in the 2013–2016 National Health and Nutrition Examination Survey (NHANES), they built a long-term forecasting model.
The results showed that if fluoride was completely stopped, the rate of tooth decay would increase by 7.5 percentage points within 5 years, equivalent to 25.4 million new cases of tooth decay. Families without health insurance or with only public insurance would be particularly affected, due to limited access to dental care.
Economically, the model estimates that stopping fluoride supplementation in drinking water would cost the US health system approximately $9.8 billion over five years, and $19.4 billion over ten years, primarily due to the cost of treating tooth decay and related complications.
“Our cost-effectiveness analysis clearly shows that discontinuing fluoride supplementation would significantly increase the disease burden and health care costs in the United States,” Choi and Simon emphasize.
Although the study only focused on oral health and did not extend to other systemic effects, according to the researchers, the existing data is enough to confirm that adding fluoride to drinking water still plays an important role, especially in protecting children's teeth, the most vulnerable group.