Last week’s news that a surprising number of teens have damaged teeth due to over-exposure to fluoride has made the bottled-or-tap question even more complicated to answer.
The government study found that about 2 out of 5 adolescents have tooth streaking or spottiness because of too much fluoride. But the debate over whether fluoride is helpful or harmful—or both, depending on the dose—has been around for several decades, says Dr. Tara Blank, science and health officer for the Fluoride Action Network, a consumer health group.
In small amounts, fluoride can strengthen tooth enamel, but its therapeutic range is small, and, in high amounts, teeth can be pitted by fluoride, which can lead to cavities and tooth loss. And research shows that older people who ingest too much fluoride can develop microscopic bone abnormalities that can lead to osteoarthritis or osteoporosis. Fluoride can also act as an endocrine disruptor, targeting the thyroid gland and causing hypothyroidism.
The Food and Drug Administration (FDA) and Department of Health and Human Services (HHS) recently lowered the amount of fluoride they recommend be added to municipal water supplies to respond to such health concerns. The new level is 0.7 mg/L, down from the previous recommendation of 0.7 to 1.2 mg/L.
Unfortunately there is no reliable, easily available test to determine if you or you children have been exposed to too much fluoride, says Dr. Yolanda Whyte, an Atlanta pediatrician with a special interest in children’s environmental health. “Fluoride binds strongly to teeth, bones and nails, so blood tests don’t reveal true exposure levels,” she says. “A specialized urine test, not readily available, can determine acute exposure, but must be done soon after exposure to fluoride, so it does not reveal the kind of long-term, non-acute overexposure to fluoride that is a problem for most children.” Instead of getting tested, she suggests, simply reduce your exposure to fluoride, especially if you have the telltale white mottling of fluorosis on your teeth or nails. Here’s how:
Filter your water—the right way. The major source of exposure to fluoride is drinking water. To find out if your drinking water is fluoridated, contact your local water department or search the Centers for Disease Control website for the fluoridation status of your water system. You can use a home water distiller, such as the D-3 (recommended by Andrew Weil, M.D.) to remove fluoride. Or you can use a reverse osmosis water filter, such as APEC, a popular brand of both in-home and commercial reverse osmosis water filters. Activated alumina cartridges also remove about 90 percent of fluoride, but are expensive (about $60 each) considering that they need to be replaced frequently.
Whatever type of filter you choose, look for a system that meets the standards of the National Sanitation Foundation. These methods are the only ways to remove fluoride, Blank says. “Unfortunately, activated charcoal filters such as Brita and Pur do not remove fluoride,” she says.
Be careful with bottled water. Bottled water has its own problems. Fluoride must be listed on the label only if the bottler adds fluoride to the water. If the water is naturally fluoridated, it need not be listed on the label, but U.S.-produced bottled water cannot exceed 2.4 mg/L (2.4 parts per million). Check this list of fluoride-free bottled waters.
Baby your babies. Most sensitive to overexposure to fluoride are infants and children younger than ages 7 or 8, says Blank. Breastfeeding your infant reduces fluoride exposure by 100- to 200-fold. Avoid using fluoridated water to mix infant formula or cereals, she recommends. Use, instead, fluoride-free brands like Gerber Pure Water. “Distilled water is as close to fluoride-free as you can get,” Dr. Blank says. (But still, check the label to make sure the distilled water does not have fluoride added back to it.)
Also, don’t use fluoridated toothpaste in children younger than age 2 — they are more likely to ingest it as they can’t spit it out properly. And don’t allow children to use fluoridated mouthwashes.
Avoid fluoridated foods. Note that some foods contain high amounts of fluoride. Among the highest: instant teas, some sodas, mechanically deboned chicken like that found in frozen, breaded chicken and chicken “fingers,” (the label will list mechanically deboned chicken) and processed lunch meats like those sold at grocery stores.
Stick with fluoride rinses. If you’re concerned about cavities in older children, Blank says, stick with topical applications of fluoride from toothpaste or rinses. But don’t ingest it. “There is no proof that ingested fluoride helps to prevent cavities,” she says.
For more information on the fluoride controversy, see:
The Centers for Disease Control:
The Agency for Toxic Substances and Disease Registry
Fluoride Action Network
For more on fluoride in foods, see the USDA National Fluoride Database of Selected Beverages and Foods at http://www.nal.usda.giv/fnic.