Water Fluoridation and Dental Health

Utah is about to become the very first state in the USA to ban fluoridation of public water. But I’m not mad about this. To understand why, it first helps to understand exactly what the facts are about fluoridation and oral health. Fluoridation of water is praised by the CDC as being “one of the 10 greatest public health interventions of the twentieth century.” But the CDC also says that water fluoridation only reduces childhood cavities rate by about 25%. (I tried to link directly to the CDC but that page no longer loads, probably as a result of the Trump admin trying to delete science from the government), and while 25% is statistically significant in studies it is not practically significant in reality. For instance this effectively means that if a child was to normally get 4 cavities, after water fluoridation they would still get 3. Or for every 4 children that would get cavities, 3 of them still do. This really isn’t meaningful in terms either of public health or individual health, and if fluoridation nearly completely eradicated caries (cavities), I could better understand the rationale behind fluoridation of public water. But the actual rate of effectiveness isn’t even very high, probably estimated much higher than reality, and certainly within the range of possibly not being very effective at all such as demonstrated by a recent study of dental health which ranks states from worst to best according to a wide range of dental health parameters. The states with the best dental health are Wisconsin, Illinois, Idaho, Minnesota, and Michigan, while the worst are Montana, Louisiana, West Virginia, and Mississippi. Surprisingly (or not so, depending on your familiarity on this subject) water fluoridation does not correlate at all with these findings. This interactive map of fluoridation rates by state shows that Idaho, one of the states with the best oral health, only has a fluoridation rate of about 31%, while West Virginia, the 2nd to worst state for oral health in the entire nation, has a 90% rate of water fluoridation. New Jersey, ranked 11th best oral health, also only has a fluoridation rate of 16%. Hawaii has the lowest fluoridation rates in the nation, but still comes in at the 19th spot in rankings for oral health.

The disparity of claimed effectiveness versus demonstrated in the real world is not only reflected only in local trends and politics here in the U.S. The Netherlands as a country banned fluoridation in the 1970s, after coming to the conclusion that the science wasn’t good enough to support doing something so drastic to the public water supply, and other countries which do not fluoridate their water include Italy, France, Germany, Sweden, and Switzerland, all of which could be arguably described as more pro-science than the USA. While some American scientific institutions laud the supposed health benefits of fluoridation, the reason these other countries have not is because the science really isn’t there. The NHS (of the UK) recently conducted a study which found only a 3% and 2% reduction in invasive dental treatments from fluoridated water. Considering other studies which demonstrate the potential toxicity of fluoride, the fact that it is so hyped in the United States seems without merit at best, and possibly egregiously harmful at worst.

What is missing from the dialogue about fluoridation is the context around how fluoride actually functions (not what is glibly repeated by proponents of fluoridation). Fluoride is the reduced form of fluorine, the atomic element, and the form of fluoride added to public drinking water is typically sodium fluoride which is made by reacting acids to mined mineral forms of calcium fluoride in fluorspar rock. Both the reason fluoride is used in treating tooth decay and found naturally in calcium deposits is that fluorine reacts very strongly to calcium, so when it’s used in oral care products or drinking water it also becomes deposited in tooth and bone, which are sites of highest calcium deposition in the body and part of what make teeth and bones rigid. Our immune system also uses halides like fluoride in the immune reaction, where peroxidase enzymes oxidize halides like fluoride, chloride, iodide, bromide, and the pseudohalide cyanide in order to kill opportunistic pathogens, to resolve infections and disease when we become sick. This does include also oral disease and oral pathogens, including those which cause tooth decay.

While fluoridation of water is heralded as a major scientific achievement, the problem with fluoride is that it is not the primary strategy our body uses to fight tooth decay. It’s not even second on the list, and because fluoride is also a substrate for the oxidative reaction of the immune system which eradicates microbes it can and does also alter populations of commensal microbes, which are themselves our primary defense against disease causing organisms. While many anti-science proponents like RFK Jr who was just appointed Secretary of Health and Human services deny obvious scientific evidence, people who claim to support science also do that too and, just like RFK, choose to deny science which obviously refutes their previously held biases, such as that fluoridation of water is healthy. In reality, fluoride is the most reactive halide, and because of this its bonds are much stronger with other elements than the other halides like chloride, which our body appears to prefer since chloride is one of the most abundant elements which occurs in the human body and is the reason we respond so favorably to salt in food (which is usually sodium chloride). The halides are all highly reactive, and because of this the body has very tightly controlled systems for regulating their function but also which make them exploitable by opportunistic pathogens. For instance, microbial ammonia in the gut produced from parasites or H. pylori alkalizes chloride in opposition of the function of stomach acid (which is hypochlorous acid) to not only inhibit digestion but also to impair the absorption and uptake not only of chloride but also sodium and any other elements which react to chloride or dependent on sodium for transport.

This also brings up the rarely discussed fact that many things which are toxic to microbes are also toxic to us, so the fact that fluoridation kills caries causing bacteria does not mean it’s also safe. Arsenic is poisonous to most bacteria, but nobody would use that to clean their mouth. Our body does use things which are or can be toxic, however, such as ammonia, hydrogen sulfide, and even cyanide in our own systems, and their natural regulation and function has useful purposes in our body, but when dysregulated or occurring in excess become poisonous or cause health problems by dysregulating other systems, so the context of toxicity of things like fluoride is often missing when “science” is used to support policies like adding halides to public water systems, and because context is everything when it comes to biochemistry, the potential dangers for doing things like fluoridation of water is enormous.

The famous dentist Weston A. Price surveyed indigenous populations both with traditional diets and after the introduction of industrial diets and documented clear evidence of the harmful effects of refined, industrial diets on dentition and dental health. But Price’s work also occurred a century ago before we had access to the sheer quantity of scientific information we had today (and the people who run his foundation are very wrong about a lot of stuff they promote), and in my own research I have found that many of the reasons for the results Price observed are from diets rich in polyphenols like tannins and anthocyanins, while Price also recognized the presence of fat soluble vitamins (but didn’t know what they were specifically) such as carotenes and vitamin K, all nutrients frequently missing from industrial diets which are required not only for resistance against pathogens and a working immune system as discussed in my book but also for supporting the commensal microbiome which are our primary defense against disease causing microbes such as those which cause tooth decay and other oral disease.

Oral microbes and the oral environment are also primarily dependent on the amino acid proline which our body feeds to oral microbes (via saliva and mucosal secretions) between meals to keep them alive. While dietary proline can serve this purpose, I made the discovery in the course of my work and research that it is dietary citrulline, most commonly found in the cucurbits (cucumber, watermelon, squashes, etc.) which is the primary mediator of this mechanism because our body interconverts citrulline with other amino acids like proline but which does not occur during citrulline deficiency (because of something called the arginine paradox), and because of this dietary citrulline and consumption of cucurbits is a far greater predictor of dental health than water fluoridation.

The fatal flaw scientists and public health officials make in terms of water fluoridation is considering all forms of fluoride equivalent. Because fluoride is so highly reactive to calcium it occurs more commonly in nature as calcium fluoride, but the process of making and adding sodium fluoride to drinking water very likely causes perturbations in calcium dependent pathways in the human body which account for the negative affects of fluoride like cognitive and behavioral effects. Naturally occurring calcium fluoride is much safer because it is already reacted to calcium and thus will not react to the calcium in our bodies the way that sodium fluoride does, which is its entire justification for dental health, but many pathways in our body depend on calcium, and fluoride could, can, and does interfere with calcium sensitive channels. Far greater than the effects of fluoridation on oral health are factors like economic stress and poor access to healthy food, nutrition, and healthcare such what is rampant across the United States, unlike other nations in the world which largely have public healthcare access for all their citizens. In addition to an industrial diet, fluoridation is simply a poor solution to problems like inequality, poverty, and exploitation of people we create in our country that should not be occurring in the first place.

There is clearly some evidence for positive effects of fluoride on dental health, but this is not necessarily achieved in a way that is actually safe or healthy overall, and very likely causes other health problems, especially in people who are vulnerable who also cannot avoid it when all drinking water is treated. In criticism of the work of Weston A. price a person points out that malnutrition inhibits cavities due to the lack of food. While this is true, they were also racistly assuming that indigenous and aboriginal people were all starving before the advent of industrial food systems (lol dumb fucking racist), but it also inadvertently points out that just because something has an effect does not necessarily mean that it’s good. The fact of the matter when it comes to fluoride is that oral health is not and never has been a function of water fluoridation, but of good diets and dietary behaviors, and knowledge of health and human biology as discussed in the chapter on oral health in my book (Fuck Portion Control) elucidates the why and how of most of it. Oral health is extremely complicated, in fact, concerning principles of cellular and molecular polarity, the immune system, oral microbiome, and diet, and while most people will never even bother to learn how to care for their oral health there is a plain and glaring disparity between the supposed claims of water fluoridation and the actual results seen in populations around the world. Considering that fortification with potentially harmful elements as is so common a practice can very likely cause harm, these ARE NOT things we should be doing to our food and water supply unless they present a clear and overwhelming benefit to the public with NO even remote potential for harm. In even the most liberal litmus for safety and benefits, water fluoridation does not pass.