Fluoride- A Health-Conscious Hygienist’s View

Oh boy, I never thought I would be writing this article.  I have hemmed and hawed about this topic for a long time now and debated over whether I should go here…and here I go!! (stay tuned to watch me fall down this rabbit hole head-first)

When I started to get in to living a more natural lifestyle, cutting out unwanted ingredients in foods and household products, I had to take a long hard look at my views on fluoride.  Being a dental hygienist, I have always been taught it is amazing, all the hype about it being harmful and having negative side effects are poorly researched and not evidence based.  But, after all these years, I cannot help but question it a little bit myself.  Unfortunately, most of the research suggesting that fluoride is harmful is questionable, and the research is not evidence-based, so it makes it extremely hard to understand.  What I am willing to say is this:  the safety of fluoride is very controversial.  Even as a dental hygienist I am willing to admit this. 

Being so conflicted on the matter, where does this leave me?  Well it leads me to my next question- does the benefit outweigh the risk?  This is where I base a lot of my decisions as to whether I use a product, take a medicine, etc.  Are there more benefits to using a topical, fluoridated toothpaste vs the risk of using this product?  It absolutely breaks my heart when I get a little kiddo in my chair that has numerous cavities.  Maybe you think, “what’s the big deal, it’s just a cavity”, but maybe your brain does not walk you through this completely.  It’s not just a cavity- it’s a filling, which won’t last forever, so eventually will need to be replaced by a bigger filling, which will most likely eventually be replaced by a crown, which who knows how long will last… it’s a domino effect.  Teeth are so important to our overall health… when you start losing teeth your quality of life is just not the same.  And start to do the math on how much this is going to cost you or your child over their lifetime- dental work is not cheap!  So, when I see these kids and then their parents refuse a fluoride treatment, it makes me sad for them.  I think that for kids the benefit does outweigh the risk. 

Another thing worth noting here- is the source of fluoride topical or systemic?  Topical being the fluoride treatment in your dental office, your toothpaste and mouthwash.  Systemic being from the foods we eat (YES, fluoride is found NATURALLY in your foods and water) and then the fluoride that is added to our water supplies.  Personally, I think that maybe this is where we are getting it wrong- the doses in the water supplies.  You can easily google this and find out how much fluoride is in the water where you live.   A few years back, they lowered the optimal fluoride level in drinking supplies from .7-1.2 mg/liter to .7mg/liter- which also leads me to believe we are starting to learn more and more about what levels of fluoride are safe and effective. Unfortunately, when there is too much fluoride in the water, it can lead to a plethora of issues and can make the teeth weaker instead of stronger.  There is always the argument that topical fluoride becomes systemic because it is absorbed very quickly sublingually… I just have a hard time believing that the amount of fluoride absorbed in the short amount of time we are brushing our teeth is enough to make a difference, but I am sure there is research that shows it does.  Maybe this is something you can research on your own!

Here are some quick take-aways and facts about fluoride:

  • Fluoride is a naturally occurring mineral.  It is naturally found in foods and drinks, so even if you completely cut it out, you will still be getting some through these things.
  • Fluoride makes teeth stronger by aiding in remineralization.  Many of the foods and drinks we eat on a daily basis are acidic- how many of you think those La Croix’s are harmless? – they break down your enamel.  Fluoride has been proven to help re-mineralize these areas, and in turn make your teeth stronger and prevent cavities. 
  • I am unsure of the source of the fluoride added to water??? A quick google search states it is a by-product of the fertilizer industry- I have never heard this before, but it makes me want to do some more research there.  
  •  Overexposure to systemic fluoride can cause fluorosis.  This can happen to children under 8 years old, as this is when their permanent teeth are developing and are affected by the amounts of fluoride. 

By now you should all be completely confused about your stance on fluoride…Ha, just kidding, that is not the point.  My point is, yes, it is controversial, but the benefits cannot be denied either.  I am hoping that maybe after reading this you can weigh the options yourself- does the benefit outweigh the risk.  Do your research BUT make sure your research is evidence-based and not just from anywhere.  There is a lot of information out there, and not all of it is correct!

Keep reading if you want to hear about some fluoride-free product recommendations…

Here are a few fluoride-free products that I have done some research on:

  1. Risewell
    • Uses hydroxyapatite(HA) as a re-mineralizing agent. HA is a natural mineral and is a major component of teeth and bone.
    • Has been used in eastern countries as a preventative measure against cavities for a long time.
    • I love the ingredient profile here- we haven’t gone in to how many additives toothpastes have, but I really like the Risewell’s profile!
    • I have personally verified that it’s abrasiveness is about average, as far as a toothpaste goes. (some of these “natural” toothpastes are actually really abrasive- which is bad)
    • It is a new product, so the research will continue to develop. It takes years and years to do adequate research on these topics, so we have to be patient, but I’m hopeful it will have good results!
    • No prescription needed for this one- you can buy online at Risewell.com. Use code INTEGRATEDFNF for a discount!
    • Their floss is my FAVORITE floss… which is pretty big for a hygienist to say!
    • If you have made up your mind to not use fluoride products, I recommend this one, in hopes that the HA will aid in re-mineralization.

2. MI Paste

  • Uses amorphous calcium phosphate (ACP) to aid in re-mineralization. Teeth are made up of calcium and phosphate, so it makes sense that this would aid in remineralizing them.
  • MI Paste has been around for a long time, so the research is pretty substantial.
  • It is not a toothpaste, but a tooth creme- so application is not as simple as brushing with it.
  • If you have a milk allergy, you do NOT want to use this product.
  • You do need a prescription for this one- your dentist can provide you with that.
  • MI Paste PLUS has fluoride in it- just so you’re aware.
  • The ingredient label has a bunch of other ingredients that I am not familiar with. This doesn’t mean they are bad, but my rule of thumb is if I have to google it, do I really want to be consuming it anyways? But if you are choosing to not use fluoride products, you may have to decide what the lesser of two evils is.

**While these are both fluoride-free products, if you are concerned about where the fluoride is coming from, you should also ask yourself where the hydroxyapatite and amorphous calcium phosphate are coming from, that they add to these products. I have NO idea, but if we are going to harshly judge the sources of fluoride, shouldn’t we do that same for other ingredients?

Well, that was longer than I anticipated…shocking I had more to say than I thought!  So, wrapping it all up, fluoride is controversial, and it also has some great benefits.  If I were going to be concerned about it, I would probably start with the systemic sources of fluoridation, as I feel like they probably have a larger scale effect.  But do your research, especially if you have kids- think about the potential long-term ramifications of not using fluoride for your children.  Ask yourself if the benefit outweighs the risk.  What do I personally do?  I use a fluoridated toothpaste once a day and now Risewell once a day.  I really like the Risewell, so I am excited to see the long-term studies on it! (If you want to order some, use code INTEGRATEDFNF for a discount)  At the end of the day, I still believe that, for me personally, the benefit of using fluoride outweighs the risk. You have to decide that for yourself though- do your own research, and let me know what you find out!


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