Looking after your teeth…. and the controversy around Fluoride

Are you brushing your teeth twice a day? Are you changing your toothbrush every three or four months? This is what all of the guidance says we should be doing. I suspect most of us are brushing twice a day but wonder if we are all changing our toothbrush as regularly as we should? I know I’m not. It is also recommended that you use a fluoride toothpaste. There’s been a lot of discussion over the years about the inclusion of fluoride and whether it’s necessary. Lisa Watson explores the pros and cons.

Gum Disease, Tooth Decay and Why They are Harmful

Gum Disease is caused by the build-up of a sticky substance on the teeth called Plaque containing bacteria. Through lack of cleaning or not cleaning correctly, plaque can build up and irritate your gums. This leads to bleeding gums, swelling or soreness. Left untreated it can lead to Periodontitis, a condition that affects the ligaments and bones holding your teeth in place. Over time this results in receding gums and loosening of the teeth.

Tooth decay occurs when we eat or drink anything containing sugar. The sugar can react with the bacteria in plaque and form dental acids. These acids can attack the enamel, (the hard protective outer coating of the tooth) and soften the dentine which lies under the enamel of the teeth. This is why it is important we brush our teeth, as if left untreated, acid can create small holes in the enamel called a ‘cavity’.  We don’t always know we have tooth decay until we end up with toothache, or sensitivity to hot, cold or sweet things. Bad breath and an unpleasant taste in your mouth may also be indicators.  

Left untreated tooth decay can lead to bacteria entering the soft centre of the tooth, called the ‘pulp’. This is where our tooth nerves and blood vessels are contained. In a worst-case scenario, bacteria can enter the bloodstream and infect the heart valves. People with gum disease are more likely to have chronic life-threatening health issues such as high blood pressure and diabetes.

Fluoride?

There is controversy around the use of Fluoride these days, with some even suggesting it is added to our water as a means of keeping ‘us’ all submissive to the high powers that be such as our government. So, are we all being poisoned by governing bodies? Not sure! Tell me what you think! Let’s have a debate!! But here’s the facts….

According to Hefferman and Edwards-Lunn, (2018) Fluorine is the element from which Fluoride is derived. Fluorine is found occurring naturally in the air and in water. In addition, Fluorine compounds can be found in everyday products such as non-stick frying pans, dental floss and Prozac. Cafasso, (2018) states Fluoride is also found in cleaning agents and pesticides.

 So, why Do We Need Fluoride?

So why on earth do we need fluoride in our toothpaste if it’s a mineral used to make Teflon, steel, and aluminium products?

The NHS, (2018), states Fluoride can be naturally found in our teeth and bones, so argue it is something we already have within our bodies. Fluoride has been scientifically proven to be beneficial to help teeth fight against tooth decay as it is absorbed into the tooth enamel, replenishing lost calcium and phosphorous, which keep teeth hard.

The process is called ‘remineralization’ and helps strengthen teeth and prevent dissolution caused by acid, thereby by stabilising and enhancing the replenishment of minerals caused by gum disease and decay (Hefferman and Edwards-Lunn 2018). It is because of these benefits Sodium Fluoride is an active ingredient in most toothpastes.

So Is Fluoride Harmful?

Our teeth are pretty important to us for many reasons including helping us chew food. If Fluoride is such a good guy for our teeth why does it get so much bad press? For many the issue centres upon the fact Fluoride is a hazardous poison and in large parts of England, UK is added to our water supplies.

The World health Organisation states, “….Fluoride has beneficial effects on teeth at low concentrations in drinking-water, but excessive exposure to fluoride in drinking-water…….can give rise to a number of adverse effects…….These range from mild dental fluorosis to crippling skeletal fluorosis as the level and period of exposure increases…..” (2006: 2). So that sounds pretty nasty, but let’s not panic just yet. I think we need to take a closer look at this water business and see if it’s a bridge too far!

Fluoride And Water

Ground water, surface water and the various rocks and minerals they have been in contact with determines the natural level of fluoride in water. Ocean water contains fluoride at around 1 part per million, according to Hopcraft (2017). Bearing in mind Fluoride is also naturally occurring in the air and even in our food. So, if we obtain fluoride naturally anyway, then why do we need it adding to our water supply?

Artificial Fluoride in Water

A US, dental study in the 1930’s and 1940s by Dean et al (1950) showed lower levels of tooth decay in areas with naturally occurring fluoride in water supply.  This led to further studies about adding artificial fluoride to water and swiftly concluded that it was beneficial in the prevention of dental decay, (Lennon, 2006: 759). So surely that’s good news especially when we know how gum disease and dental decay can impact upon our overall health!

Health Implications

There are some quarters of the scientific world who argue prolonged exposure of fluoride such as artificial fluorination of water, can lead to Dental Fluorosis, (visual changes in appearance such as white or brown spots on the teeth) and Skeletal Fluorosis, (joint pain or stiffness – Reddy, 2009).

Some argue fluoride can increase risk of bone cancer, although various studies have been undertaken including one by Blakey et al (2014) here in the UK, which found no clear link.

A study in China suggests children living in areas with higher fluoride exposure can lead to lower IQ levels than those living in areas with lower fluoride exposure (Choi et al, 2012). Again further research is required as the authors admit.

What About Here In The UK?  

Between 2005 – 2015 on average 72% of the population received a water supply with a low concentration of fluoride, less than 0.2mg per litre. Hospital admissions for dental decay tooth extractions of children and young people aged 0-19 years were found to be 59% lower in areas with higher fluoride content than those in lower fluorinated areas.

When it comes to skeletal fluorosis, hip fractures in the age groups of 50 to 64 or 65 to 79 age groups showed under the age of 49, fluoride concentrations were associated with lower risk of hip fracture admission. Whilst older adults (80+), fluoride concentrations were associated with a small increase in hip fractures. However, surely other age-related health factors need to be considered. There has also been limited statistical evidence for the rate of Down’s syndrome being higher in fluorinated areas, and evidence of bone cancer in 0-49 year olds, (PHE, 2018).

Conclusion

Whilst the benefits of fluoride in aiding the prevention of dental decay and gum disease seem well established there is a wide range of contradictory information about the overall health benefits, or rather contra-indications, that suggest fluoride is harmful to us in larger doses through addition to our water supplies.

It is interesting the statistics gathered about possible health issues in England in 2018 are taken from a Health Monitoring Report by Public Health England, an executive agency of the Department of Health and Social Care. For me, I would be open minded about the impartiality of such statistics provided by government bodies telling us something is good for us. Once again, it comes down to personal opinion, how you perceive the abundant amount of information, studies and research out there and your moral or ethical viewpoint. The jury is still well and truly out and I think the debate around ‘yes or no’ for Fluoride addition to our water will rumble on for some time to come!

Keep brushing your teeth though!!

The MouthHealth.org website gives us some good advice on technique. Have a look here.

If you would like to check out whether your area has fluoride enhanced water, click this link.

Lisa Watson

References

Blakey, K., Feltbower, R.G., and Parslow, R.C., James, P.W., Gómez Pozo, B., Stiller, C., Vincent, T.J., Norman, P., McKinney, P.A., Murphy, M.F., Craft, A.W., and McNally, R.J. (2014) Is Fluoride A Risk Factor For Bone Cancer? Small Area Analysis Of Osteosarcoma And Ewing Sarcoma Diagnosed Among 0-49-Year-Olds In Great Britain, 1980-2005 in International Journal of Epidemiology. 2014 Feb;43(1):224-34.

Bupa, (2020) Treatments; Gum Disease https://www.bupa.co.uk/dental/dental-care/treatments/gum-disease#periodontitis

Cafasso, J, (2018) What Is Fluoride, and Is It Safe? https://www.healthline.com/health/what-is-fluoride

Choi, A.L., Sun, G., Zhang, Y., and Grandjean, P. (2012) Developmental Fluoride Neurotoxicity: A Systematic Review And Meta-Analysis in Environmental Health Perspectives. 2012 Oct;120(10):1362-8.

Dean, H.T., Arnold, F.A., Jay, P and Knutson, J.W., (1950), Studies on Mass Control of Dental Caries through Fluoridation of the Public Water Supply in Public Health Reports (1896-1970) Vol. 65, No. 43 (Oct. 27, 1950), pp. 1403-1408

Den Besten P., and Li W, (2011) Chronic Fluoride Toxicity: Dental Fluorosis in Monographs Oral Science, 2011;22:81-96

Harvard health Publishing, (2020) Hidden Dental Dangers That May Threaten Your Whole Body https://www.health.harvard.edu/staying-healthy/hidden-dental-dangers-that-may-threaten-your-whole-body

Healthy Choices, Water Fluoridation http://www.healthychoices.co.uk/fluoridation.html

Heffernan, M and Edwards-Lunn, T., (2018), A Common Sense Guide To Fluoride, The Great Dental Conspiracy Magnet https://www.telegraph.co.uk/health-fitness/body/common-sense-guide-fluoride-great-dental-conspiracy-magnet/

Hopcraft, M. (2017) Four Myths About Water Fluoridation And Why They’re Wrong  http://theconversation.com/four-myths-about-water-fluoridation-and-why-theyre-wrong-80669

Lennon, M.A. (2006) One In A Million, The First Trial Of Water Fluoridation in Bulletin of The World Health Organisation, Sept 2006, 84, (9).   https://www.who.int/bulletin/volumes/84/9/05-028209.pdf

NHS 2018  Fluoride  https://www.nhs.uk/conditions/fluoride/

NHS, (2019) Gum Disease https://www.nhs.uk/conditions/gum-disease/

NHS, (2019) Tooth Decay https://www.nhs.uk/conditions/tooth-decay/

Oral Health Foundation.org Dental Decay https://www.dentalhealth.org/dental-decay

Public Health England, (2018) Water Fluoridation: Health Monitoring Report For England 2018, PHE, London. 

Reddy, D.R. (2009) Neurology Of Endemic Skeletal Fluorosis in Neurology India. 2009 Jan-Feb;57(1):7-12.

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