What to Do If Fluoride Is Removed From Your Water

Health – TIME – Read More

Right now, it’s politically hot to spit out fluoride. Health Secretary Robert F. Kennedy Jr. has long railed against fluoride in public water supplies, claiming that it correlates to lower IQs in kids. (Research suggests that fluoride may be linked to lower IQ scores only at very high exposures.) Dozens of places in the U.S.—including Miami-Dade County, Fla., Peshtigo, Wis., and the entire state of Utah—have recently passed restrictions banning the fluoridation of public water supplies. Florida just announced plans to ban fluoride beginning July 1, 2025.

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More states and localities may follow suit after the U.S. Food and Drug Administration (FDA) announced on May 13 that it is taking steps to remove ingestible fluoride supplements prescribed to children from the market. The U.S. Environmental Protection Agency (EPA) also said in April that it’s studying the health risks of fluoride, and Kennedy has signaled that the U.S. Centers for Disease Control and Prevention will stop recommending water fluoridation.

These concerns contrast with the views of most U.S. dentists and pediatricians, who advise that fluoride is safe in small doses and one of the few bright spots in the fight against cavities since its addition to water in 1945. About 1 in 4 kids have dental decay by kindergarten, with those at lower economic levels affected most.

“I am concerned about the fluoride issue,” said Dr. Mike Simpson, a Republican congressman from Idaho, to Kennedy during a May 14 congressional hearing. “I’ve seen the benefits, having been a practicing dentist for 22 years.”

“If you are successful in banning fluoride…we better put a lot more money into dental education, because we’re going to need a whole lot more dentists,” Simpson said.

Here’s what you should do if your water stops being fluoridated, and what to know about the various sources of the mineral.

Why fluoride helps

Fighting cavities is important throughout life, but especially during childhood, from infancy through early adolescence. “There is a critical window for getting fluoride to protect teeth as they’re developing,” says Dr. Erica Caffrey, clinical assistant professor at the University of Maryland School of Dentistry. When kids miss this window, they have more cavities and, as adults, higher rates of dental disease. “Treatment is a much different game” than prevention, Caffrey says.

An expensive game at that: the U.S. spends billions of dollars treating cavities, even though they’re preventable. Caffrey deals with serious complications from dental disease in her Maryland practice, including kids with swollen faces and so much pain they can’t eat. Sometimes their dental infections spread elsewhere in the body, causing dehydration and fatigue. “What affects your teeth can also affect cardiac health and your child’s behavior, nutrition, and speech,” Caffrey says.

Fluoride helps protect teeth by making the hard outer layer—the enamel—more resistant to acid attacks by bacteria and sugars. When acid starts to wear down enamel, fluoride draws in calcium and phosphate to rebuild the weakened areas, in a process called remineralization.

When fluoridated, drinking water applies fluoride to the teeth continually and passively, without people needing to think about it. “The fluoride sits in the oral environment and makes the teeth stronger over time,” Caffrey says. This is critical for the millions of Americans who struggle to access dental care.

Most Americans still live in places with fluoridated water, but if your child’s water supply is not fluoridated, professional associations of dentists and pediatricians recommend talking with your health care providers about fluoride supplements to help ward off dental decay.

Diet and dental hygiene

Cavities are mainly caused by eating excess sugar and refined carbohydrates. Just by having a healthier diet, people can reduce their vulnerability to cavities and the need for fluoride supplements to make up for its absence from community drinking water.

Refined carbs are processed by the bacteria in our mouths, creating the acid that breaks down tooth enamel. When bacteria are fed less, it’s harder for them to create the tiny holes in teeth known as cavities, Caffrey explains. Liquids, such as juice and soda, are especially problematic because they soak the teeth in sugars, she adds. Sugar-free soda doesn’t help much; the carbonation harms the enamel because it’s acidic.

“The fundamental cause of cavities is sugar and starches,” says Dr. Philippe Hujoel, professor of oral health sciences at the University of Washington, so limiting intake is important for dental health. Talk with your dentist or primary care doctor about replacing these foods with fruits, vegetables, and lean proteins for oral and overall health, especially if your community doesn’t fluoridate the water. You could also opt for foods that are naturally higher in fluoride, such as tea, shrimp, and, if you can tell from the label, products grown or packaged in other communities that do fluoridate the water, Caffrey recommends.

It’s just as important to reduce risk through good oral hygiene: brushing in the morning and before bed, flossing once per day, and attending regular dental checkups.

Varnishes

Fluoride is most effective for oral health when it’s topical, or applied directly to the teeth. This is “the predominant effect of fluoride,” Wright says.

Your dentist may recommend a topical fluoride, depending on your diet and dental hygiene. One option is painting the teeth with a concentrated form of fluoride, called varnish. It sticks to the enamel, gradually releasing fluoride that bolsters the tooth surface. Applied by a dentist, pediatrician, or nurse, these treatments are especially recommended for kids and adults with high risk of tooth decay.

An extensive research review found that fluoride varnish lowers the risk of cavities in kids and adolescents by about 40%—and it has this benefit regardless of whether kids live in communities with fluoridated water. Varnish offers significant protection on its own, even without other fluoride exposures. It’s applied as frequently as every three months for children with high cavity risk.

Toothpaste and mouth rinse

Another topical approach is fluoridated toothpaste. “Using toothpaste with fluoride twice per day is among the most critical ways to prevent dental disease,” Caffrey says.

Researchers have found that using fluoridated toothpaste regularly is protective enough that access to fluoridated water offers only a small additional benefit.

Children under 3 should brush with no more than a rice-grain-sized smear of fluoridated toothpaste on a soft toothbrush. For ages 3-6—after which kids can typically rinse with water and spit out the paste—a slightly larger pea-sized dollop suffices. After age 6, a slim ribbon is okay.

Depending on your oral health, dentists may also recommend a mouth rinse with fluoride. Rinses can help kids with braces, who may have a harder time reaching the whole tooth.

“As with anything, there’s such a thing as too much fluoride,” Caffrey explains, but “it takes a significant amount of ingested fluoride daily to get into the worry zone.” Hujoel is more concerned about this threshold. “There are many fluoride exposures” even without fluoridated water, such as fluoride in food, he says. “You can easily go above the recommended dose.” One risk, researched by Hujoel, is fluorosis, a condition causing mild discoloration of teeth. Discuss cumulative intake with a dentist to better understand your personal risk.

Bottled fluoride

Bottled water with fluoride is another supplement option. In communities without fluoridated water—like Clifton, N.J., where pediatrician Dr. Bob Jawetz practices—it’s ideal to combine bottled fluoride water with a topical supplement (like toothpaste, mouth rinse, and/or a varnish), Jawetz says. Although topical fluoride has the strongest effect, when you drink fluoride, too, it’s absorbed into the inner structure of the tooth, providing some degree of additional benefit.

Prescription gels, drops, and chewables

Some fluoride supplements are prescribed, including stronger versions of the mouth rinses, but also lozenges and tablets that can be chewed and swished around the mouth. To maximize fluoride’s effect, keep them in the mouth for 1-2 minutes before swallowing. You could also dissolve such chewables into water, in which case “you’re back to water fluoridation,” Wright says.

Kids too young for chewables might instead be prescribed drops or gels. A 2015 review found gels—a topical treatment applied in a tray—are effective without adverse effects, but Caffrey rarely uses them because kids could end up swallowing more than is ideal, she says.

Dentists may recommend these supplements in communities lacking fluoridated water for infants whose teeth haven’t erupted yet. Follow the recommended dose. Your dentist may advise minimizing other fluoride sources to reduce risk of fluorosis.

The consequences of forgoing fluoride

Removing fluoridated water can negatively impact kids who may not brush regularly or optimally, and whose diets may increase cavity risk, Caffrey says. “When you take a blanket health measure away, such as community water fluoridation, the most at-risk children are the ones likely to suffer most.”

“The dental community is very worried” about fluoride’s removal from the water, Wright says. “Increasing the burden on an already-stressed health care system is going to be challenging to manage.”