As an endodontist focused on preserving natural teeth, I notice the subtleties of oral health every day. In my practice, I can recognize floss users, those passionate about tooth whitening, and individuals who indulge in sweets. Nonetheless, among younger adults, significant tooth decay frequently indicates they originate from regions where their water supply lacks fluoride.

Fluoride, once celebrated by the CDC as a major health milestone of the 20th century, has recently come under fire due to incomplete information and misinterpreted research—some sourced from nations with much higher and uncontrolled fluoride exposure than the U.S. As fluoride is extracted from water supplies across the nation, dental professionals must highlight the alarming danger this poses to oral health.

Fluoride: A dental gem

To fully grasp fluoride’s significance, one must understand its role. Naturally found in water and soil, fluoride often exists in levels that are not beneficial for dental health. When introduced to water in controlled quantities, it strengthens enamel, inhibiting decay by making it more resistant to acids. Fluoride’s capacity for remineralization aids in repairing tooth structure, benefitting individuals of all ages—though it is particularly crucial during the development of teeth.

In 1945, Grand Rapids, Michigan, became the pioneer city to infuse fluoride into its water. A decade later, local children exhibited a 50-60% decline in decay rates compared to cities without fluoridation. Presently, over two-thirds of Americans enjoy access to fluoridated water. The cessation of fluoride could lead us back to a time demanding more root canals and extractions due to decay.

Effects on disadvantaged communities

The elimination of fluoride disproportionately impacts lower-income, disadvantaged groups. As a fair public health initiative, fluoride serves to benefit everyone, irrespective of socio-economic standing. Its removal imposes a heavier load on those with limited access to dental care, potentially resulting in more severe decay and higher expenses.

A pricey risk with no beneficiaries

The ramifications of removing fluoride go beyond heightened decay levels. They encompass more frequent dental consultations, steeper costs, lost work and school time, and permanent tooth loss. In the absence of fluoride, underserved populations encounter even less access to care coupled with a greater need. Cities such as Calgary, Canada, and regions in Alaska have reinstated fluoride after observing rising decay rates following its removal. In my Cleveland practice, patients using well water devoid of fluoride often display significant decay that necessitates root canals.

Fluoride’s safety, when utilized as intended, is well-established over the past century. Communities with fluoridated water report a 25-50% decrease in cavities. Maintaining fluoride in our water is essential for safeguarding public oral health, and our children merit the proven advantages it offers.

Steven J. Katz is an endodontist and president of the American Association of Endodontists.