Opinion: It's time to reevaluate the fluoride conversation

Fluoride has long been hailed as a miracle ingredient for preventing tooth decay. But as a dentist with more than 40 years of experience, I'm here to tell you that it's time to reevaluate the conversation. For years, fluoride's benefits have been sold as a one-size-fits-all solution, especially in water fluoridation, yet the recent federal court ruling challenges this status quo.

First, let's bust a few myths. Fluoride isn't a catch-all solution. Contrary to common belief, water fluoridation isn't a guaranteed way to prevent tooth decay.

Yes, it's effective for some, but the efficacy and safety are far more nuanced than we've been led to believe. It's all about the dose. The recent court ruling emphasizes a crucial point: "It's the dose that makes the poison." This principle comes from toxicology and has been highlighted in recent studies that suggest higher fluoride levels could have adverse effects, including a potential impact on children's brain development.

Dr. Mark Burhenne.

The ruling by a federal judge in August 2024 brings much-needed attention to the emerging science questioning fluoride's safety. The National Toxicology Program found that fluoride levels above 1.5 mg/L could be linked to decreased IQ in children, particularly when pregnant women are exposed. For many years, the dental community has pushed fluoride as a fundamental preventive measure, but studies like these suggest it's time to reassess our stance.

Now, turning to the economics of fluoridation in mainstream dental practices, especially in cosmetic dentistry. The push for cosmetic dentistry has shifted: More patients are becoming aware of fluoride's potential risks and turning to natural alternatives like nano-hydroxyapatite toothpaste.

As consumer demand grows for nonfluoridated options, cosmetic dentists may cater to a market that's more focused on holistic, fluoride-free treatments. This could lead to a shift in the types of treatments offered and possibly a decrease in demand for fluoride-based preventive services.

The economic impact is far-reaching: Water fluoridation is a public health measure, but in the private sector, its effectiveness in preventing dental decay is under scrutiny.

Patients who are informed about the risks of fluoride may look for alternative treatments, pushing cosmetic dentistry to evolve. There's also an opportunity for practices to offer new services, such as fluoride-free whitening solutions or preventive care that emphasizes nutrition and natural oral health.

Long-term patient trust: As the public becomes more health-conscious and well informed, there may be a shift to practices that emphasize functional dentistry. Patients are increasingly looking for dental solutions that align with their overall wellness goals, which include reducing unnecessary chemical exposure. For practices that are willing to adopt this shift and educate their patients, the long-term economic reward could be significant.

Moving forward, I encourage both patients and dental professionals to look at the alternatives. We still have time to act -- it's not over yet. Many countries around the world, including parts of Europe and Japan, have already moved away from water fluoridation, and it's time for the U.S. to follow suit.

To wrap up, if you're living in the U.S. like I do, start by filtering your water. You can also switch to fluoride-free alternatives, like nano-hydroxyapatite toothpaste, which is just as effective and safer for long-term use. I've raised three cavity-free children without fluoride -- it's entirely possible. Let's educate both practitioners and the public about safer, more effective ways to maintain oral health.

Dr. Mark Burhenne is the co-founder of Fygg, a toothpaste that offers a fluoride alternative with hydroxyapatite. With over 30 years of experience in dentistry, Burhenne is passionate about functional dental care and whole-body health. Subscribe to his newsletter at askthedentist.com or follow him on Instagram at @askthedentist.

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