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  • Dr. David Alfaro

Is fluoride safe or toxic?

By now I am sure you must have seen some sort of post online about fluoride being a poison. “Fluoride calcifies your pineal gland!” “Fluoride lowers IQ!” “Fluoride is industrial waste!”

And on the other side, you will have people like me arguing that fluoride toothpaste is not as harmful as people make it out to be, and that tooth decay is hurting children more than fluoride ever will.

As a dentist who sees children with tooth decay everyday, and as a dental specialist who deals with the long term outcomes of oral diseases, fighting tooth decay is critical and breaking the cycle of misinformation is part of the battle. If one thing I have learned from this COVID19 is that people really stick to their prejudices, even in the face of scientific proof.

But.....we will try to discuss.... is fluoride toxic, or not?

We study fluoride toxicity indirectly

Current medical ethics do not allow researchers to have humans ingest fluoridated toothpaste to assess for negative outcomes, although it was not too long ago that unethical research approaches were being taken in medicine and dentistry.

Read these articles:

So how do we know if toothpaste is toxic if we cannot study it directly?

Much of what we know about fluoride toxicity is from environmental or workplace exposures to fluorides, or studies on rats. A toxic spill in Alaska. Children living by smelters in China. People drinking improperly tested well water. Geese living in a pond with high natural fluoride levels. Forcing rats to drink fluoridated water. Etc......

While this is valuable information, there are many estimates and assumptions that are made, which leads to broad interpretations of what levels of fluoride are considered to be dangerous, and none of this information directly relates to toothpaste.

As a healthcare provider, this is frustrating. Who do you believe? The World Health Organization? Health Canada? The Environmental Protection Agency? The Fluoride Action Network?

I guess it depends on where your biases lie…..

For those of you with time on your hands, you can start here, and yes I did read these myself, including the references:

Can fluoride from toothpaste harm you?

Yes, of course. Anything in large doses can harm you. If your child swallows a tube or two of toothpaste by accident or on purpose, yes, please call poison control. The most common side effect of fluoride “overdose” is gastric distress, which if it turns into severe nausea and vomiting should receive medical attention.

It is no different than your child getting in to the liquor cabinet. Alcohol is a poison, yet we drink it.

How common do injuries arise from toothpaste?

With the amount of hysteria around fluoride, one would think that people are regularly going to the hospital because of toothpaste ingestion and that people are suffering serious injuries.

It is really just that, hysteria. Ever since the poison control warning was placed on tubes of fluoride toothpaste, tens of thousands of people contact poison control (US Statistics) every year with concerns of swallowing toothpaste. Of those, however, only one or two people need serious medical intervention because they ate too much toothpaste. There are hundreds of millions of daily users of fluoridated toothpaste, and most people know not to eat large quantities of the stuff, so really, the concerns with acute poisoning are minimal.

These are facts that are directly from a popular anti-fluoride website too by the way.....

Kids get hospitalized for dental care!

The benefits of fluoride toothpaste outweigh the risks. Hundreds of kids are hospitalized because of tooth decay every year in our own tiny community of the Kootenays, and fluoride is the best medication to fight this disease.

Tooth decay hurts children much more than fluoride does.

What about the long term effects of fluoride toothpaste?

There is a lot of fluoride in tea!

This is very hard to study because of the difficulties of accounting for non-dental sources of fluoride. People ingest more fluoride from drinking tea and certain foods than from their toothpaste. Dietary fluoride intake is a major confounding variable when looking at the long term effects of toothpaste.

In the hundreds of clinical studies on fluoridated toothpaste, however, looking at hundreds and thousands of kids, the side effect that is most commonly reported from fluoride toothpaste is something called fluorosis, which is staining that happens to teeth (infrequently!). Teeth with fluorosis are actually more resistant to tooth decay, unless it is severe, at which point they do become brittle. Fluorosis is how the benefits of fluoride were discovered! Teeth do get stained (mottled) in dental fluorosis, but it is not harmful if mild or moderate; it is primarily an aesthetic concern that has fairly simply treatment options in the dental office.

This is not from toothpaste alone.

Mild fluorosis can occur in people that swallow too much toothpaste when brushing and it can be more moderate if they have been exposed to other sources of ingested fluoride. Moderate to severe fluorosis is rare and occurs in people who have been ingesting high amounts of fluoride for some reason. It is not really caused by dental products, unless they are being misused.

Fluorosis is much less harmful than tooth decay!

But I heard about it affecting IQ and the pineal gland?

Yes, I heard that too, and that is an entire topic that will be the next blog article. Until then, think of what calcification really means…...

If you are concerned with fluoride in your toothpaste, treat it like an over the counter medicine to fight a very aggressive, very common disease. You wouldn’t give you child free access to ibuprofen, or essential oils? Fluoride toothpaste is the best medicine to fight tooth decay, but use it properly :)

Thanks for reading

Dr. Dave


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