Let’s Talk About Fluoride.
If you’ve ever found yourself squinting at the fine print on your toothpaste tube, or wondering what’s really flowing out of your kitchen faucet, you’re not alone. “Is fluoride safe?” “Should my toddler be using it?” “Do I have a say in what’s added to our drinking water?” These are questions I hear all the time—from thoughtful, curious, and often slightly overwhelmed patients or parents just trying to make the best decisions for their families.
Fluoride has re-entered the headlines as states across the country reconsider whether it belongs in their public water systems. Some – like Utah and Florida – have banned it entirely, sparking a wave of questions, debate, and growing public interest. I figured it was time for a clearer conversation.
As a functional dentist (and a water drinker!), I believe in meeting patients with transparency and context—not fear or pressure. So in this article, I’ll walk you through the facts, the risks, the benefits, and the big ethical question at the heart of this whole debate: Should fluoride be in your water without your consent?
My Position
We can say with close to 100% certainty that fluoride can help prevent cavities—though if you already have decent oral healthcare habits, the upside is small—maybe a couple cavities prevented over your entire lifetime. You can get the same benefits by brushing and flossing regularly. Simply avoiding sticky snacks (like goldfish and gummy bears!), can make just as much of a difference.
The downside of this oral health benefit is that fluoride is also a neurotoxin, which research suggests harms childhood brain development. The exact damage is hard to estimate but potentially large, perhaps a handful of IQ points, or tens of points on the SAT. But we don’t really know.
My opinion is: why bother dealing with this risk when there are alternatives?
Should public drinking water have fluoride added to it? This is an ethical question, not a scientific one. I believe in informed consent and medical autonomy. Adding fluoride to public drinking water means everyone (including infants, adults, people with kidney conditions, people who already get plenty of fluoride) is exposed to the same dose, with no consent given nor an opt-out button. Public water fluoridation seems to be a clear violation of medical ethics.
That’s why, in my practice, I only use fluoride when there are no alternatives. We live in a community that doesn’t fluoridate its water. We brush with hydroxyapatite toothpaste. And we try as hard as possible to not let our kids snack on goldfish!
What Is Fluoridation, Anyway?
No, it isn’t when your grandparents retire and move to Florida. (Ha!)
Fluoridation is the process of adding fluoride—a naturally occurring mineral—to public drinking water.
The U.S. began this public health measure in the 1940s, after researchers observed that communities with naturally high fluoride levels had lower rates of tooth decay. It was widely considered a success story in modern preventive dentistry—but nearly a century later, it’s time to revisit the assumptions behind it.
The Case For Fluoride
Credit where credit’s due: Water fluoridation achieved its primary purpose to reduce cavities, especially in children. The American Dental Association (ADA) continues to support it as a cost-effective, equitable intervention. According to the latest research (cited by ADA President Dr. Linda Edgar, D.D.S.), people who drink fluoridated water should expect to have 25% fewer cavities over a lifetime. That number comes from a study of pediatric Medicaid patients in rural Alaska, comparing cavity rates before and after fluoride was removed from their water supply.
When you break down the data, though, that reduction may only amount to one or two fewer cavities across your entire adult life. And context matters—most of us don’t live in rural Alaska, and our diets, routines, and access to dental care are completely different.
So while fluoride may still help in some cases, we now have better hygiene habits, more access to dental care, and greater nutritional awareness than we did 80 years ago. Which raises the question: Does blanket fluoridation still make sense?
What Are the Risks?
The most well-known side effect of fluoride is fluorosis, a condition where developing teeth show white or brown spots due to too much fluoride exposure during childhood. It’s largely cosmetic, but it’s a sign that the system may be over-delivering.
More recently, though, researchers have begun asking bigger questions. Is fluoride just an enamel-strengthener—or could it have effects beyond the teeth?
In 2024, the National Toxicology Program (NTP)—a division of the NIH—published a report linking high fluoride levels in drinking water to a 2–5 point drop in IQ among children. The NTP reported this in a ‘State of the Science’ monograph, and a linked analysis of the effect of fluoride on children’s IQ was published in JAMA Pediatrics in January 2025. This is probably the largest meta-analysis ever conducted on the subject. It took over six years to complete—and another two years to be released after legal pressure from advocacy groups.
The main takeaway? Drinking water with more than 1.5 mg/L of fluoride is consistently associated with lower IQs—somewhere between 2–5 points. For context, there are many areas in Texas that have naturally occurring fluoride far in excess of that level. While that may not sound like much, a population-wide shift of even a few points can have major consequences.
And while critics of the study note that many of the contributing research papers were conducted outside the U.S., the central concern remains: fluoride, like lead and mercury, may be a neurotoxin at any dosage.
What Do the Experts Say?
Not all experts agree, but a growing number of respected scientists are raising concerns. The following are direct quotes from experts, given during sworn testimonies at EPA trials:
“The weight of epidemiological evidence leaves no reasonable doubt that developmental neurotoxicity is a serious human health risk associated with elevated fluoride exposure, including those occurring at the levels added to drinking water in fluoridated areas. The IQ losses associated with community water fluoridation are substantial and of significant public health concern.”
Dr. Philippe Grandjean, MD, DMSc
Physician, environmental epidemiologist Adjunct Professor, Harvard T.H. Chan School of Public Health / Professor and Chair of Environmental Medicine, University of Southern Denmark
“The collective evidence from prospective cohort studies supports the conclusion that fluoride exposure during early brain development diminishes the intellectual abilities in young children, including at the purportedly “optimal” levels of exposure for caries prevention.”
Dr. Bruce Lanphear, MD, MPH
Clinical Investigator, BC Children’s Hospital Research Institute, BC Children’s Hospital / Professor in the Faculty of Health Sciences at Simon Fraser University
“Fluoride is a developmental neurotoxicant at levels of internalized exposure seen in water-fluoridated communities.”
Dr. Howard Hu, MD, MPH, ScD
School of Public Health, University of Washington
“Fluoridation chemicals present an “unreasonable risk” of neurotoxic effects, including IQ loss, if assessed under the same risk characterization and risk determination framework that EPA uses in its evaluations of other chemicals.”
Kathleen Thiessen, Ph.D.
Scientist at Oak Ridge Center for Risk Analysis, Oak Ridge, Tennessee
Ethical Considerations
Here’s where things get personal. Fluoridation isn’t just a dental topic—it’s a philosophical one.
Fluoride is added to public water for medical reasons. Not to improve the water itself, but to create a public health benefit. And unlike other culturally permissible public health interventions—like vaccine mandates or smoking bans—fluoridation doesn’t impact community health in the same way. Its effects are personal, not collective.
So the question becomes: Is it ethical to medicate a population without consent? Especially when safer, equally effective alternatives exist?
I believe in your right to opt in—not be opted in by default.
What Are the Alternatives?
Good news: there are plenty of other ways to keep your teeth healthy without drinking fluoride.
- Hydroxyapatite toothpaste is gaining popularity—and for good reason. It’s made of the same mineral that makes up your enamel and has been shown to remineralize teeth, reduce sensitivity, and even reverse small cavities. At home we use Boka…
- Xylitol, a natural sweetener found in certain gums and mints, can reduce cavity-causing bacteria and help rebalance your oral microbiome.
- Dietary changes, like cutting back on sugary snacks and drinks is one of the most effective ways to lower your cavity risk—especially when sugar makes up less than 10% of your daily calories.
None of these require ingesting a neurotoxin.
What Can I Do If I Want to Avoid Fluoride?
Whether you’re trying to reduce your family’s fluoride exposure or just want more control over what goes into your body, here are a few steps:
- Use a reverse osmosis filter to remove fluoride from tap water
- Choose fluoride-free toothpaste, especially for young kids who are more likely to swallow it
- Check bottled water labels—fluoride isn’t always listed, so you may need to call the company
- Test your water, especially if you’re on a private well or live in an area with naturally high levels
What do we have in Houston?
Houston is one of the rare communities in the US that does not add fluoride to our public water. Our water has low levels of naturally occurring fluoride at .3 Mg/L vs. the “recommended” level of .7 mg/L
You can find your Municipal Utility District here.
What are other countries doing?
This isn’t just an American debate. I was surprised to learn that many developed nations have tried and rejected public water fluoridation.. Here are some fun facts about what some countries in Europe do:
- The Netherlands’ supreme court, the Hoge Raad, banned the practice in 1973
- Germany banned the practice in the 1970s, though consumers can buy fluoridated salt
- Sweden overturned a 1962 law enabling fluoridation in 1971
- Finland experimented with fluoridation starting in 1959 but phased it out by 1992. It isn’t illegal, but no municipalities do it
- In Spain, a few northern municipalities fluoridate their water, accounting for about 10% of the national population
- Portugal has no publicly fluoridated water
- France’s Chief Health Minister declared public water fluoridation “too dangerous” in 1980 and the practice ceased. Fluoridated and non-fluoridated salt has been available since 1986.
- Ireland is the only country in Europe with mandatory water fluoridation.
- Germany, Belgium, and Luxembourg cite ethical concerns about mass medication
- France, the Netherlands, and Sweden rely on other methods of dental prevention
Even in the U.S., local municipalities and entire states—from Utah to Florida—are reconsidering or banning fluoridation programs.
Your Health, Your Decision
I was trained in traditional dental school. I’ve seen fluoride work. But I’ve also seen the research evolve—and I’ve chosen to evolve with it.
Today, I believe there are safer ways to get the same benefits without the same risks. And most importantly, I believe you deserve the choice.
Looking for a Houston dental team who is thoughtful about fluoride?
Book an appointment with us today.
