The following information is being reposted upon request from the Fluoride Action Network
1) 97% of western Europe has chosen fluoride-free water. This includes: Austria, Belgium, Denmark, Finland, France, Germany, Iceland, Italy, Luxembourg, Netherlands, Northern Ireland, Norway, Scotland, Sweden, and Switzerland. (While some European countries add fluoride to salt, the majority do not.) Thus, rather than mandating fluoride treatment for the whole population, western Europe allows individuals the right to choose, or refuse, fluoride.
2) Fluoride is the only chemical added to drinking water for the purpose of medication (to prevent tooth decay). All other treatment chemicals are added to treat the water (to improve the water's quality and safety - which fluoride does not do). This is one of the reasons why most of Europe has rejected fluoridation. For instance:
In Germany, "The argumentation of the Federal Ministry of Health against a general permission of fluoridation of drinking water is the problematic nature of compulsion medication."In Belgium, it is "the fundamental position of the drinking water sector that it is not its task to deliver medicinal treatment to people. This is the sole responsibility of health services."In Luxembourg, "In our views, drinking water isn't the suitable way for medicinal treatment and that people needing an addition of fluoride can decide by their own to use the most appropriate way."
3) Contrary to previous belief, fluoride has minimal benefit when swallowed. When water fluoridation began in the 1940s and '50s, dentists believed that fluoride needed to be swallowed in order to be most effective. This belief, however, has now been discredited by an extensive body of modern research (1).
According to the Centers for Disease Control, fluoride's "predominant effect is posteruptive and topical" (2). In other words, any benefits that accrue from the use of fluoride, come from the direct application of fluoride to the outside of teeth (after they have erupted into the mouth) and not from ingestion. There is no need, therefore, to expose all other tissues to fluoride by swallowing it.
4) Fluoridated water is not recommended for babies. In November of 2006, the American Dental Association (ADA) advised that parents should avoid giving babies fluoridated water (3). Other dental researchers have made similar recommendations over the past decade (4). Exclusively breastfed babies need no liquids other than their mother's milk to drink (or eat).
Babies exposed to fluoride are at high risk of developing dental fluorosis - a permanent tooth defect caused by fluoride damaging the cells which form the teeth (5). Other tissues in the body may also be affected by early-life exposures to fluoride. According to a recent review published in the medical journal The Lancet, fluoride may damage the developing brain, causing learning deficits and other problems (6).
5) There are better ways of delivering fluoride than adding it to water. By adding fluoride to everyone's tap water, many infants and other at-risk populations will be put in harm's way. This is not only wrong, it is unnecessary. As western Europe has demonstrated, there are many equally effective and less-intrusive ways of delivering fluoride to people who actually want it. For example:
A) Topical fluoride products such as toothpaste and mouthrinses (which come with explicit instructions not to swallow) are readily available at all grocery stores and pharmacies. Thus, for those individuals who wish to use fluoride, it is very easy to find and very inexpensive to buy.B) If there is concern that some people in the community cannot afford to purchase fluoride toothpaste (a family-size tube of toothpaste costs as little as $2 to $3), the money saved by not fluoridating the water can be spent subsidizing topical fluoride products (or non-fluoride alternatives) for those families in need.C) The vast majority of fluoride added to water supplies is wasted, since over 99% of tap water is not actually consumed by a human being. It is used instead to wash cars, water the lawn, wash dishes, flush toilets, etc.
6) Ingestion of fluoride has little benefit, but many risks. Whereas fluoride's benefits come from topical contact with teeth, its risks to health (which involve many more tissues than the teeth) result from being swallowed.
Adverse effects from fluoride ingestion have been associated with doses atttainable by people living in fluoridated areas. For example:
a) Risk to the brain. According to the National Research Council (NRC), fluoride can damage the brain. Animal studies conducted in the 1990s by EPA scientists found dementia-like effects at the same concentration (1 ppm) used to fluoridate water, while human studies have found adverse effects on IQ at levels as low as 0.9 ppm among children with nutrient deficiencies, and 1.8 ppm among children with adequate nutrient intake. (7-10)
b) Risk to the thyroid gland. According to the NRC, fluoride is an “endocrine disrupter.” Most notably, the NRC has warned that doses of fluoride (0.01-0.03 mg/kg/day) achievable by drinking fluoridated water, may reduce the function of the thyroid among individuals with low-iodine intake. Reduction of thyroid activity can lead to loss of mental acuity, depression and weight gain (11)
c) Risk to bones. According to the NRC, fluoride can diminish bone strength and increase the risk for bone fracture. While the NRC was unable to determine what level of fluoride is safe for bones, it noted that the best available information suggests that fracture risk may be increased at levels as low 1.5 ppm, which is only slightly higher than the concentration (0.7-1.2 ppm) added to water for fluoridation. (12)
d) Risk for bone cancer. Animal and human studies – including a recent study from a team of Harvard scientists – have found a connection between fluoride and a serious form of bone cancer (osteosarcoma) in males under the age of 20. The connection between fluoride and osteosarcoma has been described by the National Toxicology Program as "biologically plausible." Up to half of adolescents who develop osteosarcoma die within a few years of diagnosis. (13-16)
e) Risk to kidney patients. People with kidney disease have a heightened susceptibility to fluoride toxicity. The heightened risk stems from an impaired ability to excrete fluoride from the body. As a result, toxic levels of fluoride can accumulate in the bones, intensify the toxicity of aluminum build-up, and cause or exacerbate a painful bone disease known as renal osteodystrophy. (17-19)
7) The industrial chemicals used to fluoridate water may present unique health risks not found with naturally-occurring fluoride complexes . The chemicals - fluorosilicic acid, sodium silicofluoride, and sodium fluoride - used to fluoridate drinking water are industrial waste products from the phosphate fertilizer industry. Of these chemicals, fluorosilicic acid (FSA) is the most widely used. FSA is a corrosive acid which has been linked to higher blood lead levels in children. A recent study from the University of North Carolina found that FSA can - in combination with chlorinated compounds - leach lead from brass joints in water pipes, while a recent study from the University of Maryland suggests that the effect of fluoridation chemicals on blood lead levels may be greatest in houses built prior to 1946. Lead is a neurotoxin that can cause learning disabilities and behavioral problems in children. (20-23)
8) Water fluoridation’s benefits to teeth have been exaggerated. Even proponents of water fluoridation admit that it is not as effective as it was once claimed to be. While proponents still believe in its effectiveness, a growing number of studies strongly question this assessment. (24-46) According to a systematic review published by the Ontario Ministry of Health and Long Term Care, "The magnitude of [fluoridation's] effect is not large in absolute terms, is often not statistically significant and may not be of clinical significance." (36)
a) No difference exists in tooth decay between fluoridated & unfluoridated countries. While water fluoridation is often credited with causing the reduction in tooth decay that has occurred in the US over the past 50 years, the same reductions in tooth decay have occurred in all western countries, most of which have never added fluoride to their water. The vast majority of western Europe has rejected water fluoridation. Yet, according to comprehensive data from the World Health Organization, their tooth decay rates are just as low, and, in fact, often lower than the tooth decay rates in the US. (25, 35, 44)
b) Cavities do not increase when fluoridation stops. In contrast to earlier findings, five studies published since 2000 have reported no increase in tooth decay in communities which have ended fluoridation. (37-41)
c) Fluoridation does not prevent oral health crises in low-income areas. While some allege that fluoridation is especially effective for low-income communities, there is very little evidence to support this claim. According to a recent systematic review from the British government, "The evidence about [fluoridation] reducing inequalities in dental health was of poor quality, contradictory and unreliable." (45) In the United States, severe dental crises are occurring in low-income areas irrespective of whether the community has fluoride added to its water supply. (46) In addition, several studies have confirmed that the incidence of severe tooth decay in children (“baby bottle tooth decay”) is not significantly different in fluoridated vs unfluoridated areas. (27,32,42) Thus, despite some emotionally-based claims to the contrary, water fluoridation does not prevent the oral health problems related to poverty and lack of dental-care access.
9) Fluoridation poses added burden and risk to low-income communities. Rather than being particularly beneficial to low-income communities, fluoridation is particularly burdensome and harmful. For example:
a) Low-income families are least able to avoid fluoridated water. Due to the high costs of buying bottled water or expensive water filters, low-income households will be least able to avoid fluoride once it's added to the water. As a result, low-income families will be least capable of following ADA’s recommendation that infants should not receive fluoridated water. This may explain why African American children have been found to suffer the highest rates of disfiguring dental fluorosis in the US. (47)b) Low-income families at greater risk of fluoride toxicity. In addition, it is now well established that individuals with inadequate nutrient intake have a significantly increased susceptibility to fluoride’s toxic effects. (48-51) Since nutrient deficiencies are most common in income communities, and since diseases known to increase susceptibility to fluoride are most prevalent in low-income areas (e.g. end-stage renal failure), it is likely that low-income communities will be at greatest risk from suffering adverse effects associated with fluoride exposure. According to Dr. Kathleen Thiessen, a member of the National Research Council's review of fluoride toxicity: “I would expect low-income communities to be more vulnerable to at least some of the effects of drinking fluoridated water." (51)
10) Due to other sources, many people are being over-exposed to fluoride . Unlike when water fluoridation first began, Americans are now receiving fluoride from many other sources* besides the water supply. As a result many people are now exceeding the recommended daily intake, putting them at elevated risk of suffering toxic effects. For example, many children ingest more fluoride from toothpaste alone than is considered “optimal” for a full day’s worth of ingestion. According to the Journal of Public Health Dentistry:
"Virtually all authors have noted that some children could ingest more fluoride from [toothpaste] alone than is recommended as a total daily fluoride ingestion." (52)
Because of the increase in fluoride exposure from all sources combined, the rate of dental fluorosis (a visible indicator of over-exposure to fluoride during childhood) has increased significantly over the past 50 years. Whereas dental fluorosis used to impact less than 10% of children in the 1940s, the latest national survey found that it now affects over 30% of children. (47, 53)
* Sources of fluoride include: fluoride dental products, fluoride pesticides, fluorinated pharmaceuticals, processed foods made with fluoridated water, and tea.
1. Featherstone JDB. (2000). The Science and Practice of Caries Prevention. Journal of the American Dental Association. 131: 887-899. (Additional references available at: www.fluoridealert.org/health/teeth/caries/topical-systemic.html )
2. Centers for Disease Control and Prevention (2001). Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States. Mortality and Morbidity Weekly Review. (MMWR). August 17. 50(RR14):1-42.
3. Online at: http://ada.org/prof/resources/pubs/epubs/egram/egram_061109.pdf
4. References online at:
5. Hong L, Levy SM, et al. (2006). Timing of fluoride intake in relation to development of fluorosis on maxillary central incisors. Community Dentistry and Oral Epidemiology 34:299-309.
6. Grandjean P, Landrigan P. (2006). Developmental neurotoxicity of industrial chemicals. The Lancet, November 8.
7. National Research Council. (2006). Fluoride in Drinking Water: A Scientific Review of EPA's Standards. National Academies Press, Washington D.C. p. 173-188.
8. Varner JA, et al. (1998). Chronic Administration of Aluminum-Fluoride and Sodium-Fluoride to Rats in Drinking Water: Alterations in Neuronal and Cerebrovascular Integrity.Brain Research. 784: 284-298.
9. Lin Fa-Fu, et al. (1991). The relationship of a low-iodine and high-fluoride environment to subclinical cretinism in Xinjiang. Iodine Deficiency Disorder Newsletter. Vol. 7. No. 3.
10. Xiang Q, et al. (2003a). Effect of fluoride in drinking water on children's intelligence. Fluoride 36: 84-94; 198-199.
11. NRC (2006). p. 189-224.
12. NRC (2006). p. 107-148.
13. National Toxicology Program. (1990). Toxicology and Carcinogenesis Studies of Sodium Fluoride in F344/N Rats and B6C3f1 Mice. Technical report Series No. 393. NIH Publ. No 91-2848. National Institute of Environmental Health Sciences, Research Triangle Park, N.C.
14. Hoover RN, et al. (1991). Time trends for bone and joint cancers and osteosarcomas in the Surveillance, Epidemiology and End Results (SEER) Program. National Cancer Institute In: Review of Fluoride: Benefits and Risks. US Public Health Service. Appendix E & F.
15. Cohn PD. (1992). A Brief Report On The Association Of Drinking Water Fluoridation And The Incidence of Osteosarcoma Among Young Males. New Jersey Department of Health Environ. Health Service: 1- 17.
16. Bassin EB, Wypij D, Davis RB, Mittleman MA. (2006). Age-specific Fluoride Exposure in Drinking Water and Osteosarcoma (United States). Cancer Causes and Control 17: 421-8.
17. Johnson W, et al. (1979). Fluoridation and bone disease in renal patients. In: E Johansen, DR Taves, TO Olsen, Eds. Continuing Evaluation of the Use of Fluorides. AAAS Selected Symposium. Westview Press, Boulder, Colorado. pp. 275-293.
18. Ittel TH, et al. (1992). Effect of fluoride on aluminum-induced bone disease in rats with renal failure. Kidney International 41: 1340-1348.
19. Ayoob S, Gupta AK. (2006). Fluoride in Drinking Water: A Review on the Status and Stress Effects. Critical Reviews in Environmental Science and Technology 36:433–487
20. Masters RD, Coplan M. (1999). Water treatment with Silicofluorides and Lead Toxicity. International Journal of Environmental Studies. 56: 435-449.
21. Masters RD. et al. (2000). Association of Silicofluoride Treated Water with Elevated Blood Lead. Neurotoxicology. 21(6): 1091-1099.
22. Maas R, et al. (2005). Effects of fluorides and chloramine on lead leaching from leaded-brass surfaces. Environmental Quality Institute, University of North Carolina, Ashville. Technical Report # 05-142 .
23. Macek M, et al. (2006). Blood lead concentrations in children and method of water fluoridation in the United States, 1988-1994. Environmental Health Perspectives 114:130-134.
24. Colquhoun J. (1985). Influence of social class and fluoridation on child dental health. Community Dentistry and Oral Epidemiology 13:37-41.
25. Diesendorf M. (1986). The Mystery of Declining Tooth Decay. Nature. 322: 125-129.
26. Gray AS. (1987). Fluoridation: Time For A New Base Line? Journal of the Canadian Dental Association. 53: 763-5.
27. Kelly M, Bruerd B. (1987). The Prevalence of Baby Bottle Tooth Decay Among Two Native American Populations. Journal of Public Health Dentistry 47:94-97.
28. Hildebolt CF, et al. (1989). Caries prevalences among geochemical regions of Missouri. American Journal of Physical Anthropology 78:79-92.
29. Hileman B. (1989). New Studies Cast Doubt on Fluoridation Benefits. Chemical and Engineering News. May 8.
30. Brunelle JA, Carlos JP. (1990). Recent trends in dental caries in U.S. children and the effect of water fluoridation. J. Dent. Res 69, (Special edition), 723-727.
31. Yiamouyiannis JA. (1990). Water Fluoridation and Tooth decay: Results from the 1986-87 National Survey of U.S. Schoolchildren. Fluoride. 23: 55-67.
32. Barnes GP, et al. (1992). Ethnicity, location, age, and fluoridation factors in baby bottle tooth decay and caries prevalence of head start children. Public Health Reports 107: 167-73.
33. Domoto P, et al. (1996). The estimation of caries prevalence in small areas. Journal of Dental Research 75:1947-56.
34. Heller KE, et al (1997). Dental Caries and Dental Fluorosis at Varying Water Fluoride Concentrations. J Pub Health Dent. 57(3): 136-143.
35. Colquhoun J. (1997). Why I changed my mind about Fluoridation. Perspectives in Biology and Medicine 41: 29-44.
36. Locker D. (1999). Benefits and Risks of Water Fluoridation. An Update of the 1996 Federal-Provincial Sub-committee Report. Prepared for Ontario Ministry of Health and Long Term Care.
37. Kunzel W, Fischer T. (2000). Caries prevalence after cessation of water fluoridation in La Salud, Cuba. Caries Research 34: 20-5.
38. Kunzel W, Fischer T, Lorenz R, Bruhmann S. (2000). Decline of caries prevalence after the cessation of water fluoridation in the former East Germany. Community Dentistry and Oral Epidemiology 28: 382-9.
39. Seppa L, Karkkainen S, Hausen H. (2000). Caries Trends 1992-1998 in Two Low-Fluoride Finnish Towns Formerly with and without Fluoridation. Caries Research 34: 462-468.
40. Burt BA, et al. (2000). The effects of a break in water fluoridation on the development of dental caries and fluorosis. J Dent Res. 79(2):761-9.
41. Maupome G, Clark DC, Levy SM, Berkowitz J. (2001). Patterns of dental caries following the cessation of water fluoridation. Community Dentistry and Oral Epidemiology 29: 37-47.
42. Shiboski CH, et al. (2003). The association of early childhood caries and race/ethnicity among California preschool children. Journal of Public Health Dentistry 63(1):38-46.
43. Armfield JM, Spencer AJ. (2004) Consumption of nonpublic water: implications for children’s caries experience. Community Dent Oral Epidemiol 32:283-296.
44. Neurath C. (2005). Tooth decay trends for 12 year olds in nonfluoridated and fluoridated countries. Fluoride 38:324-325.
45. Online at:
46. Online at:
47. Centers for Disease Control and Prevention. (2005). Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis--United States, 1988-1994 and 1999-2002. MMWR 54:1-43.
48. Massler M, Schour I. (1952). Relation of endemic dental fluorosis to malnutrition. JADA. 44: 156-165.
49. Marier J, Rose D. (1977). Environmental Fluoride. National Research Council of Canada. Associate Committe on Scientific Criteria for Environmental Quality. NRCC No. 16081.
50. Agency for Toxic Substances and Disease Registry (ATSDR) (1993). Toxicological Profile for Fluorides, Hydrogen Fluoride, and Fluorine (F). U.S. Department of Health & Human Services, Public Health Service. ATSDR/TP-91/17.
51. Online at:
52. Levy SM, Guha-Chowdhury N. (1999). Total fluoride intake and implications for dietary fluoride supplementation. Journal of Public Health Dentistry 59: 211-23.
53. National Research Council. (1993). Health Effects of Ingested Fluoride. National Academy Press, Washington DC.