I have been asked by several people to write about fluoride.  I have been hesitant to do this because everyone who has asked me to do so is anti-fluoride and I am not sure that I completely agree with that position.  If you do some on line research about fluoride most of what you come across reads like a 1970’s era Jane Fonda talking about nuclear power.  Not exactly what you would call unbiased.

The way I see it there is still a use for fluoride in dentistry today.  I do see its use becoming increasingly controversial as people want to take control of their own health and make these decisions for themselves, so lets start with what is good about fluoride.  Tooth enamel is mostly a mineral called hydroxylapatite. Its molecular structure is described as Ca₁₀(PO₄)₆(OH)_2.   Fluoride can replace the –OH groups and form a fluoridated hydroxylapatite crystal.  Since fluoride is smaller than the hydroxyl group it forms a harder crystal, more resistant to an acid attack.  This is a good thing.

Fluoride can be applied two different ways; first, it can be applied topically.  This is the form in toothpaste, fluoridated rinses, and at the dental office.  The concentration of topical fluoride is usually 1000 ppm in over the counter products with some prescription products approaching 5000 ppm. This type of application hardens the outer surface of the enamel. The second way is called systemic application.  This is when it is added to children’s vitamins or community water supplies.  This allows the fluoride to be incorporated into the mineral matrix of growing teeth. This makes such teeth harder not just on the outer layer but all the way thru.  There are places in the world, Colorado is one, that have naturally occurring fluoride in the water.  The observation in the late 19^th and early 20^th centuries that while people living here had stained teeth, they did not have tooth decay, lead to the advocacy for its use in modern water supplies.

Now for the bad, as the lightest of the halogen, or group 17 elements on the periodic table it is very reactive.  This makes it toxic in high doses.  We have all used hydrochloric acid and know what its capable of.  Hydrofluoric acid cannot be kept in glass jars because it eats thru the glass!  If you breathe in the vapors it will literally dissolve lung tissue. In addition the form that it is currently used in today starts out as an industrial byproduct.  Deaths by fluoride overdose are rare but have occurred. By lowering the maximum number of fluoride vitamins you can get at one time and requiring toothpaste tubes to be no larger that a certain size organized dentistry and pharmacology have reinforced a subtle message that this is a deadly product. There also have been recent rule changes lowering the maximum amount of fluoride in municipal systems from 1 to .7 ppm. This has aroused suspicion that organized dentistry has something to hide.

A hot area of research right now is thyroid function.  Your thyroid needs iodine to function.  Guess what, fluoride and iodine are both halogen, or group 17 elements.  Is this the mechanism?  Are dental does, which are considered relatively small, enough to disrupt it?  I am not sure.  I began this post by stating that I believe that there is still a need for fluoride in dentistry.  How can this be if it so deadly?

In a previous post I outlined the three determinates needed for tooth decay.  Teeth, bacteria, and carbohydrates.  The standard American diet today is rich in refined, fermentable carbohydrates.  Most of my patients are eating such a diet.  Fluoride is naturally occurring and has an over 100-year track record of lowering decay rates.  If we ban fluoride without doing anything else the law of unintended consequences kicks in and tooth decay will go up 20-30%.

A better way of preventing this occurrence is to take away the refined carbohydrates.  Remember, they are not nor ever were an obligate nutrient.  The agricultural era is roughly 10,000 years old and decay is common The Paleolithic era lasted over 2.5 million years, or 250 times longer and tooth decay was an extreme rarity.  I have examined many Paleolithic skulls myself and have not observed any decay.

If we as a society can move to this paradigm people will live healthier without any decay.  Fluoride becomes unnecessary and dies a natural death.  I do not see this happening very quickly but I do believe it will happen.