Is Fluoride in the water the best cure for decaying teeth?

By December 15, 2008Sugar

Nobody gets tooth decay by drinking water, but Coca-Cola recently announced they were “investigating the possibility of including fluoride in some of [their] bottled waters”.  A strange announcement given water drinkers are not the ones who need the tender ministrations of industrial medication. 

Juice and soft drink gulpers are the ones who need help with their teeth, but government and now Big Sugar are carpet bombing the water drinkers rather than laser targeting the sugar drinkers.

Researchers have known since the 60s that tooth decay is caused by a little chap called Streptococcus Mutans (SM).  It is one of the two to three hundred species of bacteria that inhabit our mouths.

SM is a little unusual though.  It’s rather like a koala in that it only really likes one thing to eat.  No, not gum leaves.  SM wants sugar.  To be more precise, SM likes the two components of sugar, glucose and fructose in exactly the proportions they are found in sugar, 50/50.

In hundreds of well controlled studies, scientists have been able to determine that feeding SM sugar causes it to produce plaque and lactic acid.  Plaque is the gummy coating on teeth.  If you feed SM pure glucose or fructose it can only produce the acid.  It can’t make plaque without sugar and without plaque there is no decay.  If you want to rot teeth, the most effective way is to give SM a constant wash of sugar solution (like soft drink or fruit juice).   Eating sugar in food still works but it is nowhere near as effective at helping SM do its job.

SM has really enjoyed our change in diet in the last few decades.  The amount of sugar laden, soft drink, juice and flavoured milk we drink has risen from virtually nothing prior to the Second World War to almost 1 litre per person per day.  Consumption of soft drink alone has more than doubled in the last 30 years.  And with this our need for dental services has also risen exponentially.

Unfortunately fixing decayed teeth is monumentally expensive, so our governments have been reluctant to include those costs in our ‘free’ public health system.  The number of decayed teeth in the mouth of the average six year old increased by 11.4 percent between 1990 and 1999.  And Australia now spends 1 in every 10 health dollars on those white (well, yellowish) things in our mouths. The health cost is accelerating almost as fast as the sales of soft drink.

Our Governments, desperate to avoid the popular demand for them to pay the bill for a disease that affects everyone (that consumes sugar), have increasingly turned to the quick-fix solution of mass medication using fluoride.   And there is no denying that mass fluoride medication has an economic appeal.  Victoria estimates that it has saved more than $1 billion in public dental services in the three decades since it started pumping fluoride into its water supplies.  Big Sugar doesn’t mind some free marketing, so has clearly jumped on board with the message.

The chemical used most commonly for water fluoridation is fluorosilicic acid.  It is produced as a co-product from the manufacture of phosphate fertilizers.  Because some people have concerns that putting such a thing in our water supply might not be a good thing, the World Health Organisation (WHO) conducted a thorough review of the health effects of fluoride in 2002.

The WHO report concluded that there was at least a 12.5 percent reduction in the number of dental cavities in communities where water fluoridation had been introduced.   These numbers are supported out by a recent Australian study which show that the average six year old will have one less decayed tooth (which still leaves two) if there is fluoride in the water.

The problem is that 90 percent of swallowed fluoride is retained by the body.  Fluoride accumulates in the bone (and tooth) internal structure and ultimately causes a disease called fluorosis. The WHO report noted that the risk of dental and skeletal fluorosis was significantly increased in areas where the water was heavily fluoridated.  Over time, the accumulation of fluoride may result in increased brittleness leading to crumbling teeth and more easily broken bones.

And WHO aren’t the only ones raising red flags.  The risks associated with swallowing too much fluoride are so real that earlier this year the American Dental Association put out a warning to mothers not to mix infant feeding formula with fluoridated water.

Not even the most wildly supportive research suggests that fluoridating water cures tooth decay.  It merely defers the problem and the expense of treatment.  The price for treating less decayed teeth now, is that someone in the future can deal with elderly people suffering continuous fractures.

You don’t have to look too hard to see why.  Fluoridation lets Government and Big Sugar alike look like they are doing something tangible about dental health without actually doing anything which challenges the status quo.  At the same time politicians can justify the closure of public dentistry facilities (such as school clinics) because they have ‘solved’ the problem.  And they can defer discussion about who should pay for dental health until somebody else’s watch.  Best of all, the ‘treatment’ is administered without asking any voter to change their lifestyle.

Strangely, neither government nor Big Sugar appears to be contemplating the possibility of removing or changing the sugary drinks that cause the problem in the first place.

If mass medication is the way we solve society’s lifestyle influenced health problems, then why stop at fluoride?  Bowel cancer is growing at unprecedented rates, so let’s back the Metamucil trucks up to the reservoirs and the bottling plants.  Too many of us still smoke, so how about dumping a load of whatever they put in nicotine patches into the water as well.  Maybe if we tip in a few hundred gallons of anti-depressant, we could even do something about our falling consumer confidence (there’s an idea, Kevin).  The possibilities are endless.

Image courtesy of olovedog /

Join the discussion 4 Comments

  • Malcolm says:

    Hi David, sorry to go over old ground but I wanted to ask a question about tooth decay. I checked this post and your books and couldn’t find a reference to the studies you mentioned regarding fructose and tooth decay. The reason I ask is because my wife works in dental health promotion and insists that the dextrose I have added to the plain yoghurt to make it more palatable on the kids brekky is still ‘sugar’ and is as bad for their teeth. Can you help my case with a few links to peer reviewed studies? Thanks, Malcolm (18mths sugar free and lovin’ it)

  • Gordon says:

    Hi Malcolm,

    Unless your children are consuming NO sucrose then there will still be a plaque biofilm on their teeth. The bacteria in the plaque will happily consume glucose to create acid which will create a cavity.

    Bacteria in pits, fissures and natural concavities on the teeth will contain a biofilm that you will be unlikely to clean off. The biofilm concentrates the acids on the tooth surface. On smooth accessible surfaces you can clean the biofilm off.

    Your wife is correct dextrose is still bad for teeth BUT you have still done a great thing for your kids by no doubt massively reducing their sugar intake.

    There is no magic solution (be it fluoride or sugar reduction). You must mechanically remove as much of the bacterial plaque as you can by FLOSSING and brushing your kids teeth. Children up until the age of at least eight years old require a parent to brush and floss for them at least once per day. Children should also brush in the morning (but older than 4 they can probably do the morning clean unassisted).

    I always tell all new parents that the best thing they can do for their child’s teeth is to never give them sugar at all unless it can’t be avoided. Children DON’T need biscuits, juice, softdrinks. They will happily eat fruit (chopped), sugarfree crackers (Sakata plain rice crackers are pretty safe) and sandwiches if that is what their parents and siblings are eating.

    As kids get older and start to be more adventurous with food, limit their sugar intake to as little as possible until you (as the parent) are completely confident that you are doing an excellent job with the tooth cleaning. I would say for me, with my child, that was about 2.5years old.

    Use dental floss first then a Braun Oral B electric toothbrush on your child and brush their teeth for the recommended 2 minutes. Allow them to spit intermittently during the cleaning. Constantly reinforce the message that you’re cleaning off germs as well as food and really good tooth cleaning must follow the consumption of sweet foods. If you say it enough times it will eventually seep in.

    Good Luck.

    (I’m a dentist by the way)

  • Gordon says:

    Water fluoridation is mass medication but it is also the most equitable and cost effective way of reducing the burden of dental disease in our society.

    Unfortunately the demographic of families most likely to be affected by dental caries in children are also those least likely to be reading health journals and “Sweet Poison” and most likely to have unhealthy diets and poor family oral hygiene.

    Sugar reduction would also be a great government strategy to reduce dental decay. But as posted above you still gotta clean the teeth (especially between the teeth). Kids cavities occur most commonly between the teeth.

    David mentioned fluorosis, both dental and skeletal.

    Dental fluorosis is a condition where white striations or speckles form on the teeth when too much fluoride is ingested (they can be brown at really high doses). Most people will not develop fluorosis at the recommended water fluoridation concentrations used in Australia. In any case, fluorosis is almost always only a cosmetic problem that makes your teeth look whiter and rarely requires treatment. A cavity is MUCH worse in my opinion (especially in a six year old). If fluoride is ingested in REALLY high doses it can make the teeth brittle but without eating adult toothpaste on a regular basis it would be almost impossible to achieve this result in Australia.

    Skeletal fluorosis is a problem often raised by those opposed to fluoride. The WHO report shows that skeletal fluorosis occurs with long term ingestion of fluoride doses much higher than is achievable in Australia (about 10 times or more). The best evidence from studies has found that there is no evidence of any increase in bone brittleness or bone fractures in communities fluoridated at optimal levels (08-1.0ppm).

    Don’t just believe me. There is a lot of information on the Australian Dental Association website and the British Dental Association

    You can also read the “York Review” at

    Happy reading. It’s quite a tome.


  • Mal says:

    Belated thanks for taking the time to respond, Gordon. This makes a lot of sense. Cheers, Malcolm

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