Posted by: Transform Limiting Beliefs | January 19, 2012

Hot Topic: Talking Fluoride with Green Dental Patients

Fluoride is a hot topic among green dental patients—and with good reason. Many studies indicate that fluoride is an effective method for preventing tooth decay and remineralizing enamel. However, a steady stream of research suggests that ingesting too much fluoride can have negative effects. The evidence is conflicting and can be confusing for parents and patients who want to make the best decision for long-term cavity prevention. Regardless of your position on the matter, it’s not a simple “good or bad” answer, and green dental patients will appreciate the time you take to explain the issue fully.

I always start by explaining that it’s important to differentiate between topical fluoride use and community water fluoridation as a method of reducing tooth decay. There are a growing number of US and European countries removing fluoride additives in community water supplies, which I think is a good decision.

On the other hand, toothpaste containing fluoride is an excellent way to prevent tooth decay with no known adverse health risks, as long as an excessive amount of the toothpaste isn’t ingested.  Ingesting fluoride at levels greater than 1.2 parts per million causes fluorosis (or white spots) in the teeth. Other anecdotal evidence of harmful systemic health problems isn’t well documented, so prevailing health authorities have ruled that the benefits of reducing tooth decay outweigh any possible side effects.

According to the Center for Disease Control and Prevention, the recommended guideline for fluoride ingestion is between 0.7 and 1.2 ppm, and anything above that amount should be considered toxic. While most adults are aware that they shouldn’t swallow toothpaste while brushing, it is much harder for children to avoid (especially when brushing with the flavored types made especially for kids). This can be worrisome, especially with dental decay ringing in as the number one disease amongst children.

I recommend to parents that only a “pea” sized or smaller amount of toothpaste is used and that they make sure their children know not to swallow the toothpaste, as they guide them in brushing properly.

Green dental patients will appreciate an approach to fluoride that allows individual patients and parents to decide what’s right for themselves and their children. Our role as their wellness practitioners is to provide as much information as we can, so they can make the best decision based on their values.

I always remind them that the approach to preventive oral wellness is no different than the rest of our bodies. It’s always best to start with diet and hygiene! Minimize sugary drinks and be sure that your family is getting plenty of vitamins from their meals. Regularly brush, particularly before bed. And see the dental hygienist according to your team’s recommendation. I share with them how this will help us achieve our common goal: setting their child up for a lifetime of good oral health habits.

How do you handle this controversial issue in your practice? Please share! Your advice could help other green dentists and EDA members.

Be well,

EDA Co-Founder, Dr. Fred Pockrass 


  1. Fred, firstly, I have to agree with the statement “It’s always best to start with diet and hygiene!” especially when it comes to young children, who either can’t or do not want to spit out toothpaste.
    With my patients, I firstly assess their risk of tooth decay. Depending on this risk, I then discuss with them their lifestyle and diet risk, but if people are unable to modify these risks, I recommend topical fluoride supplements- stronger toothpaste or mouthwash.
    However, I do accept that some people have strong views on fluoride, not only in water supply but also in oral hygiene products. For these people, I recommend “Toothmousse” (I think you know it as MI paste in US, a GC product), which is a cassein-bound calcium supplement. It has been proven to remineralise teeth best in conjunction with fluoride toothpaste, but even alone works better than commercially available toothpastes. It does add a step to a client’s routine and there may be issues with compliance, but if their risk of decay is high, it is their decision to make: swap your non-fluoride toothpaste for a fluoridated one at similar cost or add to your routine with a more expensive product.
    I think most people nowadays can make what I hope is an informed choice to fliter their water if they wish to bypass additives in their water supply, but as a public health measure, fluoride in water is at least doing a little bit for the poor, uneducated and disabled sections of our societies, who either do not have the financial ability, the knowledge or the physical ability to perform proper oral hygiene practices and control their diet.
    Thanks for the article!
    Tijana, Sydney

  2. Thank you for such an informative post. I’ve heard the debates but frankly, it has all seemed rather confusing. I grew up having Fluoride treatments and don’t seem worse for it but then … one never knows about the long term affects of these things … and it seems that the experts aren’t completely sure either. So I really appreciate your article … it takes the fear factor out of brushing.

  3. I disagree with your statement, “Many studies have indicated…” The only ‘studies’ that I can find in favour are those produced by the fluoride industry or governments that support fluoride. They are by far outweighed by the overwhelming evidence of independent studies that say the opposite about adding ‘rat poison’ to our water.

    Even as a toothpaste additive, I can’t agree, while I bow to your professional knowledge, whereas I am Joe Public. People need more choice, more fluoride-free toothpastes need to be available and at an affordable cost.

    The most disturbing aspect that I find is the effect on the brain, that school performances have decreased to a marked extent since the advocacy of fluoride.

    To my mind, fluoride is just plain wrong.


  4. Interesting article. I remember when I was young my mom telling me to not swallow my toothpaste. I’m glad she was (and still is) so smart. If I understood you correctly you are in favor of removing fluoride from community water supplies. I wish they would do this in my community. I guess I should contact my local representatives about that. Thanks for the info!

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