Fluoride - Alberta Dental Association and College Skip to main content

The ADA&C supports water fluoridation as a safe, effective method for the prevention of dental cavities.

There are more than 90 national and international professional health organizations that support the safe and effective use of fluoride for the prevention of dental cavities. Included among these are the ADA&C, Alberta Health Services, the Canadian Dental Association, the Canadian Medical Association, Health Canada, the Public Health Agency of Canada, the United States Centers for Disease Control and Prevention and the World Health Organization.

Dental decay is the most common chronic disease in children, affecting five to eight times as many children as asthma. According to recent data from the Canadian Health Measures Survey, 56.8 per cent of children in Canada aged six to 11 years are affected by dental cavities and 58.8 per cent of adolescents aged 12 to 19 have experienced decay in one or more permanent teeth. By adulthood, nearly 96 per cent of dentate Canadians have experienced coronal decay, with a mean count of 10.7 DMFT (decayed, missing and filled teeth).

The safety and efficacy of water fluoridation has been frequently studied and continues to be supported by current science. Over 60 years of research and recent systematic reviews have shown that water fluoridation is a safe, effective and efficient public health measure for the prevention of dental decay. In fact, the United States Centers for Disease Control and Prevention has recognized water fluoridation as one of the 10 great public health achievements of the 20th century.

“When combined with healthy food and good oral health habits, fluoride is safe and effective whether it occurs naturally or is added to the optimal level in water. In this way fluoridation uniquely allows us to prevent disease and suffering and promote the wellness of all Albertans, equitably. It is pretty simple: adults and children from areas with water fluoridate have fewer cavities than people in communities where the water fluoride level is too low,” states Dr. James Talbot, former chief medical officer of Health, Alberta.

Health Canada’s Chief Dental Officer states that “the safety and efficacy of water fluoridation has been frequently studied and continues to be supported by current science. Canadian and international studies agree that water that was fluoridated at optimum levels does not cause adverse health effects.”

Health Canada convened an expert panel to review fluoride and after an extensive toxicological review concluded that the weight of evidence from all currently available studies does not support a link between exposure to fluoride in drinking water and any adverse health effects, including those related to cancer, immunotoxicity, reproductive/developmental toxicity, genotoxicity, neurotoxicity. and/or intelligence quotient deficit.

Fluoridation of drinking water continues to be the most economical means of getting the proven protection that fluoride gives to teeth. Children need fluoride protection while their teeth are developing. Adults also benefit from fluoride since the risk of root decay increases with aging. A 2013 Canadian study estimates that for every dollar invested in water fluoridation $71.05–82.83 is saved in dental costs.

Frequently Asked Questions

  • What is fluoride?

    Fluoride is a mineral found in soil, water (both fresh and salt) and various foods.

  • What does an “optimal” level of water fluoridation mean?

    An optimal level of water fluoridation is achieved by adjusting the level of fluoride in the water to achieve the right balance between the benefit of preventing tooth decay and the risk of developing dental fluorosis, which is an esthetic condition.

    Dental fluorosis is an esthetic change in the appearance of teeth. It is caused when higher than optimal amounts of fluoride are ingested in early childhood. In its mildest and most common form, it affects the look of the tooth with small white specks appearing on a child’s teeth.

    The Canadian Health Measures Survey 2007-2009 found that dental fluorosis is not an issue of concern for the vast majority of children (84%). Some children (16%) have mild forms of fluorosis that often go unnoticed by both the children and their parents.

  • How does fluoride prevent tooth decay?

    Fluoride has a positive effect on oral health by making teeth more resistant to decay. Fluoride can also prevent or even reverse tooth decay that has started.

    For many Albertans, fluoride is in public drinking water, which provides protection to the entire community. Fluoride toothpastes and rinses are available for purchase, and your dentist can provide professional fluoride products such as gels and varnish.

  • What is water fluoridation?

    Water fluoridation is the process of adjusting the level of naturally occurring fluoride in a public drinking water supply to optimize the dental benefits of preventing tooth decay.

    Fluoride is added to public drinking water to protect all members of the community from tooth decay. Community water fluoridation is a safe and effective way of preventing tooth decay at a low cost.

    Municipal water treatment facilities monitor the level of fluoride. These municipalities rely on the Federal-Provincial Territorial Committee on Drinking Water who makes recommendations about the optimal level of fluoride in public drinking water to prevent tooth decay.

    With the exception of dental fluorosis, an esthetic condition, scientific studies have not found any credible link between water fluoridation and adverse health effects.

  • Should I be using fluoridated toothpaste with my child?

    The Canadian Dental Association advises that for children from birth to three years of age, the use of fluoridated toothpaste is determined by the level of risk of tooth decay. Parents should consult a health professional to determine whether their child up to three years of age is at risk of developing tooth decay. If such a risk exists, the child’s teeth should be brushed by an adult using a minimal amount (a portion the size of a grain of rice) of fluoridated toothpaste. Use of fluoridated toothpaste in a small amount has been determined to achieve a balance between the benefits of fluoride and the risk of developing fluorosis. If the child is not considered to be at risk, the teeth should be brushed by an adult using a toothbrush moistened only with water.

    For children from three to six years of age, only a small amount (a portion the size of a green pea) of fluoridated toothpaste should be used. Children in this age group should be assisted by an adult in brushing their teeth.
  • Why do young children need to be assisted or supervised with tooth brushing?

    Young children tend to swallow toothpaste when they are brushing, which may increase their exposure to fluoride and contribute to dental fluorosis. For this reason, children need to be assisted or supervised with tooth brushing. An adult needs to ensure that an appropriate amount of toothpaste is used, that the child spits out the toothpaste rather than swallows it, and that the teeth are cleaned effectively.

  • How do I know if my child is getting enough fluoride protection?

    Your dentist is able to assess your child’s risk of developing tooth decay and advise you of an appropriate level of fluoride protection.

Fluoride - Evidence Reference List

  • Since 1997 the following reviews have been conducted concerning water fluoridation:

    Health Canada. Findings and Recommendations of the Fluoride Expert Panel (January 2007). 2008.

    McDonagh, M S, et al. Systematic review of water fluoridation. Br Med J 2000, 321: 855-859.

    Government of Ireland. Forum on Fluoridation. Dublin, Ireland: Stationery Office, Government Publications, 2002.

    National Health and Medical Research Council. Review of Water Fluoridation and Fluoride Intake from Discretionary Fluoride Supplements. Melbourne, Australia: NHMRC, 1999.

    National Health and Medical Research Council. A Systematic Review of the Efficacy and Safety of Fluoridation, Part A: Review Methodology and Results. Australian Government, 2007.

    Health Canada. Guidelines for Canadian Drinking Water Quality: Fluoride Guideline Technical Document. Environmental and Workplace Health, Prepared by the Federal-Provincial-Territorial Committee on Health and the Environment. December 2010.

    Whiting, P, McDonagh, M and Kleijnen, J. Association of Down’s Syndrome and Water Fluoride Level: A Systematic Review of the Evidence. BMC Public Health 2001, 1(1)

    Truman, B I, et al. Reviews of Evidence on Interventions to Prevent Dental Caries, Oral and Pharyngeal Cancers, and Sports-related Craniofacial Injuries. Am J Prev Med 2002, 23(Suppl 1): 21S-54S

    National Research Council. Fluoride in Drinking Water: A Scientific Review of EPA’s Standards Committee on Fluoride in Drinking Water, Board on Environmental Studies and Toxicology. Washington, D.C.: National Academy Press, 2006

    Locker D. Benefits and Risks of Water Fluoridation: An Update of the 1996 Federal-Provincial Sub-committee Report. Community Dental Health Services Research Unit Faculty of Dentistry, University of Toronto, November 1999.

    Scientific Panel on Dietetic Products, Nutrition and Allergies. Opinion of the Scientific Panel on Dietetic Products, Nutrition and Allergies on a Request From the Commission Related to the Tolerable Upper Intake Level of Fluoride (Request no. EFSA-Q-2003-018). Scientific Panel on Dietetic Products, Nutrition and Allergies, 2005. 81

    United Kingdom Medical Research Council. Water Fluoridation and Health. United Kingdom Medical Research Council 2002. [Cited: October 20, 2011]

    National Academy Press. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine, 1999.

    Lepo, J E and Snyder, R A. Impact of Fluoridation of Municipal Drinking Water Supply: Review of the Literature. Escambia County Utilities Authority, 2000. [Cited: October 29, 2011]

    Centers for Disease Control and Prevention. Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States. MMWR 2001; 50(RR14):1-42

    Calgary Regional Health Authority Expert Panel for Water Fluoridation Review. Report of the Expert Panel for Water Fluoridation Review. Calgary Regional Health Authority, 1998

    Fort Collins Fluoride Technical Study Group. Report of the Fort Collins Fluoride Technical Study Group. Fort Collins, Colorado, April 2003. [Cited: November 6, 2011]

    Levy M and Corbeil, F. (2007) Water Fluoridation: An Analysis of the Health Benefits and Risks. Institut National de Sante Publique Du Quebec, 2007. [Cited: November 6, 2011]