Fluoride is a naturally occurring mineral found in soil, water and certain foods. It’s also a common ingredient in toothpaste because it helps strengthen tooth enamel and protect against cavities. Fluoride has even been added to public water supplies in the United States for decades to help prevent tooth decay.

But in recent years, it’s become the subject of debate. And that can leave you wondering: Is fluoride bad for you?

We asked dentist Anne Clemons, DMD, about what fluoride does, where the concerns come from, and how to make informed decisions for you and your family.

Is fluoride safe?

In small amounts, fluoride is safe and recommended by most dental health professionals. That includes fluoride in toothpaste, mouthwash, dental treatments and the U.S. public water system.

“Fluoride, like many minerals, can be harmful in very high amounts,” Dr. Clemons clarifies. “But the levels used in dental products and procedures and in community water systems don’t come near that threshold.”

In very high amounts, fluoride can have risks. Let’s look at the pros and cons.

Benefits of fluoride

Topical fluoride — such as in toothpaste, mouth rinses and professional varnishes — works on the surface of your teeth.

Fluoride in water affects your teeth from the outside and the inside of your body. It sits in your saliva, acting as a coating similar to topical fluoride. Systemic fluoride also gets incorporated into the actual structure of your teeth as they’re developing. For kids, that means that fluoride can help them develop stronger teeth as adults.

Strengthens enamel

Sure, you may not want to think about it, but your mouth is home to lots of bacteria. And when you eat or drink, those bacteria help themselves to what’s left. As they feast, they produce acid, and as that acid builds, it removes important minerals from your teeth, weakening your enamel (the outer surface of your teeth).

Fluoride supports a process called remineralization. That means it helps restore the minerals that acid eats away. This process can slow or even stop early tooth decay.

Helps prevent cavities

“Decades of research show that fluoride lowers cavity rates, especially in children and communities with limited access to dental care,” Dr. Clemons reports.

How? Fluoride makes your enamel more resistant to acid. In children, fluoride swallowed from water can make its way into their developing teeth. That adds extra protection as their adult teeth form.

Possible risks

Like many nutrients and minerals, fluoride is beneficial in small amounts, but it can cause problems in excess. Too much fluoride could potentially cause:

  • Dental fluorosis: Too much fluoride during childhood can cause cosmetic changes to your tooth enamel. It’s typically mild and appears as faint white streaks on your teeth.
  • Bone health concerns: Very high levels of fluoride over long periods have been linked to bone problems like pain, stiffness and bone deformities. These concerns are rare in the U.S., but are more common in parts of Asia and Africa, where groundwater naturally has excessive amounts of fluoride.
  • Brain development concerns: Some studies examining regions with naturally high fluoride levels have raised questions about possible effects on brain development. These levels are significantly higher than what’s used in U.S. community water systems.

Current U.S. guidelines set fluoride levels at 0.7 milligrams per liter. That’s well below amounts that have been associated with harm in research studies.

Reap the benefits of fluoride

To get the most benefit from fluoride, follow these tips:

  • Brush twice daily with a fluoride toothpaste.
  • Use only a rice-sized amount of fluoride toothpaste for children under 3.
  • Use a pea-sized amount of fluoride toothpaste for children ages 3 to 6.
  • Supervise young children when they brush their teeth and encourage them to spit, rather than swallow, toothpaste.
  • If you get your water from a private well, have it tested regularly to ensure fluoride levels are within a safe range.

“Fluoride is an important tool we use to prevent tooth decay,” Dr. Clemons says. “For many patients, it plays an important role. But decisions about oral health should always be made with your provider based on your goals and your personal risk.”

If you have questions about fluoride exposure, your dentist or healthcare provider can help you review your risk and decide what’s right for you and your loved ones.

This article was written by Cleveland Clinic Health Essentials (editorial@ccf.org) from Cleveland Clinic and was legally licensed through the DiveMarketplace by Industry Dive. Please direct all licensing questions to legal@industrydive.com.