At Lakes Regional Healthcare, we care deeply about the well-being of our community, not just in times of illness, but in preventive care as well. One of the most effective tools we have that improves oral health – especially in children – is something as simple as the water flowing from your kitchen faucet: fluoride.
Fluoride is a naturally occurring mineral that’s been added to water supplies in the United States for over 75 years. Its primary role is preventing tooth decay. But despite decades of scientific evidence and public health success, misinformation continues to cloud this important topic. In this article, we’ll break down what fluoride is, how it works, why it’s added to water, and how it continues to play a vital role in your family’s oral health.
What is Fluoride?
Fluoride is a mineral found naturally in soil, water, and foods. It plays a crucial role in strengthening teeth and preventing cavities, which are among the most common chronic health problems in children and adults alike. Unlike other preventive treatments, fluoride can reach people of all ages, income levels, and education backgrounds – simply through their drinking water.
How Fluoride Fights Tooth Decay
Every time we eat or drink, the bacteria in our mouths produce acid. That acid breaks down the surface minerals in our teeth, a process called demineralization. Over time, this can lead to cavities. Here’s where fluoride comes in:
- Remineralization: Fluoride helps rebuild the lost mineral content in enamel, the outer layer of your teeth.
- Harder Enamel: Fluoride makes the enamel more resistant to acid attacks in the future.
- Bacterial Disruption: It also inhibits the ability of harmful bacteria to stick to the teeth and produce acid.
Think of fluoride as a daily shield, constantly working in the background to keep your teeth healthy.
A Public Health Victory
The concept of community water fluoridation began in 1945 in Grand Rapids, Michigan. Within a few years, the city saw a dramatic reduction in tooth decay among school-aged children. Inspired by this success, other cities across the U.S. followed suit.
In 1962, the U.S. Public Health Service recommended fluoride levels between 0.7 and 1.2 milligrams per liter (mg/L) in drinking water. This was updated in 2015 to a standard of 0.7 mg/L to reflect increased access to fluoride from toothpaste and other sources. However, recommended levels are different than legal limits. The U.S. Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) standard of 4.0 mg/L for fluoride, applicable to public water systems. Fortunately, most public water systems maintain fluoride levels well below that amount. Below are the most recently available fluoride levels in some of Dickinson County, Iowa’s fluoridated communities:
- Arnolds Park = .71 mg/L (2024)
- Milford = .91 mg/L (2023)
- Okoboji = .79 mg/L (2023)
- Spirit Lake = .55 mg/L (2024)
Bottled water standards are set by the U.S. Food and Drug Administration (FDA). For bottled water with no fluoride added, the maximum fluoride level allowed varies, but can be up to 2.4 mg/L. For bottled water with added fluoride, the maximum allowed is 0.7 mg/L.
Today, more than 209 million Americans – 72.3% of those on public water systems – have access to fluoridated water, and the results are clear:
- Studies show fluoridated water reduces cavities by around 25% in both children and adults.
- Fluoride has been called one of the 10 greatest public health achievements of the 20th century by the Centers for Disease Control and Prevention (CDC).
- Since the 1960s, tooth decay rates in the U.S. have dropped significantly. In the early 1960s, adults – nearly all of whom had grown up without access to fluoridated water – had a per-person average of 18 decayed, missing, or filled teeth. That compares to an average of 9.3 today.
Why Fluoride in Water Still Matters, Even with Toothpaste
You might be wondering, “If fluoride toothpaste is everywhere, do we really need it in our water?” The answer is yes, and here’s why:
- Access and Equity: Not everyone has access to dental care or can afford fluoride toothpaste. Over 100 million Americans lack dental insurance. This echoes what Dickinson County’s 2022 Community Health Needs Assessment identified – a lack of dental access for the county’s Medicaid population, resulting in poor dental health. Water fluoridation ensures protection reaches everyone, regardless of income or access to dentists.
- Constant Protection: Drinking fluoridated water keeps a low level of fluoride in your mouth throughout the day, helping to continuously strengthen tooth enamel.
- Cumulative Benefit: When combined with fluoride toothpaste and regular dental visits, fluoridated water enhances the overall impact on oral health.
Tooth Decay is Still a Major Problem
Even with medical advancements, tooth decay remains one of the most common chronic conditions among children in the United States. It’s even worse for children living below the federal poverty line:
- 1 in 4 low-income children experiences untreated cavities.
- Dental decay can cause pain, missed school, difficulty eating, and low self-esteem.
- Untreated cavities can lead to infections that impact overall health.
Fluoridated water acts as a community-level safety net, helping prevent these outcomes even for those who may not be able to brush twice a day or see a dentist regularly.
What Happens When Fluoridation Stops?
Studies show that when cities remove fluoride from public water, tooth decay rates go up, often dramatically.
Case studies include:
- Windsor, Canada: Voted to remove fluoride in 2013. A 2018 study found a 51% increase in urgent dental cases among children within just a few years.
- Juneau, Alaska: Stopped fluoridation in 2007. Afterward, treatment costs for low-income children rose significantly – in some cases by over 100%.
These examples serve as strong warnings: when fluoride is taken away, communities feel the impact, both in health outcomes and economic costs.
Fluoride is Safe at Recommended Levels
Extensive research – more than 6,800 studies – has confirmed that fluoride is safe and effective at the recommended levels in drinking water.
The only documented risk of drinking water fluoridation is dental fluorosis – a cosmetic condition that causes faint white spots on teeth. In the U.S., nearly all fluorosis cases are mild and do not affect function or appearance. It typically occurs in children under 8 who ingest too much fluoride, often by swallowing toothpaste. It’s not caused by drinking water at 0.7 mg/L.
Water Fluoridation is Cost-Effective
Preventing cavities through community water fluoridation is not just effective, it’s affordable.
- Every $1 spent on water fluoridation saves $38 in dental treatment costs.
- It benefits all residents, regardless of whether they visit the dentist regularly.
That makes water fluoridation one of the few universal, low-cost preventive health measures that benefits the entire population.
What You Can Do
Here’s how you and your family can maximize the benefits of fluoride:
- Brush twice a day with fluoride toothpaste.
- Don’t rinse after brushing – spit out the toothpaste to leave a protective layer of fluoride.
- Supervise children under age 6 while brushing and use only a pea-sized amount of toothpaste.
- Know your water source. If you’re on a well or private system, have your water tested. If you drink bottled water, check the label for fluoride content or contact the bottler.
- Stay informed. Read your annual water quality report or contact your water utility.
Final Thoughts
Water fluoridation remains a cornerstone of preventive health – one of the simplest and most impactful steps we’ve taken as a society to improve oral health outcomes. As your local healthcare provider, we want you to know the science, understand the benefits, and feel confident in the water your family drinks.
