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Fluoride Strengthens Teeth Before Cavities Form

Interviewer: Fluoride isn't just about preventing cavities. It helps build stronger teeth before cavities happen. And if kids don't get enough during a small but critical window, the effects can last a lifetime. In Utah, fluoride has been removed from all public water systems, but even before that, according to a 2024 "Associated Press" analysis, fewer than one in seven Utah systems added fluoride at all. So, what happens when kids grow up without it, whether it's because it's been removed or they've never had it in the first place?

Dr. James Bekker is from the University of Utah School of Dentistry. Dr. Bekker, can you explain the role fluoride plays in childhood tooth development, that small but critical window?

Dr. Bekker: That's a great question, Scot, and one a lot of people don't understand clearly. Permanent teeth are developing even when a child is very young. There are tooth buds that are down in the bone in the jaw. And so a tooth bud that is forming in the presence of fluoride in the system forms with a higher hardness to the enamel. So later on, your permanent teeth that have developed when they were in the presence of fluoride have harder enamel, and you have less dental decay.

Interviewer: Got it. So super critical. When exactly is that happening in most kids? I realize there will probably be a range.

Dr. Bekker: It is optimal to have fluoride in the presence of tooth development starting at about 6 months of age and going on up through 13 to 15 years of age.

Missed Fluoride During Development Cannot Be Recovered Later

Interviewer: If a child misses that window, so they go through that time without the presence of fluoride, can you catch up later?

Dr. Bekker: Well, there are things that you can do for your teeth later after they've come in that are topical. Brushing with a fluoride toothpaste, getting fluoride treatments at your dentist, fluoride varnishes, staying away from sugary drinks, and those kinds of things all help your teeth not to get as much decay. But if you miss the window of that development with the fluoride at an early age, you don't get that back.

Interviewer: You don't get that hardness that you're talking about, that additional hardness.

Dr. Bekker: Right. And it's interesting because dentists around the country can look in someone's mouth, and they can look at the teeth and say, "Oh, you grew up in an area where there was fluoride," or, "You grew up in an area where there wasn't fluoride."

Interviewer: Wow. Is it that obvious?

Dr. Bekker: Yes.

Communities Without Fluoride Have Higher Rates of Tooth Decay

Interviewer: Before the recent changes, a lot of Utah communities didn't already have fluoride in their water. So what do we know about the dental health of kids in those communities? We know that a dentist could probably look in their mouth and go, "Well, you grew up in the absence of fluoride." What else does it mean for the health of their teeth?

Dr. Bekker: Great question. And Utah is a wonderful place to look at this question because we have three counties along the Wasatch Front, Salt Lake, Weber, and Davis County, that were fluoridated, and then an area in Brigham City. That is a high concentration of population. So even though it's smaller geographically compared to the entire state, that equaled about half of the population of Utah that was in a fluoridated area.

So then you have the other half of Utah that is not in a fluoridated area, and we can look at children, people who have grown up in those areas that were not fluoridated, and we see a higher incidence of dental decay.

In those areas where children grow up without fluoridation, you see an increase in dental caries. It's well documented that dental decay is the number one reason that children miss school in our country. So, where you have higher rates of dental decay, you have higher truancy from school because children are dealing with dental pain.

This lack of fluoride is particularly significant in underserved populations. Heretofore, in an area where we didn't have fluoride, you were able to get a fluoride supplement, a little vitamin tablet, or a drop that parents could give their kids. But in underserved populations, they're less likely to have that kind of follow-up and get a supplement.

So you have a higher caries rate. You have increased dental decay, which leads to pain. You have a higher rate of people going to the emergency room to get relief from their dental pain, which is the most expensive and the least effective way of getting dental care, because at an emergency room, you just simply get an antibiotic and a painkiller, and then are told to go to your dentist. So that's only a short-term fix.

The other thing that we see is, in young children who have extensive dental decay, they are not able to have that treated in a regular office setting. So they have to go to a hospital or a surgical center and receive that dental treatment under a general anesthetic. And that is an extremely expensive option when the whole thing could be taken care of in a more preventative way by having fluoride as their teeth are developing.

So bottom line is we see increased caries, increased cost to healthcare, and using our emergency rooms, which are not an effective way of receiving dental care.

Interviewer: Wow. Talk about an ounce of prevention and a pound of cure, and just all the downstream effects that could be avoided if those teeth are harder because they've been in the presence of fluoride.

Dr. Bekker: Yeah. And it's interesting because we have places around the country that have had fluoride, have taken fluoride out of the water, and then we've seen what has happened. Anchorage, Alaska; Buffalo, New York; and Calgary, Canada, they're all places where fluoride has been removed. The caries rate over the next five to seven years has started to rise.

For instance, in Buffalo, they're in the process of putting fluoride back in their water because of the extreme results of taking the fluoride out that they have seen.

Parents Should Discuss Fluoride Supplements With Health Care Providers

Interviewer: So given this information, for those that live in a community that used to have fluoride in the water and doesn't anymore, or if there are parents of kids in communities that don't have fluoride in the water, what kind of conversations should those individuals have with their parents if they're interested in trying to make up that shortcoming and make sure their children have those good, hard teeth?

Dr. Bekker: That's a great question, and that's something that all dental professionals are working together... To go forward, how do we handle this where fluoride has been taken out of the water? It's an educational thing, and we need to get parents talking to their professional providers, their pediatric dentists, their pediatricians, their family physicians.

That professional, in talking with the parent, determines where they live and if there's any naturally occurring fluoride there. And if they don't have any fluoride, then a prescription is written so that the child can get a fluoride supplement.

Now, it's very interesting because supplements in Utah . . . As fluoride was taken out of the water, it was widely shared that those who wanted fluoride should simply talk to their professional, have that conversation, and get a supplement.

I was just in Washington, D.C., last week and testified before the FDA subcommittee about the possibility that the FDA is considering removing fluoride supplements from being available. And so that's an ongoing conversation, which is not good because that would eliminate the ability to even get a supplement in an area where you don't have fluoride.

Right now, you can get supplements. The conversation is you talk to your pediatrician, your family doctor, your pediatric dentist, your regular dentist, you get a prescription, and give those children the appropriate dosage of the supplement.

It's widely been shown that... and we're talking a very, very tiny amount of fluoride, but at that optimal level, it has a tremendously positive effect on enamel development in teeth.

Fluoride Supplements Are Available as Drops or Tablets

Interviewer: What form is this supplement in?

Dr. Bekker: Two forms. You can get drops that can just be dropped into juice or water, or whatever it is that the child is drinking. And then you can get tablets. You can get chewable tablets, or you can get tablets that they swallow.

And the dosage is graduated. It starts very small at age 6 months. When you get to 3 years, then it goes up. It increases. And then when you're 6 years and above, you get a full dose, which is a milligram a day.

Fluoride Is Safe and Effective in Recommended Amounts

Interviewer: And that is more effective? Just brushing with a toothpaste that has fluoride in it just doesn't quite get it done? You just really need that extra little bit. Am I understanding that correctly?

Dr. Bekker: Well, think about it. Brushing gets to the surface of your tooth. That's very helpful and very important. But what the fluoride supplement does is it makes your enamel harder before it even comes in. It comes in harder.

Interviewer: Okay. So it's not touching the tooth necessarily because those tooth buds, I think you called them, aren't exposed. But it's getting into the body and then the presence of that chemical... Just like vitamin C helps prevent us get colds, this gets into the body and gets absorbed by the teeth and the enamel and used to make them harder.

Dr. Bekker: Exactly. Yeah. So both things are important. The topical things like toothpaste and good care, that's very important. But in areas where you can have exposure to fluoride at a young age during development, it is an added benefit.

Interviewer: As we wrap up, what's the one thing you wish all parents knew right now about fluoride and their kids' teeth?

Dr. Bekker: The one thing I wish everybody would know is that fluoride in the recommended dosage has never been shown to have any negative side effects to health and no negative side effects to development, only benefit to helping teeth to be stronger. In the recommended dosages, it's a win-win.