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HomeHealth articleswater fluoridationWhat Are the Benefits of Water Fluoridation?

Water Fluoridation - Benefits and Adverse Effects

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Fluoride intake has both positive and negative effects. It benefits by reducing the incidence of dental caries, and the side effects include skeletal fluorosis.

Medically reviewed by

Dr. Basti Bharatesh Devendra

Published At January 20, 2023
Reviewed AtJanuary 20, 2023


Many decades ago, fluoride was first added to drinking water in some parts of the United States, but there is controversy about the possible health effects of drinking water fluoridation. All public health, medical and dental organizations recommend community water fluoridation. Adding fluoride to local drinking water helps prevent cavities.

What Is Fluoride?

Fluoride is an element that combines with other substances, often a metal. Examples include stannous fluoride, sodium fluoride, mono fluorophosphate, etc. Some fluorides naturally occur in air, soil, or water. They can also be found in plants and animal food sources. When the fluorides are ingested, they are absorbed into the blood through the digestive tract. Fluoride travels through the blood and is found in bones and teeth. The major sources of fluoride are water, food, and fluoride-containing dental products like toothpaste and mouthwash. Fluoride protects teeth from decay.

What Is the History of Water Fluoridation?

Water fluoridation began in 1945 in some parts of the United States. Grand Rapids, Michigan, was the first city to add fluoride to its city water system to provide benefits of fluoride in 1945. The scientist noted that the people living with the higher water fluoride level have fewer cavities than those living in the area with low water fluoride levels. The United States Public Health Service in 1962 recommended that public water supply must contain fluoride to help prevent tooth decay. Fluoride is now being used in the public drinking water supply. The process of testing the water supply for fluoride and adjusting it to the right amount to prevent cavities is called community water fluoridation.

What Are the Benefits of Water Fluoridation?

Fluoride is naturally found in freshwater; its concentration depends on the location and source, ranging from 0.01 ppm to 100 ppm. Fluoride benefits children and adults throughout their life. In children below eight years of age, fluoride helps to strengthen the teeth and for adults drinking fluoridated water helps to support tooth enamel.

  • Decrease in cavities.

  • Decreased pain and suffering because of tooth decay.

  • Strong teeth.

  • Fluoride works to control early dental caries in several ways.

How Is Fluoride in Drinking Water Regulated?

Several government agencies regulate fluoride levels in the water, and fluoride is not required in all drinking water sources. In 1962 the United States public health service recommended that community water supply contain fluoride levels between 0.7 and 1.2 milligrams per liter of drinking water to help prevent tooth decay. This recommendation was updated in 2015 to a 0.7 mg/L fluoride level. The maximum fluoride in drinking water should be 4.0 mg/L per the (EPA) US Environmental Protection Agency. The EPA has also set another standard of not more than 2.0 mg/L to help protect children from dental fluorosis. In the case of bottled water that contains no fluoride added, the maximum fluoride level allowed is 2.4 mg/L, and for water that contains fluoride, the maximum fluorine allowed is 1.7 mg/L. CDC (Centers for Disease Control and Prevention) has a tool that is used to check the local water supply, which will help tell whether the city fluoridates its water.

What Are the Adverse Effects of Fluoride Ingestion on Human Health?

Fluoride exposure has many health effects, which include:

  • Dental Fluorosis - Exposure to high fluoride levels during childhood can lead to the risk of developing mild to severe dental fluorosis. It may cause discoloration of the teeth. Children should be monitored while brushing to avoid swallowing their toothpaste.

  • Skeletal Fluorosis - Excess fluoride exposure can also lead to skeletal fluorosis. The bones become less elastic and hardened, which might cause an increased risk of fractures.

  • Thyroid Problems - Excess fluoride can cause damage to parathyroid glands, which will result in hyperparathyroidism.

  • Neurological Problems - Children with higher fluoride levels were associated with low IQ (intelligence quotient).

  • Other Problems - Reproductive issues, skin problems, temporomandibular joint disorders, osteoporosis, muscular damage, etc.

  • Fluoride Poisoning - An acute and high level of fluoride exposure can lead to fluoride poisoning, which includes abdominal pain, nausea, vomiting, seizures, muscle spasms, and excessive salivation.

How To Reduce Fluoride Exposure?

In some places, even without water fluoridation, the natural fluoride levels in water can be even higher than 4 mg/L. For those who are concerned about the fluoride level in water or concerned about fluoride exposure and some steps that can help to reduce the exposure are:

  • Find out the level of fluoride in the drinking water. Contact the local community if the drinking water comes from a public source. Those who get their drinking water from a private source can get their fluoride levels tested by a laboratory.

  • Those living in areas with high levels of fluoride in water can use alternative drinking water sources like bottled water.

  • There are different methods to filter fluoride out of the water, although these can be expensive.

  • People can choose fluoride-free toothpaste.


Fluoride is a mineral that is used in many dental products. Adding fluoride to local drinking water helps prevent cavities. But exposure to high levels can cause several health issues.

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Dr. Basti Bharatesh Devendra
Dr. Basti Bharatesh Devendra



water fluoridation
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