Drugs & MedicationsHealthcare PolicyPediatricsPreventive MedicineWellness


There’s little or no disagreement with the statement that fluoridation of community drinking water supplies has been one of public health’s greatest success stories. For 75 years, community water fluoridation has impacted the oral health of adults and children to the degree that cavities are rare and fillings are done far less frequently. The CDC estimates that communities with fluoridated water save an average of $32 per person per year on the treatment of cavities, and in one 10-year period (‘79-‘89) saved $39 billion. The financial impact of fluoridation cannot be overstated, and the oral health benefits are well known.

By age 8 years, without fluoride, 52% of children will have a cavity in their “baby teeth.” Fifty-seven percent of adolescents age 12-19 will have one cavity in their permanent teeth. Among adults over age 20, 90% will have had one cavity. Low income children are twice as likely to have untreated cavities. Adding fluoride to drinking water supplies reduces these statistics significantly, especially during the years a child’s baby teeth are being replaced by permanent teeth.

Our water contains fluoride naturally, but the amount is insufficient to prevent tooth decay. For years, dentists all over the country had tried fluoride as a tooth decay preventive but never had the impact that adding it to the water supply did. So in 1945, Grand Rapids, Michigan became the first city to fluoridate their water. Five years later, statistics showed that Grand Rapids children had a significantly reduced number of cavities, and tooth decay was not the problem it had been previously. For the next 75 years, community after community saw the benefits of fluoridation and added it to their water. Now, fluoridation is recommended by nearly all public health, medical, and dental organizations, and 73% of the U.S. population has fluoridated water (2018 statistic).

The concentration of fluoride recommended is 0.7mg/liter (mg/L). The range of concentration is between 0.7 mg/L and 1.2 mg/L, or put another way, .7 to1.2 parts per million (ppm). Fluorine is the element and fluoride is the anion of fluorine. The periodic table symbol for fluorine is “F”and for fluoride is “F-.” Fluoride and water mix with saliva and are absorbed in the mouth by plaque. Plaque forms when food and bacteria mix together and attack the tooth enamel. Weakened tooth enamel causes tooth decay. Fluoride binds to the weakened areas to strengthen the tooth against decay. And I must say, it is quite effective!

The idea for this blog came to me as I was brushing my teeth with “Crest Toothpaste.” I remembered TV commercials in the 1950’s, when Crest was one of the first toothpastes to contain fluoride. The commercials mentioned the research done at my Alma mater, Indiana University in Bloomington, IN, and featured patients who participated in the clinical trials. Three chemists from I.U., Joseph Muhler, Harry Day, and William Negergall developed and patented the formula used in Crest. They used stannous fluoride as the critical ingredient. The formula was sold to Proctor & Gamble who brought Crest to market in 1954. For years, I have never used any other toothpaste but Crest. Oh, I’ve been given samples of other brands, but when it comes to spending money on toothpaste, for me it’s always Crest. 

Those 1950’s commercials showed actual patients from Bloomington, IN giving testimony as to the value of brushing with Crest. They were right! The Crest brand has stood the test of time. In 1955, sodium fluoride replaced stannous fluoride as the active ingredient, but Proctor and Gamble continues to own Crest and the amount they have earned from it over the past seventy years has to be in the billions. Crest generates $260 million in sales annually and holds a 35% market share. I was surprised, though, to learn Colgate is the most popular toothpaste brand. Still, Proctor & Gamble’s revenues in 2022 were $80.187 billion and profits were $38.018 billion. A good percentage of which is probably from the many varieties of Crest as well as Tide, Gillette, Old Spice, Vicks, Pampers and 18 more familiar brands.  

We use Crest toothpaste almost exclusively. The fluoridation of drinking water combined with the twice-daily use of sodium fluoride in Crest has been very successful in the oral health of my wife and me. Neither of us has had a cavity in the last fifty years. I’ve had teeth crack, break off, and need a crown, but I’ve had no cavities and no fillings.

Folks who live in rural areas and have well water have low fluoride levels. These folks should test their water for fluoride, and if the concentration is not at least 1 ppm, supplemental fluoride should be prescribed. Fluoride comes in drops, lozenges, and chewable tablets and is dosed based on the results of water level testing. I did prescribe fluoride a few times, but most patients had fluoridated water. One can get too much fluoride, however. The condition is called dental fluorosis and causes white spots in the enamel of the teeth. If excess fluoride is ingested during the time a child’s teeth are developing, fluorosis will occur. I’ve seen white spots like described in many patients and mistakenly thought they were caused by antibiotics taken during childhood. I now know differently.

Dr. G’s Opinion: Fluoridation of the water supply has been a very successful public health decision. In the 1950’s, there was no pushback, disagreement, or activist protests against the addition of fluoride to our water because attitudes were different then. During my practice years, no one ever refused a prescription for fluoride. No conspiracy theorists claimed it caused all sort of physical abnormalities. It was approved during an era when people welcomed things that made life better. If fluoridation were to be decided today, half the country would think the government was trying to poison us or expose us to a chemical with adverse effects years from now. Thankfully, there is no controversy surrounding fluoridation, and fluorosis is a minimal problem if anything. The impact on the oral health of Americans is significant. Fluoridated drinking water and dental products are here to stay because unlike COVID-19 vaccines, they do what they’re supposed to do.

References: CDC.gov/community-water-fluoridation



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