Position of the Academy of Nutrition and Dietetics:

The Impact of Fluoride on Health

Billy Werthman
 It is the position of the Academy of Nutrition and Dietetics to support optimal systemic

and topical fluoride as an important public health measure to promote oral health and overall

health throughout life. The authors of this position paper are Carole A. Palmer and Joyce Ann

Gilbert. The position is in effect until December 31, 2017.

The Academys position is that fluoride is important in all aspects of health. The primary

role of fluoride is to prevent tooth decay (1). That is what the Academy is concerned with.

Treating water with fluoride is a lot more cost-effective than treating individuals for tooth decay.

Tooth decay is the most common chronic condition in children (1). The reason fluoridation of

water works is because fluoride promotes tooth mineralization and remineralization along with

reversing tooth demineralization. Water naturally contains fluoride. That is how the discovery

of fluoride on oral health came about. People recognized the correlation between the high levels

of fluoride in certain towns and their overall oral health and less prevalence of tooth decay.

There are many different aspects in fluoride. Fluoride is filtered in the kidneys. Children

usually retain more than they excrete. On the other hand, adults usually excrete more than they

retain. When an individual has too much fluoride this is called fluorosis. It usually occurs in

children developing their teeth. Therefore, parents should always teach their kids to spit out their

tooth paste instead of swallowing it. Even if the parents dont know the reason why they tell

their kids to spit out their toothpaste, let alone why they spit out their own toothpaste, they are

cutting down on the occurrence of too much fluoride.

The best way to make fluoride most effect is by applying it topically and consistently (1).

This is controversial because fluoridation of water is not only topical, it can end up in the body

and that is what people dont like. Anyways, fluoride doesnt just come from water and

toothpaste. Fluoride is found in many drinks, but also foods. These drinks and food have
fluoride due to their content of fluoride in the water that produced the food or drink. Fluoride

can also be included in day to day life through supplement (1). Individuals need to be careful of

these supplements because of fluorosis. Also, mothers breastfeeding should stay away from

these supplements. The Academy points out that an RDN should play a role in informing

mothers of fluoride and its effects on the health of an individuals child.

Fluoride is important for families who are less fortunate and cannot afford dental care.

They can still get enough fluoride to help cut down on tooth decay. This will help the family not

have to take any emergency trips to see the dentist due to tooth decay or other dental issues.

However, fluoride cannot be a substitute for regular dental care. It is only for upkeep of oral

health. It is important to note that not all water supplies are fluoridated. This is especially

relevant in small towns where it is more expensive to fluoridate the water because their water is

not cost effective to be fluoridated. On the contrary, these small towns might be where

fluoridation of water is needed the most.

People may wonder who decides whether water is fluoridated. This decision comes from

local legislators. Fluoridation is up to them and they might not be educated or informed on the

subject. What they might be aware of are the antifluoridation campaigns that are advocating to

them. These people may or may not be educated on the whole subject of fluoridation of water.

What they do know is that they do not want water fluoridated. The problem with this is that if

they are the only ones trying to get to the legislators to promote their view and are lobbying to

them, then the legislators wont have an opposite viewpoint to choose. Furthermore,

antifluoridation advocates create fear among the public. This is likely one way that they lobby to

legislators. They show the fear that is in the public over this issue of fluoride in water and try

and get them to act in accordance to their views.

 One of the opponents main arguments can be for fluorosis. They say they that fluorosis

is bad for someone. However, this is not the case. At most, it will leave embarrassing white

spots on the individuals teeth. A caveat to that is fluoride is toxic in very high amounts.

Therefore, parents need to monitor children and their use of mouthwashes and toothpastes. A

child or adult would have to consume a lot of fluoride to cause detrimental effects like death.

However, this is still a risk that needs to be noted and is one of the reasons for the

antifluoridation campaigns. This is a reason the EPA has set out regulations for fluoridation of

water. These are set at a maximum of 4.0 mg/l or 4.0 ppm (1). This will help and prevent

detrimental effects due to overconsumption of fluoride.

The RDN has an important role in educating people on the effects of fluoridation of

water. They can explain the amounts recommended per day, as well as toxic levels of fluoride in

the body. In this explanation, the RDN can help identify signs and symptoms of fluoride

intoxications as well as deficiency. Also, they can include information on where else fluoride

can be taken in. They should recommend dental visits within 6 months of first teething and no

later than 12 months old (1). Another way an RDN can promote fluoride is by contacting their

legislature on the topic. The legislator might not be aware of the issue and even if they are, they

might not be informed from the Academys position paper. From this, the legislators may be able

to pass laws or at least bring up the topic to other people of law making power. A very important

job the RDN has is to inform pregnant women on fluoride. Most infants get enough fluoride

from fluoridated formula and or from breastfeedings. If, on top of that, they are given a

supplement, they might develop mild fluorosis. Therefore, an RDN has such an important role in

informing parents of children about the issue of fluoride.

 In my opinion, the position of the Academy on fluoride, and other ways of incorporating

fluoride into the life of an individual, is correct. Tooth decay is a big problem for all people in

this country. One way to counter tooth decay is through fluoridating water. From the position

and all the studies and references it refers to, I think that fluoride in water should be a nationwide

requirement. I also believe that people should be educated from this position. I have heard

many people talk about how fluoridating water is dangerous and causes all sorts of bad things.

Based on the research, this is not the case. Yes, there is an association with silicofluoride and

increased blood lead levels in children (1). However, that is a small association and I think that

the positives outweigh the negatives in this instance. On the other hand, sodium fluoride,

another source of additive fluoride in water, showed no association with increase in blood lead

levels in children (1). Both additives are used interchangeable in fluoridation of water.

I do not know all the ins and outs of passing a law and getting it seen through the process

of becoming a law, but I think that it should be a law to have fluoridated water. I think that if it

got to a point where it became a law, people would hear about it in the news and therefore be

exposed to the real research behind the subject. On the other hand, there is potential for more

controversy, but the positive would be that water is being fluoridated. The of issue of lead in

Flint water does not need to be replicated, so the laws passed need to be concise and followed

through. If something like that happened with fluoride, I think it would be a very big boost to

the antifluoridation movement. If fluoridation of water became a requirement, people will learn

about dangers in over fluoridating and under fluoridating. All the while, being exposed to

positive, correct information on an important topic in health.

I know that there are many sound arguments that many opponents make. They have valid

reasons for their argument. However, they do not have 86 citations from reliable scientific
sources to back up their argument like this position paper has. I think that most people are quick

to judge something that is not even based on scientific evidence if only to question authority. It

is like a person being guilty no matter what evidence is shown. This is not fair to the researchers

who have studied this topic and put research forward that supports fluoridation of water.

Therefore, I agree with the position of the Academy on the issue of fluoridation of water.
 References

1. Palmer CA, Gilbert JA. Position of the Academy of Nutrition and Dietetics: The Impact

of Fluoride on Health. Journal of the Academy of Nutrition and Dietetics.

2012;112(9):1443-1453. doi:10.1016/j.jand.2012.07.012.