In last week’s episode, we traced the history of fluoridation (and the anti-fluoridation movement) to its roots in the early 20th century, but we left you wondering whether there’s anything to back up the health claims that anti-fluoridationists make. Today, we get deep into the weeds of the fluoride literature, explaining how this mineral works, the difference between topical and systemic fluoride, and whether fluoridation has been linked to any health issues. The details matter, and don’t you worry – we’ve got plenty of nitty gritty for you to feast on.
| Biology |
| Pitts, N.B., Zero, D.T., Marsh, P.D., Ekstrand, K., Weintraub, J.A., Ramos-Gomez, F., Tagami, J., Twetman, S., Tsakos, G. and Ismail, A., 2017. Dental caries. Nature reviews Disease primers, 3(1), pp.1-16. |
| Ten Cate, J.M. and Buzalaf, M.A.R., 2019. Fluoride mode of action: Once there was an observant dentist… Journal of dental research, 98(7), pp.725-730. |
| Buzalaf, M.A.R., Pessan, J.P., Honório, H.M. and Ten Cate, J.M., 2011. Mechanisms of action of fluoride for caries control. Monographs in oral science, 22, pp.97-114. |
| Taher, M.K., Momoli, F., Go, J., Hagiwara, S., Ramoju, S., Hu, X., Jensen, N., Terrell, R., Hemmerich, A. and Krewski, D., 2024. Systematic review of epidemiological and toxicological evidence on health effects of fluoride in drinking water. Critical reviews in toxicology, 54(1), pp.2-34. |
| Kumar, J.V., Moss, M.E., Liu, H. and Fisher-Owens, S., 2023. Association between low fluoride exposure and children’s intelligence: a meta-analysis relevant to community water fluoridation. Public Health, 219, pp.73-84. |
| Taylor, K.W., Eftim, S.E., Sibrizzi, C.A., Blain, R.B., Magnuson, K., Hartman, P.A., Rooney, A.A. and Bucher, J.R., 2025. Fluoride exposure and children’s IQ scores: a systematic review and meta-analysis. JAMA pediatrics. |
| National Toxicology Program, 2024. NTP monograph on the state of the science concerning fluoride exposure and neurodevelopment and cognition: a systematic review. NTP Monograph, (8) |
| Boehmer, T.J., 2023. Community water fluoridation levels to promote effectiveness and safety in oral health—United States, 2016–2021. MMWR. Morbidity and Mortality Weekly Report, 72. |
| Guth, S., Hüser, S., Roth, A., Degen, G., Diel, P., Edlund, K., Eisenbrand, G., Engel, K.H., Epe, B., Grune, T. and Heinz, V., 2020. Toxicity of fluoride: critical evaluation of evidence for human developmental neurotoxicity in epidemiological studies, animal experiments and in vitro analyses. Archives of toxicology, 94, pp.1375-1415. |
| Jack, B., Ayson, M., Lewis, S., Irving, A., Agresta, B., Ko, H. and Stoklosa, A., 2016. Health effects of water fluoridation: evidence evaluation report. National Health and Medical Research Council: Canberra. |
| Canadian Agency for Drugs and Technologies in Health. 2020. Community Water Fluoridation Exposure: A Review of Neurological and Cognitive Effects. Ottawa: CADTH Rapid Response Reports: summary with critical appraisal. |
| Iheozor-Ejiofor, Z., Walsh, T., Lewis, S.R., Riley, P., Boyers, D., Clarkson, J.E., Worthington, H.V., Glenny, A.M. and O’Malley, L., 2024. Water fluoridation for the prevention of dental caries. Cochrane database of systematic reviews, (10). |
| McLaren, L., Patterson, S., Thawer, S., Faris, P., McNeil, D., Potestio, M.L. and Shwart, L., 2017. Exploring the short-term impact of community water fluoridation cessation on children’s dental caries: a natural experiment in Alberta, Canada. Public Health, 146, pp.56-64. |
| Nezihovski, S.S., Findler, M., Chackartchi, T., Mann, J., Haim, D. and Tobias, G., 2024. The effect of cessation of drinking water fluoridation on dental restorations and crowns in children aged 3–5 years in Israel–a retrospective study. Israel Journal of Health Policy Research, 13(1), p.50. |
| Moore, D., Nyakutsikwa, B., Allen, T., Lam, E., Birch, S., Tickle, M., Pretty, I.A. and Walsh, T., 2024. How effective and cost‐effective is water fluoridation for adults and adolescents? The LOTUS 10‐year retrospective cohort study. Community Dentistry and Oral Epidemiology, 52(4), pp.413-423. |
| James, P., Harding, M., Beecher, T., Browne, D., Cronin, M., Guiney, H., O’Mullane, D. and Whelton, H., 2021. Impact of reducing water fluoride on dental caries and fluorosis. Journal of dental research, 100(5), pp.507-514. |
| Belotti, L. and Frazão, P., 2022. Effectiveness of water fluoridation in an upper‐middle‐income country: A systematic review and meta‐analysis. International Journal of Paediatric Dentistry, 32(4), pp.503-513. |
| Miranda, G.H.N., Alvarenga, M.O.P., Ferreira, M.K.M., Puty, B., Bittencourt, L.O., Fagundes, N.C.F., Pessan, J.P., Buzalaf, M.A.R. and Lima, R.R., 2021. A systematic review and meta-analysis of the association between fluoride exposure and neurological disorders. Scientific reports, 11(1), p.22659. |
| Do, L.G., Spencer, A.J., Sawyer, A., Jones, A., Leary, S., Roberts, R. and Ha, D.H., 2023. Early childhood exposures to fluorides and child behavioral development and executive function: a population-based longitudinal study. Journal of Dental Research, 102(1), pp.28-36. |
| Broadbent, J.M., Thomson, W.M., Ramrakha, S., Moffitt, T.E., Zeng, J., Foster Page, L.A. and Poulton, R., 2015. Community water fluoridation and intelligence: prospective study in New Zealand. American journal of public health, 105(1), pp.72-76. |
| Grandjean, P., Meddis, A., Nielsen, F., Beck, I.H., Bilenberg, N., Goodman, C.V., Hu, H., Till, C. and Budtz-Jørgensen, E., 2024. Dose dependence of prenatal fluoride exposure associations with cognitive performance at school age in three prospective studies. European Journal of Public Health, 34(1), pp.143-149. |
| Farmus, L., Till, C., Green, R., Hornung, R., Mier, E.A.M., Ayotte, P., Muckle, G., Lanphear, B.P. and Flora, D.B., 2021. Critical windows of fluoride neurotoxicity in Canadian children. Environmental research, 200, p.111315. |
| Green, R., Lanphear, B., Hornung, R., Flora, D., Martinez-Mier, E.A., Neufeld, R., Ayotte, P., Muckle, G. and Till, C., 2019. Association between maternal fluoride exposure during pregnancy and IQ scores in offspring in Canada. JAMA pediatrics, 173(10), pp.940-948. |
| Aggeborn, L. and Öhman, M., 2021. The effects of fluoride in drinking water. Journal of Political Economy, 129(2), pp.465-491. |
| Till, C., Grandjean, P., Martinez-Mier, E.A., Hu, H. and Lanphear, B., 2025. Health Risks and Benefits of Fluoride Exposure During Pregnancy and Infancy. Annual Review of Public Health, 46(1), pp.253-274. |
| WHO: Chemical Safety and Health – Inadequate or excess fluoride. https://iris.who.int/bitstream/handle/10665/329484/WHO-CED-PHE-EPE-19.4.5-eng.pdf?sequence=1 |
| National Academies of Sciences, Engineering, and Medicine, 2021. Review of the Revised NTP Monograph on the Systematic Review of Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects: A Letter Report. |
| National Toxicology Program, 2019. Draft NTP monograph on the systematic review of fluoride exposure and neurodevelopmental and cognitive health effects. US Department of Health and Human Services: Washington, DC, USA. |
| *opinion piece in JAMA pediatrics in response to 2025 meta-analysis: Lanphear, B.P., Den Besten, P. and Till, C., 2025. Time to Reassess Systemic Fluoride Exposure, Again. JAMA pediatrics. |
| *opinion piece in JAMA pediatrics in response to 2025 meta-analysis: Levy, S.M., 2025. Caution Needed in Interpreting the Evidence Base on Fluoride and IQ. JAMA pediatrics. |
| McLaren, L. and Petit, R., 2018. Universal and targeted policy to achieve health equity: a critical analysis of the example of community water fluoridation cessation in Calgary, Canada in 2011. Critical Public Health, 28(2), pp.153-164. |
| Patel, B., Patrick, A. and Dyer, T.A., 2025. The ethics of community water fluoridation: Part 1-an overview of public health ethics. British Dental Journal, 238(5), pp.311-315. |
| Patel, B. and Dyer, T.A., 2025. The ethics of community water fluoridation: Part 2-how has the ethics of community water fluoridation been appraised in the literature? A scoping review. British Dental Journal, 238(5), pp.336-343. |
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2 thoughts on “Ep 179 Fluoride 2: Fighting tooth and nail”
Love the podcast and hearing from you Dr. ladies! I was THRILLED to see these fluoride episodes pop up in my podcast feed! I work at the American Dental Association and this is a critical topic right now. There is a lot of work ongoing within the dental profession to push back against proposed bans of community water fluoridation and the anti-fluoride groups. It’s refreshing to hear a a detailed breakdown on the history and importance of community water fluoridation from health professionals outside of dentistry. Thank you for delivering such a great breakdown of that meta-analysis as well. It’s been so widely and irresponsibly publicized. Gets my heart rate up every time I see or hear it cited. Thanks for all you do to keep us listerners in the know.
From a Calgarian whose kids didn’t get to have the systemic fluoride benefit I recieved as a growing baby, thank you so much for these episodes. I’ve been a long-time fan of the podcast, but this episode hits close to home as Calgary is reintroducing the fluoride top-up to our municipal water and I have this amazing podcast to refer people to.
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