It’s always seemed odd to us that while caries (tooth decay) is a disease that’s driven by nutrition, many overlook the cause and focus so exclusively on fluoride.

Yet studies – this one, for instance, or this – have shown that, at best, fluoride may slow decay’s progress. It doesn’t actually prevent it, even when sugar consumption is relatively low.

We’ve known for a long time, too, that sugar is a problem. It’s the favorite food of harmful oral bacteria. When you eat it, they eat it – and as they say, what goes in must go out. The metabolic waste these microbes generate is very acidic, capable of destroying tooth enamel, the hardest tissue in the body. The loss of enamel gives pathogens access to the insides of the tooth and the living tissues found there.

And it’s not just the white stuff that some people dump in their coffee or even just the sweet stuff – honey, agave, and the rest. It includes starchy foods, too, like bread, pasta, crackers, and potato chips – any foods made from white flour and other highly refined grains and starchy carbs.

The dominance of these foods in the American diet is one reason why tooth decay continues to be such a problem. It’s not lack of fluoride, which is in most major brands of toothpaste and even in most public drinking water.

“Without sugars,” plainly noted the author of an excellent 2015 paper in the Journal of Dental Research, “the chain of causation is broken, so the disease does not occur.”

person eating sugar out of a sugar bowlBut encouraging people to eat less sugar is not anything the sugar industry wanted, according to a study of historical industry documents by UC San Francisco researchers. So “Big Sugar” did everything it could to keep dental researchers focused on any solution except for changing diets. Fluoride seemed to be one of the more promising options – so long as you overlooked its potential risks.

We believe those risks far outweigh any benefit.

Decades of scientific research has revealed the harm that fluoride exposure can cause. Systemic health problems linked to fluoride include diabetes, hypertension, thyroid dysfunction, and more. This paper from the International Academy of Oral Medicine & Toxicology (IAOMT) discusses these risks in greater detail and includes extensive scientific references.

Much of the most recent research has focused on the special harm that fluoride exposure – including exposure before birth, through the womb – can do to children’s developing brains. That harm was one of the main findings of a comprehensive report from the National Toxicology Program that was released earlier this year.

This six-year systematic review of the science underwent two rounds of independent peer review. Importantly, its authors considered not just drinking water or supplements but ALL potential sources of fluoride, including dental products, processed foods, pesticides, and more.

While “the body of evidence from studies in adults is…limited and provides low confidence that fluoride exposure is associated with adverse effects on adult cognition,” the NTP authors wrote,

there is…a large body of evidence on IQ effects in children. There is also some evidence that fluoride exposure is associated with other neurodevelopmental and cognitive effects in children; although, because of the heterogeneity of the outcomes, there is low confidence in the literature for these other effects. This review finds, with moderate confidence, that higher fluoride exposure (e.g., represented by populations whose total fluoride exposure approximates or exceeds the World Health Organization Guidelines for Drinking-water Quality of 1.5 mg/L of fluoride) is consistently associated with lower IQ in children.

And now there’s yet more evidence, courtesy of a new study just published in Neurotoxicology and Teratology.

The study focused on exposure from naturally occurring fluoride in Ethiopian drinking water, where concentrations ranged from 0.4 mg/L to 15.5 mg/L. (The standard concentration in fluoridated drinking water here in the US is 0.7 mg/L.)

Seventy-four children provided urine samples for testing and completed two tests to measure their cognitive ability, including a standard computerized memory test designed to be language- and culture-neutral. This test is closely associated with hippocampus function. That’s the part of the brain that’s associated with memory, learning, and emotion.

“Fluoride in drinking water,” wrote the authors, “was negatively associated with cognitive function” in both tests. The greater their exposure to fluoride, the more mistakes the kids made.

As a biological dental practice, we do not use fluoride at all. We believe we do our patients a much greater service by helping them address the root cause of the problem and embrace the healthy habits we know sustain excellent mouth/body health.

But “first,” as they say, “do no harm”…