Fluoride is a binary compound of fluorine and tin.
Where is it found?
Fluoride is a trace mineral found in varying concentrations in foods and in water. Foods high in fluoride include fish,
tea, and many different vegetables.
Fluoride is added into the municipal water supply of many cities in the United States. For
those people without access to fluoridated water, fluoride supplements are available in the
forms of tablets and drops. These supplements are not available without a prescription. Many
non-prescription dental care products contain fluoride as well, including toothpastes and
mouthwashes.
Fluoride has been used in
connection with the following conditions (refer to the individual
health concern for complete information):
Who is likely to be deficient?
As fluoride is not considered an essential mineral, it does not have an associated
deficiency state. Regardless, people living in areas with low concentrations of fluoride in
the drinking water do appear to be at a higher risk of significant tooth decay than those living in areas with high
amounts of natural or added fluoride.
How much is usually taken?
Drinking water containing 1 mg of fluoride per liter is considered to be roughly the
optimal amount for the prevention of tooth decay. For those without access to fluoridated
drinking water, chewable fluoride tablets containing 0.25 to 1 mg per day of fluoride or
fluoride mouthrinses with 0.05% to 0.2% fluoride content can be used. Liquid fluoride drops
are also available.
Are there any side effects or interactions?
The risks associated with fluoridation of the public water supply have been the subject of
vigorous and often heated debate since fluoridation began in 1945. Although much research has
been done regarding the safety of fluoridation, a recent review found all prior studies to be
of sub-optimal quality and far from definitive.1
Some,2 3 but not all,4 5 studies have found a
correlation between the amount of fluoride intake and increased risk of osteoporotic
fractures. The validity of the studies that found increased risk of fracture in communities
with fluoridated water has been questioned by some scientists.6 A pooled analysis
of 29 studies on this issue concluded that there did not appear to be an increased risk of
fracture in areas of water fluoridation.7
Dental fluorosis, a brown staining of teeth due to fluoride exposure during childhood, is
the best-documented adverse effect of fluoride. At a water fluoride level of 1 part per
million (or 1 mg per liter), roughly 13% will have fluorosis to an aesthetically concerning
degree.8
Some scientists have concluded that water fluoridation is associated with an increased risk
of bone tumors,9 although most others disagree.10
At the time of writing, there were no well-known drug interactions
with fluoride.
References:1. McDonagh MS, Whiting PF, Wilson PM, et al. Systematic review of water
fluoridation. BMJ 2000;321:855–9 [review].
2. Kurttio P, Gustavsson N, Vartiainen T, Pekkanen J. Exposure to natural
fluoride in well water and hip fracture: a cohort analysis in Finland. Am J Epidemiol
1999;150:817–24.
3. Danielson C, Lyon JL, Egger M, Goodenough GK. Hip fractures and
fluoridation in Utah’s elderly population. JAMA 1992;268:746–8.
4. Hiller S, Cooper C, Kellingray S, et al. Fluoride in drinking water
and risk of hip fracture in the UK: a case-control study. Lancet
2000;355:265–9.
5. Phipps KR, Orwoll ES, Mason JD, Cauley JA. Community water
fluoridation, bone mineral density, and fractures: prospective study of effects of older
women. BMJ 2000;321:860–4.
6. Rosen CJ. Fluoride and fracture: an ecological fallacy. Lancet
2000;355:247–8 [editorial].
7. McDonagh MS, Whiting PF, Wilson PM, et al. Systematic review of water
fluoridation. BMJ 2000;321:855–9 [review].
8. McDonagh MS, Whiting PF, Wilson PM, et al. Systematic review of water
fluoridation. BMJ 2000;321:855–9.[review]
9. Diesendorf M, Colquhoun J, Spittle BJ, et al. New evidence on
fluoridation. Aust NZ J Public Health 1997;21:187–90 [review].
10. McDonagh MS, Whiting PF, Wilson PM, et al. Systematic review of water
fluoridation. BMJ 2000;321:855–9 [review].