Why don't you drink fluoride

The most important things in summary

Fluorides are among the trace elements and occur naturally as salt compounds.

Fluoride hardens the tooth enamel by adding minerals to it and thereby preventing the process of tooth destruction by acids.

You can get fluoride from food, drinking water or dental care products.

Poisoning is rather unlikely due to the low intake, but too much fluoride can lead to discoloration of the teeth, a so-called fluorosis.

What is fluoride?

Fluorides are fluorine compounds and natural minerals that appear in various rock layers and are found in water and food. Fluorine is a gas and a natural chemical raw material. When fluorine combines with another substance, it is called fluoride. The following fluorides are particularly important in dentistry: sodium monofluorophosphate, amine fluoride and tin fluoride. Fluorides are essential for dental health as they help prevent tooth decay and strengthen tooth enamel.

How harmful is fluoride?

Fluoride is not harmful. In fact, it is particularly important for dental health and prevents tooth decay. In fact, fluoride is poisonous. As with many substances, however, the dose is relevant here. Sodium chloride, i.e. table salt, can also be toxic if the dose is too high. According to experts, fluoride is ten times less toxic than table salt. Fluoride is therefore only harmful if too large an amount has been ingested. In order to actually suffer from fluoride poisoning, you would have to take around 350mg of fluoride, which corresponds to about three toothpaste tubes with 75ml. So if you use toothpaste as usual, fluoride is neither harmful nor toxic. Even if you swallow some toothpaste, don't worry.

What is the difference between fluoride and fluorine?

Fluorine is actually a poisonous gas, which combines very quickly with other elements and does not occur freely in nature. Even the smallest amounts of fluorine are extremely toxic. If fluorine is now firmly bound to another substance, it is called fluoride. Fluoride can also be toxic; for this, however, a very strong overdose is necessary. In addition, fluoride is one of the most thoroughly researched substances worldwide, which is why the use of fluoride toothpastes, for example, does not pose a risk.

What role does fluoride play in teeth?

Fluoride plays an important role in our dental health, especially when it comes to preventing tooth decay. Fluoride has an antibacterial effect and fights the bacteria in the tooth enamel. This reduces their production of harmful acids and prevents the development of tooth decay.

Sodium monofluorophosphate, sodium fluoride and amine fluoride in particular prove to be very effective here. In addition, fluorides help harden the tooth enamel, making it more resistant to acid attacks. When a new tooth breaks through the oral cavity, it absorbs minerals from saliva to build up tooth enamel. The tooth also absorbs fluoride ions and integrates them into the tooth enamel. This also makes the enamel more stable and resilient. Fluorides also support remineralization. When acids attack tooth enamel, certain mineral salts are lost. This loss is compensated for by calcium and phosphate ions. The fluorides now help to release these ions from the saliva and make them available for remineralization. This means that, thanks to the fluoride, the remineralization process is faster and the bacteria have less time to use the weak points in the tooth enamel, which reduces the risk of tooth decay.

However, fluoride is not only available in the form of toothpaste. In principle, experts differentiate between systemic and local fluoridation measures. In the systemic fluoridation the entire body receives fluoride through the food chain. However, this long-term supply can cause side effects on the teeth and cause fluorosis. Forms of this type of fluoridation are tablet fluoridation, drinking water fluoridation and table salt fluoridation. However, tablet fluoridation is controversial because of its low effectiveness and the rate of side effects. Often the time the tablet stays in the mouth is simply too short, which is why it cannot work properly. There used to be a few countries that artificially added fluoride to natural drinking water. Nowadays, however, this form of fluoridation is not used anywhere in the world. The third form of systemic fluoridation, table salt fluoridation, is very common today. The fluorides are added to the common salt and act directly on the tooth surface, although they are absorbed through the food chain.

In addition to systemic fluoridation, there is also local fluoridation measureswhich takes place directly on the tooth surface and is preferred by dentists. This type of fluoridation includes toothpaste, fluoride varnish, fluoride gel and fluoride-containing mouthwashes. Toothpaste is considered very effective and should be used twice a day. Mouth rinses are also an essential part of caries prophylaxis. They also have the advantage of helping against plaque and gingivitis. Tooth gels are much more concentrated than toothpastes, which is why they should only be used once a week. The dentist applies fluoride varnish. This should be done twice a year, or even four times a year if there is an increased risk of tooth decay.

Why is there toothpaste with and without fluoride?

Despite its many benefits, many people continue to reject fluoride. This skepticism is often due to confusion between fluorine and fluoride. The effectiveness of fluoride has been scientifically proven and experts therefore recommend the daily use of toothpastes with fluoride. However, there are hardly any scientific studies on toothpastes without fluoride, which is why experts advise against their use. In certain cases, however, such toothpastes are an alternative. Baby teeth in particular are still very sensitive and fluorosis quickly develops. The fluoride content in children's toothpaste has therefore already been reduced to 0.05 percent. Nevertheless, the uncertainty often outweighs the situation and parents opt for a toothpaste without fluoride. In this case, however, the fluoridation should be compensated and done differently.

How much fluoride should there be in a toothpaste?

The limit values ​​for fluoride in cosmetic products are regulated in the European Cosmetics Regulation. Toothpastes for adults can contain between 0.10 and 0.15 percent fluoride. Adult toothpastes with less than 0.10 percent are not optimal. The recommended maximum amount for children's toothpastes is 0.05 percent.

When should fluoride be incorporated into dental care?

You should incorporate fluoride into dental care at an early stage. Fluoridation in babies is a very controversial issue. You may be given fluoride tablets in the hospital after the child is born, but the dentist advises against them. As the maximum recommended daily intake of fluoride in babies is very low, the risk of an overdose is also higher. Therefore, some experts do not recommend using toothpastes containing fluoride until the first teeth appear.
In the first and second year of life, the milk teeth should be brushed once a day with a fluoridated children's toothpaste. From the age of three, teeth should be cleaned twice a day with fluoridated children's toothpaste. From the age of six and the eruption of the first permanent teeth, experts recommend switching from a children's toothpaste containing fluoride to an adult toothpaste. In addition, a fluoride tooth gel should be used once a week. For adults with experience of periodontal disease, we recommend the additional use of a fluoride-containing rinsing solution to reduce the risk of caries. Additional hardening of the teeth may be necessary at an advanced age. A higher fluoride concentration in the toothpaste can help here. In this case, however, you should speak to your dentist.

What is the daily need for fluoride?

The daily fluoride requirement for adults aged 19 and over is 3.8 mg for men and 3.1 mg for women. 19 to 13 year olds should take 3.2 mg and 2.9 mg, respectively. For children, the daily requirement is 2.0 mg (ten to thirteen years), 1.1 mg (four to ten years) or 0.7 mg (one to four years). Infants should take 0.5mg (four to twelve months) or 0.25mg (zero to four months) fluoride. For pregnant and breastfeeding women this value is 3.1 mg.

What should I watch out for when using fluoride?

When using fluoride, you should be careful not to use too much fluoride, especially with children. So if your child uses fluoride tablets, no additional fluoride-containing children's toothpaste should be used. In the case of fluoride tablets, there is also a risk that children will swallow them. However, the tablets only work when they are sucked. This is very difficult for children between the ages of 0 and 2. There is no reason not to use fluoride during pregnancy. During this time, pregnant women should even pay more attention to their dental care and plan specific dental appointments. In some patients, additional fluoridation may be necessary due to pregnancy-related nausea. According to experts, it is unlikely that the unborn child will suffer damage in the womb due to toothpaste containing fluoride. For this, the mother would have to have had too high a fluoride intake on a regular basis.


What happens if I overdose with fluoride?

As already mentioned, poisoning with fluoride toothpaste is very unrealistic. Nonetheless, fluoride can be harmful if ingested in very large amounts suddenly. A 70kg adult would need to ingest at least 350mg of fluoride to notice the first signs of poisoning. For a child weighing 15kg that would be 150ml, i.e. two tubes of toothpaste. Signs of an overdose include nausea, vomiting, diarrhea, and headache. Basically, these signs occur from an intake of 5 mg fluoride per kg of body weight. Such poisoning can even be fatal from 30mg per kilogram. However, that would correspond to twelve tubes of toothpaste and is therefore very unlikely. If too much fluoride is taken over a long period of time, experts speak of chronic fluoride poisoning. This can lead to bone fluorosis or dental fluorosis. In bone fluorosis, the bones harden and lose their elasticity, making them more and more fragile. Dental fluorosis manifests itself in white to brownish spots on the tooth enamel, mostly on the incisors.

How does a lack of fluoride manifest itself?

There is actually no such thing as a fluoride deficiency. A completely fluoride-free diet is simply impossible, as fluoride is contained in drinking water. Even if a person consumes very little fluoride, they will not show any symptoms of deficiency. Someone who consumes little fluoride does not automatically fall ill and does not necessarily have to suffer from tooth decay, although the risk of it can be increased. However, experts disagree on this issue. For many, fluoride is not an essential trace element and therefore not absolutely necessary for the body. Other doctors and scientists warn that too little fluoride intake can lead to tooth decay, osteoporosis and hardening of the arteries. In summary, however, it can be said that too little fluoride is much less harmful to the body than too much.

Where is fluoride naturally found?

Drinking water naturally contains fluoride. One liter of low-fluoride water contains around 0.3 mg of fluoride. So if you drink two liters of water per day, you will consume a maximum of 0.6 mg of fluoride. In addition to the fluoride content of the drinking water, black and green teas contain 1 mg of fluoride per liter. However, this value fluctuates enormously depending on the type of tea. Walnuts are a very fluoride-rich food and contain around 0.68mg per 100g. Other foods with a relatively high content of fluoride per 100g are salmon with 0.65mg, sardines with 0.4mg and matjes with 0.38mg. Cashew nuts, beef fillet and Emmentaler contain between 0.14 and 0.16mg per 100g. Please note, however, that these values ​​can also fluctuate greatly and depend on the respective fluoride load in the country of origin of the product.

What do dental care products with fluoride cost?

A toothpaste containing fluoride costs around four euros. Toothpaste without fluoride is also available for this price. Tooth gels are a bit expensive and can be bought for five to eight euros. You can buy mouthwashes with fluoride for around five euros.

Does the health insurance company cover the costs of fluoridation of the teeth?

Certain fluoridation measures such as pills for children are covered by health insurance. You usually have to pay for other measures yourself, such as those carried out by the dentist, for example.


About the author: Dr. Florian Lanza

Assistant doctor at the University Dental Clinic in Vienna

Dr. Florian Lanza works as an assistant doctor at the University Dental Clinic in Vienna and has been supporting MOOCI as a medical expert in the field of dentistry since August 2019.

In addition to conservative and aesthetic dentistry, he enthusiastically trains the next generation of dentists.

It is his concern that the education and information work at MOOCI helps to offer patients absolute transparency.


Depending on the fluoridation measure


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The most important things in summary

Fluorides belong to the trace elements and occur naturally as salt compounds.

Fluoride hardens the tooth enamel by adding minerals to it and thereby preventing the process of tooth destruction by acids.

You can get fluoride from food, drinking water or dental care products.

Poisoning is rather unlikely due to the low intake, but too much fluoride can lead to discoloration of the teeth, a so-called fluorosis.

Do you have any questions on this topic?