Fluoride has been in the news recently, thanks to the long-continued efforts of the Fluoride Action Network. Due to scientific evidence provided and the persistent efforts of this group, a federal court has finally ruled fluoridated water to be a public health hazard, with previously deemed “optimal” levels now proven to lower IQs in children. Despite the court’s ruling, the EPA has yet to act on orders to remove fluoride from drinking water, so at present many people continue to be exposed.
While fluoride’s negative effects on cognitive development have been legally recognized, its negative effects on bone health remain widely underappreciated. Skeletal ailments including bone spurs1, joint and ligament calcification2, and even osteoporotic fractures3 have been associated with fluoride exposure, yet this is rarely addressed when attempting to support bone and joint health. Bone spurs, which can be painful and debilitating, are so common that they’re widely considered a normal part of aging, when it’s possible that decades of fluoride exposure are in fact causing them to form on a gradual yet epidemic level.
There are two primary ways that fluoride negatively affects bone. First, it has long been known that fluoride stimulates osteoblasts, cells responsible for increasing bone deposition and maintaining bone density. Fluoride works so well for this that it was actually researched for a while as an osteoporosis drug. It never caught on as a way to improve bone density, however, for while it does increase the thickness of cancellous bone, typically located at thick areas near the joints, it actually decreases the density of cortical bone, the main structural support of long, thin bones like the femur. It is the loss of this cortical bone specifically that has been associated with osteoporotic fractures, which explains why early trials found that fluoride worsens osteoporosis, even despite increasing overall bone mass.
It is fluoride’s ability to trigger bone growth in an unnatural, unregulated manner that likely explains its association with bone spurs and joint calcification, but it has a second negative effect that may be contributing to fracture risk. Basically, it makes bones more brittle: denser and harder, but also more likely to shatter on impact. To understand the mechanism here, it’s useful to consider the reason fluoride gets added to drinking water in the first place - its effects on teeth.
Exposure to very high levels of fluoride can cause an unsightly brown mottling of the teeth known as dental fluorosis. This occurs because calcium has a high affinity for fluoride. The calcium in normal, healthy tooth enamel is primarily calcium phosphate, which lends teeth their pearly white appearance. When excess fluoride is present, the fluoride ions will displace phosphates due to their higher binding affinity, replacing the normal enamel with a patina of calcium fluoride. When enough enamel is replaced, the teeth appear brown, though the dose of fluoride applied through toothpaste and drinking water is rarely enough to do this.
But how can this be beneficial, especially when normal calcium phosphate lends remarkable properties to tooth enamel? Apart from cosmetic concerns, there is an important advantage to preserving calcium phosphate in normal tooth enamel. This material, being the principal component of healthy bones as well as teeth, is unique in combining the properties of extreme hardness with extreme flexibility. Teeth must be hard enough at the surface to chop and grind, yet flexible enough to withstand intense pressure, and calcium phosphate allows them to do this. Bones too must be rigid enough to provide structural support and serve as an anchor for muscles, and yet bend under pressure or impact to resist shattering. Healthy bones are indeed surprisingly flexible, and many fractures don’t occur because they are able to bend quite substantially before developing hairline cracks.
Calcium phosphate does have one glaring weakness when it comes to teeth: it’s very sensitive to acid erosion. Prolonged exposure to acid is the main cause of cavities and tooth decay, and this exposure does not come from acidic foods because they contact the teeth very long. It’s mostly acid produced by bacterial plaques fermenting in sugar that sticks to the teeth after eating sweet foods. Tooth decay was rarely noted before starches became significant in the human diet, and it became rampant after sugar was introduced. The ultimate reason we have put up with fluoride in the drinking water, and even considered it an essential nutrient, is that unlike calcium phosphate, calcium fluoride is extremely acid resistant. Topical application of fluoride from toothpaste or dental treatments can essentially coat the teeth in a layer of acid-resistant mineral, thus reducing the risk of cavities. Fluoride likely does work for this, but at what cost? One consequence of fluoride exposure is an increased risk of tooth chipping and breakage4. This is because calcium fluoride is rigid, brittle and poor and resisting compression forces. For the same reason fluoride makes bones denser but simultaneously increases fractures, it makes teeth more likely to chip and break under the pressures they can be exposed to when chewing.
Using fluoride to prevent cavities doesn’t in truth make teeth any healthier; rather it provides a tradeoff where they become less susceptible to one disease and more susceptible to another. Depending on one’s risk for cavities, this may be worth it, and one can make a case for fluoridated toothpaste on the grounds that its use is voluntary. If you want the benefits fine, but if you avoid sugar, you can simply opt not to use it. Most people will realistically struggle, however, to avoid drinking fluoridated water. It’s essentially a form of compulsory medication: fluoride is not an essential nutrient and the body can remain in perfect health without ever being exposed to it. So if it is conceded that it can prevent a disease like dental cavities, this makes fluoride by definition a drug.
Water fluoridation has indeed been challenged in the courts on this very principle, but the courts ruled it was not compulsory medication because people can “choose” not to drink their community’s drinking water. Technically this is true, but many people lack the means to avoid drinking and cooking with tap water. The main disadvantage to water fluoridation, especially when fluoridated toothpaste is widely available, is that it’s simply a bad way of exposing the teeth to fluoride. Fluoride treatments work best when the surface of teeth are exposed for a prolonged period, unlike what occurs when drinking a glass of water. When dentists apply fluoride treatments, they instruct patients not to swallow and thoroughly rinse their mouths afterward to prevent systemic exposure. When fluoride is swallowed, it enters the bloodstream and displaces both phosphate and iodine all over the body. Doing this chronically, i.e. by drinking and cooking with fluoridated water, contributes to the bone diseases aforementioned as well as thyroid disease5, likely because fluoride ions displace iodine. It also lowers IQ in developing children and has been accused of calcifying the pineal gland. Worst of all, whereas exposing the dental surfaces to fluoride has arguably some benefit, there is absolutely no benefit to exposing the rest of the body to fluoride which might counteract the known and obvious harms. So while fluoridated toothpaste arguably makes sense (and one can argue otherwise), fluoridated water absolutely does not. In fact, toothpaste labels even come with warnings not to swallow it, due to the fact that this would expose a child to toxic levels of fluoride.
To do justice to both sides of the debate, the argument put forth to defend water fluoridation is that while fluoridated toothpaste is available, many of the poorest people in communities may be unable to afford toothpaste or are not educated enough to brush their teeth regularly, hence adding it to the drinking water keeps these people covered. To opponents of water fluoridation, however, this seems like a lazy and frankly corrupt excuse to simply deny some people medical freedom, instead of providing others with better education and more fair economic opportunities. Communities use tax dollars to provide fluoridated water: could they not simply use those tax dollars to provide fluoridated toothpaste?
There have been accusations that fluoride is an industrial waste product, especially from aluminum refinement, and water fluoridation in fact began as a way for these industries to sell a toxic waste product to municipal governments that would otherwise require costly disposal measures to keep it out of the community’s drinking water. Whether or not this is true, many other countries in Europe and Asia have abandoned water fluoridation and it seems likely that the United States may soon follow.
In the meantime, fluoride exposure remains prevalent and may well be contributing to musculoskeletal diseases like calcified joints and bone spurs. One way to mitigate fluoride exposure, especially if it has already occurred, is to supplement with iodine and selenium. Iodine will displace fluoride ions in some tissues like the thyroid gland, though it may not do much to remove fluoride from bone. Selenium is an important chelator and antioxidant to the central nervous system, and may help remove fluoride from the brain. Another natural approach that has been recommended to remove is tamarind tea. Homeopathic cell salts, including calcium fluoride (Calc Fluor), can also be used to support a healthy mineral balance in tissues, including bones, ligaments, and joints.
- Savas S, Cetin M, Akdoğan M, Heybeli N. Endemic fluorosis in Turkish patients: relationship with knee osteoarthritis. Rheumatol Int. 2001 Sep;21(1):30-5. doi: 10.1007/s002960100132. PMID: 11678300. ↩︎
- Singh VK, Rathore KS, Khan G, Rahim A, Rashid A, Chauhan S. Clinical and Radiological Study of Serum Fluoride in Relation to Knee Osteoarthritis. Malays Orthop J. 2020 Nov;14(3):151-154. doi: 10.5704/MOJ.2011.023. PMID: 33403076; PMCID: PMC7751991. ↩︎
- Vestergaard P, Jorgensen NR, Schwarz P, et al. Effects of treatment with fluoride on bone mineral density and fracture risk: a meta-analysis. 2008. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK75462/ ↩︎
- DenBesten P, Li W. Chronic fluoride toxicity: dental fluorosis. Monogr Oral Sci. 2011;22:81-96. doi: 10.1159/000327028. Epub 2011 Jun 23. PMID: 21701193; PMCID: PMC3433161. ↩︎
- Iamandii I, De Pasquale L, Giannone ME, Veneri F, Generali L, Consolo U, Birnbaum LS, Castenmiller J, Halldorsson TI, Filippini T, Vinceti M. Does fluoride exposure affect thyroid function? A systematic review and dose-response meta-analysis. Environ Res. 2024 Feb 1;242:117759. doi: 10.1016/j.envres.2023.117759. Epub 2023 Nov 28. PMID: 38029816. ↩︎
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