As a board-certified orthodontist serving the Lynchburg community, my mission is to provide evidence-based care that promotes lifelong oral health. Given recent debates surrounding fluoride, I want to address its role in dental health and clarify the science behind its use.
What Exactly Is Fluoride?
Fluoride is a naturally occurring mineral that strengthens tooth enamel and helps prevent cavities. The main structural component of tooth enamel is called hydroxyapatite. In the presence of optimal levels of fluoride, the fluoride ion replaces the hydroxyl groups in the hydroxyapatite structure forming Fluorapatite, which is less soluble than hydroxyapatite, making it more resistant to demineralization (the initiation of the tooth decay process). So basically, fluoride aids in strengthening enamel, remineralizing enamel, and inhibiting the growth of harmful oral bacteria. This is why fluoride is commonly added to toothpaste and, in many communities, to public water supplies.
The Centers for Disease Control and Prevention (CDC) recognizes community water fluoridation as one of the ten great public health achievements of the 20th century. Studies have shown that water fluoridation reduces tooth decay by about 25% in children and adults.
Why Fluoride Matters for Orthodontic Patients
For patients undergoing orthodontic treatment, fluoride is especially important. Braces, aligners, and other appliances can create more surfaces for plaque and food particles to accumulate, increasing the risk of demineralization and cavities, especially around brackets and wires. Fluoride strengthens enamel, helping to prevent enamel demineralization (“white spot lesions”) and maintain tooth health throughout treatment.
At Bates Family Orthodontics, we often recommend fluoride-enhanced products and may even suggest in-office fluoride treatments with your general dentist as part of your care plan. Our goal is not just to align your teeth, but to ensure your smile stays strong and healthy during — and long after — orthodontic treatment.
How to Incorporate Fluoride As Part of Your Dental Care
I work closely with your family dentist to ensure you’re getting the right level of fluoride exposure based on your unique needs. If you’re in braces or aligners, your dentist may recommend additional preventive steps like topical fluoride treatments or prescription-strength toothpaste to help reduce your risk of demineralization.
Here are a few ways we encourage coordinated care:
1. Regular dental cleanings and checkups: Your general dentist can help monitor for early signs of enamel demineralization or cavities and recommend fluoride applications if needed.
2. Use of fluoride toothpaste and rinses: Daily use of fluoride products is often sufficient, but your dentist may suggest stronger options if you’re at higher risk.
3. Professional fluoride treatments: Depending on your treatment plan and risk factors, your dentist may apply fluoride during routine cleanings to strengthen enamel, especially around brackets or appliances.
Together, our shared goal is to protect the long-term health of your smile—during orthodontic treatment and beyond.
Addressing the Controversy
In recent months, Health and Human Services Secretary Robert F. Kennedy Jr. has amplified the national debate on fluoride by labeling it an “industrial waste” and attributing it to various health issues, including arthritis, bone cancer, and reduced IQ.
Despite decades of research supporting fluoride’s safety and efficacy, these public comments have reignited an old debate — should government bodies add fluoride to public water sources? In 2025, both Utah and Florida responded by enacting bans on adding fluoride to public water systems, citing concerns over potential health risks. Similar bans may follow pending findings from an evaluation performed by the EPA.
These actions were influenced by studies, including one by The National Toxicology Program, suggesting a tenuous link between HIGH levels of fluoride exposure and reduced IQ in children. But as an oral care professional, I believe it’s important to point out that this study’s findings have been taken out of context. This same study, a systematic review and meta-analysis published Journal of the American Medical Association Pediatrics in early 2025 found that “that higher levels of fluoride exposure, such as drinking water containing more than 1.5 milligrams of fluoride per liter, are associated with lower IQ in children” but also affirmed that “there were insufficient data to determine if the low fluoride level of 0.7 mg/L currently recommended for U.S. community water supplies has a negative effect on children’s IQ” and that “the NTP found no evidence that fluoride exposure had adverse effects on adult cognition”.
The optimal fluoride level recommended by the U.S. Public Health Service is 0.7 ppm (0.7 mg/L) — a standard that has been thoroughly researched and is continually monitored for safety and effectiveness. The risk for dental fluorosis (discoloration or pitting of tooth enamel due to an excess intake of fluoride) or any appreciable impact on neurological development occurs when fluoride levels exceed 1.5 ppm (1.5 mg/L) and the risk for skeletal fluorosis (a condition characterized by changes to bone structure and increased bone density) occurs when fluoride intake levels exceed 5-10 ppm (5-10 mg/L) for extended periods of time. Here in Lynchburg, municipal water is tested regularly to ensure it meets this guideline. I feel confident saying that the appropriate levels of fluoride in our public water systems are perfectly safe and vital for maintaining oral health.
Final Thoughts
It is always important to understand the full context of any studies being referenced as the basis of recommendations/claims/debate. It is clear that a large portion of the public controversy regarding fluoride stems from comments that are out of context. Fluoride has played a pivotal role in reducing dental decay and improving oral health outcomes across populations. While it’s crucial to remain vigilant and consider emerging research, current evidence supports the optimal fluoride level recommended by the U.S. Public Health Service (0.7 ppm) in public water is safe. For those on well water who are advised to take fluoride supplements, it is also important to ensure appropriate dosages.