Fluoride Facts

Fluoride is a mineral that occurs naturally in all water sources, even the oceans.

Fluoride is effective in preventing and reversing the early signs of tooth decay. Fluoride makes the tooth surface (enamel) stronger, so teeth are more resistant to acid attacks. Acid is formed when the bacteria in plaque break down foods high in sugar and starch such as candy, juice, chips, and milk. Repeated acid attacks break down the tooth, which causes tooth decay. Fluoride can repair early damage where acid attacks have already begun.

Fluoride is obtained in two forms: topical and systemic.

Topical Fluorides

Topical fluorides strengthen teeth; fluoride is absorbed into tooth enamel, making the teeth harder and more resistant to tooth decay. Topical fluorides include toothpaste, fluoride mouth rinse and professionally applied fluoride therapies such as fluoride varnish. Water with fluoride also has a topical effect. 

Fluoride varnish is a treatment that is particularly effective in preventing tooth decay in high-risk young children. It is highly effective, easy to apply and economical. It is particularly useful for treating very young children, children with special needs, and otherwise difficult patients.

Fluoride varnish should be put on the teeth every six months, starting as soon as the child has teeth. Fluoride varnish has been widely used as a preventive treatment in Europe, Scandinavia, and Canada for over 25 years. The UNC-CH School of Dentistry and the American Dental Association recommend fluoride varnish as a preventive treatment for tooth decay.

Applying fluoride varnish to teeth is a simple process for a trained professional. After teeth are cleaned and dried, a thin layer of the gold-colored fluoride varnish is painted on the teeth. It dries almost immediately. The varnish leaves a protective coating of fluoride which remains on the teeth until brushed or wiped away by the parent, usually after the recommended 24 hours. The procedure is not painful and takes only a few minutes.

The N.C. Oral Health Section is proud to be a partner in the Into the Mouths of Babes oral evaluation and fluoride varnish program. Into the Mouths of Babes trains and assists medical professionals who provide oral preventive care, including fluoride varnish applications, to the youngest Medicaid-covered children.

Systemic Fluoride

Systemic fluorides are those that are swallowed. Systemic fluorides include water fluoridation and dietary fluoride supplements in the form of tablets, drops or lozenges.

Community Water Fluoridation

Position statement on community water fluoridation from the Office of the State Health Director:

In April 2014, North Carolina Acting State Health Director, Robin Gary Cummings, M.D., issued a Community Fluoridation Position Statement that summarizes the benefits and effectiveness of community water fluoridation, and the support of the N.C. Division of Public Health.

What is water fluoridation?

Fluoride is a common mineral and occurs naturally in all water and many foods. Water fluoridation is the process of adjusting the amount of fluoride in the water to the 0.7 parts per million (ppm) concentration recommended for best protection against tooth decay.

Fluoride’s benefits were discovered early in the twentieth century. In 1949 Charlotte became the first city in North Carolina to adjust the amount of fluoride in its drinking water to 1 ppm. By 2008, over 88 percent of North Carolinians who drink water from local water systems were receiving the benefits of fluoride. The story of fluoridation is provided in more detail on the National Institute of Dental and Craniofacial Research website.

How does water fluoridation work?

Fluoride protects teeth from decay by strengthening tooth enamel and making it more resistant to the acids that are produced by bacteria that occur naturally in our mouths. During childhood while teeth are forming, fluoride becomes a permanent part of the tooth enamel. After the teeth are formed, fluoride strengthens and repairs the enamel on the surfaces of teeth. Both children and adults of all ages benefit from fluoridation.

Is water fluoridation safe?

Fluoridation has been studied for over 60 years -- more thoroughly than any other public health measure. The overwhelming weight of credible scientific evidence indicates that fluoridation of community water supplies is safe. The last five U.S. Surgeons General and the Centers for Disease Control and Prevention (CDC) recommend fluoridation It is also supported by the American Dental Association, the American Medical Association, the American Cancer Society, the American Academy of Family Physicians, the American Public Health Association, the Consumers Union, and many other organizations in the fields of health, science, and public affairs.

See the full list of organizations that recognize the public health benefits of community water fluoridation (PDF, 28KB).

How effective is water fluoridation?

Sixty years of scientific studies show that fluoridation is effective in reducing tooth decay. In the years before community water fluoridation, virtually every child grew up with severe and widespread tooth decay. After the introduction of fluoridation in the 1940s, children in communities with optimally fluoridated water had reductions in decay rates of about 60%. By 1987 a survey of North Carolina children showed that over half of all children had no dental decay. This impressive reduction is due in large part to fluoridation.

Fluoride is now available from other sources including food and beverages prepared with fluoridated water, dental products such as toothpaste, and dietary supplements. As a result, many people who drink water with low amounts of fluoride now also receive some protection against cavities. Even in this era with widespread availability of fluoride from a number of sources, studies prove water fluoridation continues to be effective in reducing dental decay by 20-40%.

What are the costs of fluoridation?

Fluoridation is the most cost-effective method of preventing tooth decay. It is also a very equitable method of disease prevention -- all people benefit regardless of their incomes, educational levels, ages, or ability to get dental treatment. The average cost of fluoridation is only about 50 cents per person per year. The cost of a lifetime of fluoridation for one person is less than the cost of one filling. For every dollar spent on community water fluoridation, approximately $38 is saved in treatment costs for tooth decay.