Key Takeaways (expand)
- Fluoride is the negatively charged ion of the element fluorine.
- Fluoride is best-known for its role in dental health; in fact, the use of fluoride for preventing tooth decay is considered the most successful public health measure ever implemented for dentistry!
- Despite being extremely important for the integrity of the bones and teeth, fluoride is technically non-essential (meaning we don’t need it to survive).
- Fluoride helps stabilize tooth and bone tissue by binding to the hydroxyapatite crystals (made mostly of calcium and phosphate) that help form these tissues, in turn increasing the size of bone mineral crystals and making them more resistant to breakdown.
- High doses of fluoride also stimulate bone-building cells called osteoclasts, and increase the amount of mineral that gets deposited into bone.
- Topical fluoride (such as from toothpaste and mouthwash) has a well-established role in reducing dental decay in both children and adults: it inhibits mineral loss from tooth surfaces, protects against bacterial enzymes, reduces dentin sensitivity, protects enamel from acid damage, and reduces the rate of cavities.
- By helping protect teeth, fluoride plays a role in preventing various health conditions associated with dental decay—including localized infection, nutritional deficiencies due to difficulty chewing, systemic infections, inflammation, and chronic inflammatory diseases like type 2 diabetes and cardiovascular disease.
- During childhood, ingested fluoride (such as from drinking water) gets readily incorporated into developing teeth, helping increase the size of bone mineral crystals.
- For adults, the importance of ingested fluoride is more controversial: research shows that permanent (adult) teeth don’t take up much fluoride, at least at doses deemed safe to consume, and may not significantly benefit dental health.
- Unlike topical fluoride, ingested fluoride poses some health risks—including the development of dental fluorosis, an aesthetic condition where white spots form on the surface of teeth, and skeletal fluorosis, a more serious condition where fluoride accumulates in bones and joints.
- Although some research shows that ingested fluoride can increase bone density, the doses needed to achieve these effects come with significant side effects, and it doesn’t necessarily protect against actual fractures.
- The best food sources of fluoride are seafood (especially shrimp and crab), grapes, wine, tea, coffee, cocoa powder, and potatoes, though most of the fluoride people consume comes from fluoridated drinking water.
Fluoride is the ionic form of the element fluorine, and is most famous for its role in dental health! Research into its applications in dentistry began in 1901, when a dentist named Frederick McKay noticed that a large portion of Colorado Springs residents had severe, inexplicable brown stains on their teeth. There was no mention of this unusual condition in any dental literature of the time, so McKay took it upon himself to solve the mystery. After three decades of conducting studies, trekking to other parts of the country where the bizarre staining disorder was also being reported, interviewing residents and parents, and collaborating with other dental researchers, McKay finally found his answer: the brown staining came from high concentrations of fluoride in local drinking water—which, along with aesthetic tooth mottling, produced teeth that were abnormally decay-resistant.
Thus began many more decades of investigation into the role of fluoride and dental health. Today, the use of fluoride to prevent tooth decay is considered the most successful dental public health measure ever implemented!
Fluoride is important for the integrity of tooth and bone, but because it isn’t required for growth or sustaining life, it’s not technically considered essential in humans. However, some scientists argue for its essentiality under different definitions, because the consequences of insufficient fluoride exposure can lead to such painful dental health problems.
Most of the fluoride people consume comes from fluoridated drinking water (including tap water), or foods and beverages prepared with fluoridated water. But, there are also some naturally occurring sources of fluoride, such as seafood (especially crab and shrimp), grapes, wine, potatoes, brewed tea, brewed coffee, and cocoa powder.
The Biological Roles of Fluoride
Fluoride’s most important function is in stabilizing mineralized tissue—such as bones and developing teeth—through its interactions with calcium and phosphate. The majority of minerals found in teeth and bone are in the form of hydroxyapatite crystals, composed largely of calcium and phosphate. Since fluoride is highly reactive and small in size, it’s able to bind the hydroxyapatite and fill empty spaces in the crystal (especially when acidic conditions in the mouth cause hydroxyapatite to partially dissolve); this creates another compound called fluorapatite. The incorporation of fluoride increases the size of the bone mineral crystals, in turn reducing their solubility, making them more resistant to the action of osteoclasts (a type of specialized cell that breaks down bone tissue), and creating harder tooth enamel. In high enough doses, fluoride also stimulates the proliferation of osteoblasts (another specialized bone cell that builds bone tissue) and increases the amount of mineral deposited into bone.
It’s important to note that fluoride plays different roles in developing versus established bone tissue. In adults, about 50% of ingested fluoride is absorbed, while the other 50% is excreted; but, up to 80% can be retained in children due to increased fluoride uptake by developing teeth and bone! When dietary fluoride is incorporated into teeth that haven’t yet erupted through the gum, those teeth are significantly more decay-resistant once they do break through. In permanent teeth that have already erupted, additional systemic fluoride doesn’t have this same effect.
Fluoride also seems to accumulate in the pineal gland (the gland in our brain that secretes the sleep hormone melatonin) as we age, although the ramifications of this are unknown.
Interactions with Other Nutrients
Several other minerals influence the bioavailability and retention of fluoride. When they’re present in the same meal as fluoride, calcium and magnesium can both form insoluble complexes with fluoride and significantly decrease its absorption. Meanwhile, diets low in chloride (such as from table salt) have been shown to reduce urinary fluoride excretion, leading to more of it being retained in the body.
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Fluoride in Health and Disease
Fluoride only has one definite, well-established relationship to health and disease: the prevention of tooth decay. However, the research differs when it comes to topical versus ingested fluoride, and these differences are at the crux of many debates surrounding this mineral (especially the hot topic of water fluoridation)!
Fluoride and Dental Health
The relationship between topical fluoride and dental health is very clear. When it makes contact with the surfaces of the teeth (such as through fluoridated tooth paste or mouth wash), fluoride inhibits demineralization (mineral loss) at the crystal surfaces of the teeth, promotes remineralization (mineral uptake) in the enamel, protects against bacterial enzymes, reduces the sensitivity of dentin (the tooth layer beneath the surface enamel), makes enamel more resistant to acid from food or drinks, and ultimately bolsters against dental decay. In fact, epidemiological studies have shown up to a 43% reduction in tooth decay among children and teens who use fluoride toothpaste compared to those who don’t. Similarly, a wide variety of trials have found that various topical fluoride interventions (such as the use of fluoride varnish, fluoride lozenges, or other oral fluoride products) lead to significant reductions in decayed or missing tooth surfaces, as well as lower incidence of cavities in both children and adults.
Remineralized enamel that includes fluoride is particularly resistant to the cariogenic (cavity-causing) bacteria found in dental plaque. These bacteria can metabolize sugars on the teeth to organic acids, which can then dissolve tooth enamel. As this process progresses, the bacteria penetrate past the enamel and into the soft pulp tissue at the center of teeth, causing holes known as dental caries or cavities. If left untreated, these caries can cause severe pain, localized infection, tooth loss, nutritional deficiencies stemming from difficulties with chewing and eating, and even serious systemic infections (due to bacteria from the mouth entering circulation).
What’s more, this process can trigger body-wide inflammatory responses that contribute to the risk for chronic diseases like insulin resistance, type 2 diabetes, hypertension, and cardiovascular disease—all of which have been associated with gum infections and poor oral health. So, by helping protect against dental decay, fluoride may also indirectly help protect against other conditions we don’t usually associate with dental hygiene, but that are mediated by inflammation!
However, the action of ingested fluoride differs from that of topical fluoride, and this is where the science becomes less settled. Although developing tooth structures (forming during childhood) have high fluoride uptake and are able to incorporate ingested fluoride to increase bone crystal size, permanent (adult) teeth don’t use fluoride from the “inside out” in this same way—at least at doses that are non-toxic. In adults, the main benefit of ingested fluoride is that higher levels in the body lead to greater fluoride secretion in the saliva, which then bathes teeth and contributes to topical protection.
Overall, research does point to clear associations between the addition of fluoride to public water supplies and improved dental health: in studies, water fluoridation has been widely associated with reductions in dental caries, and clinical trials in the 1970s and 1980s demonstrated that adding fluoride to community water systems could reduce the incidence of dental caries by 15 to 35% in permanent teeth and 30 to 60% in baby teeth. Scientists generally agree that the benefits of water fluoridation are a result of both ingesting it (primarily for young children) and from the physical contact it makes with teeth during drinking.
Fluoride and Bone Health
As for fluoride and skeletal health? While studies have demonstrated definite mechanisms by which fluoride affects bone density (namely, stimulating the proliferation of bone-building cells and increasing mineral deposition into bone), the amount of fluoride needed to accomplish this also comes with unfavorable side effects. For example, at doses shown to increase markers of bone building, ingested fluoride can cause leg pain, calcium deficiency, and stomach irritation—sometimes to the point of producing ulcers. And while a small number of studies found associations between higher fluoride levels in drinking water and lower risk of hip fracture among the local elderly, larger studies (including a meta-analysis of 13 prospective cohort studies and one case-control study) found no effect of fluoride exposure on risk of hip fracture.
Likewise, higher fluoride concentrations in the blood don’t appear protective for bone mineral density or fracture incidence. Some studies have even found links between higher fluoride exposure and more fragile bones! A cohort study looking at two separate indicators of fluoride exposure (urinary concentrations and estimated intake from diet and water) found that women in the highest versus lowest third of fluoride exposure had a 59% greater risk of hip fracture, despite also having greater bone mineral density. This study suggested that both bone mineral density and skeletal fragility increase when fluoride concentrations in the drinking water exceed 1 mg/L. Several other observational studies have found similar links between fluoride intake, higher bone mineral density, and either greater fracture risk or no fracture-protective effect at all.
What’s more, clinical trials testing the effect of fluoride on fracture risk and osteoporosis suggest the same phenomenon: fluoride at therapeutic doses (much higher than normal intake from food and water) can increase bone mineral density, but fails to protect against actual fractures or even increases their likelihood. One meta-analysis of 11 studies found that fluoride treatment generally increased bone mineral density at the lumbar spine, but had no impact on fracture risk after two years of treatment, and significantly increased fracture risk (by 85%) by the four-year mark. Similarly, the risk of gastrointestinal side effects was significantly elevated after four years of fluoride therapy. The detrimental effects of fluoride on bone health appear worse when inadequate vitamin D and calcium are consumed.
Although denser but more brittle bones might seem like a paradox (given that greater bone density is usually associated with fracture protection), this probably occurs because the bone formation stimulated by fluoride is of relatively low quality. In mechanistic studies, fluoride has been shown to negatively impact the mechanical properties of bone (including bone architecture and geometry) independently of its effects on bone turnover; other research shows that fluoride prompts bone cells to lay down immature tissue, which has a weaker collagen pattern than mature tissue—making the resulting bone less fracture-resistant.
Additional research has investigated whether fluoride intake during childhood and adolescence—when bones are still developing—could influence bone health later in life, but have generally found little association here.
Didn’t know fluoride was this interesting? Maybe your friends will enjoy this too!
Health Effects of Fluoride Deficiency
The only well-established consequence of low fluoride intake in humans is an increased risk of tooth decay. No diseases of fluoride deficiency have been identified (hence why this nutrient is generally not regarded as essential!).
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Problems From Too Much Fluoride
While topical fluoride is considered safe even at very high exposures, excess ingested fluoride poses some important health risks. One of those is the potential for dental fluorosis—a condition where white spots form on the surface of developing teeth. This typically occurs in children under the age of eight, and fortunately isn’t known to cause any harm or symptoms other than aesthetic changes (ranging from hard-to-see white flecking on teeth in mild cases, to extreme staining and pitting in severe cases).
However, a high intake of fluoride (especially over time) can also cause a more serious condition called skeletal fluorosis, which is similar to dental fluorosis but involves the bones rather than the teeth. Unlike dental fluorosis, skeletal fluorosis can be overtly damaging, causing joint pain, stiffness, and longer-term changes in bone structure. The most severe cases are referred to as “crippling skeletal fluorosis,” and is characterized by ligament calcification, muscle wasting, immobility, and neurological issues resulting from compression of the spinal cord. In some isolated cases, skeletal fluorosis has been caused by extremely high, long-term intake of tea.
The EPA currently approves fluoride levels in water of up to 4 mg/L, while the Department of Health and Human Services recommends an upper limit of 0.7 mg/L. A 2015 Cochrane Review found that at fluoride levels of 0.7 mg/L, about 40 percent of the population develops some degree of dental fluorosis. Much higher levels of fluoride (3 to 6 mg/L) can cause adverse changes in bone structure, and levels above 10 mg/L can cause crippling skeletal fluorosis. Interestingly, because people tend to drink more water (and therefore ingest more fluoride) when the weather is hot, dental fluorosis is more prevalent in warmer regions, even when the fluoride levels in the water are relatively low!
In addition, acute fluoride toxicity can occur when extremely high levels—such as through fluoride supplements—are consumed within a short period of time. Consuming 5 mg per kg of body weight of fluoride is the lowest known dose to trigger adverse symptoms (such as nausea, diarrhea, abdominal pain, vomiting, excessive salivation, sweating, and overall weakness), while 15 mg per kg of body weight can be potentially fatal. (Topical fluoride from professional dental treatments, or from fluoride-containing dental products like mouth rinses and toothpaste, don’t pose a toxicity risk.)
It’s also worth noting that the there’s a lack of high-quality research regarding the safety of fluoridated water. For example, whereas the fluoride salts used in dentistry (like sodium fluoride and stannous fluoride) have been widely tested for safety, the silicofluorides added to drinking water (byproducts of manufacturing phosphate fertilizers) haven’t been the subject of many toxicology studies. In epidemiological research, no links have shown up between water fluoridation and increased risk of cancer, heart disease, kidney disease, liver disease, thyroid disease, Alzheimer’s disease, birth defects, or Down’s syndrome. But, some studies have uncovered correlations between local water fluoride levels and lower IQ in children, as well as higher fluoride exposure during pregnancy and subsequent cognitive delays and attention deficit disorders in offspring—leading to fears that fluoride, which can penetrate the blood-brain barrier in fetuses, negatively impacts early brain development. However, these studies may have been confounded by neurotoxins also present in the drinking water, as well as design flaws related to measuring fluoride intake, and therefore may not be reliable.
How Much Fluoride Do We Need?
Dietary fluoride recommendations are based on the amount needed to prevent dental caries without causing additional, unwanted side effects like dental fluorosis. With these criteria in mind, the adequate intake level is set at 4 mg daily for adult men and 3 mg daily for adult women (including while pregnant and breastfeeding). For children and adolescents, the adequate intake is 0.01 mg daily for infants aged 0 to 6 months; 0.5 mg daily for infants aged 7 to 12 months; 0.7 mg daily for children aged 1 to 3 years; 1 mg daily for children aged 4 to 8; 2 mg daily for children aged 9 to 13; and 3 mg daily for adolescents aged 14 to 18.
Nutrient Daily Values
Nutrition requirements and recommended nutrient intake for infants, children, adolescents, adults, mature adults, and pregnant and lactating individuals.
Citations
Expand to see all scientific references for this article.
Adair SM. Evidence-based use of fluoride in contemporary pediatric dental practice. Pediatr Dent. 2006 Mar-Apr;28(2):133-42; discussion 192-8.
Bahekar AA, Singh S, Saha S, Molnar J, Arora R. The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: a meta-analysis. Am Heart J. 2007 Nov;154(5):830-7. doi: 10.1016/j.ahj.2007.06.037.
Bashash M, Marchand M, Hu H, Till C, Martinez-Mier EA, Sanchez BN, Basu N, Peterson KE, Green R, Schnaas L, Mercado-García A, Hernández-Avila M, Téllez-Rojo MM. Prenatal fluoride exposure and attention deficit hyperactivity disorder (ADHD) symptoms in children at 6-12 years of age in Mexico City. Environ Int. 2018 Dec;121(Pt 1):658-666. doi: 10.1016/j.envint.2018.09.017.
Batty GD, Jung KJ, Mok Y, Lee SJ, Back JH, Lee S, Jee SH. Oral health and later coronary heart disease: Cohort study of one million people. Eur J Prev Cardiol. 2018 Apr;25(6):598-605. doi: 10.1177/2047487318759112.
Berg J, Gerweck C, Hujoel PP, King R, Krol DM, Kumar J, Levy S, Pollick H, Whitford GM, Strock S, Aravamudhan K, Frantsve-Hawley J, Meyer DM; American Dental Association Council on Scientific Affairs Expert Panel on Fluoride Intake From Infant Formula and Fluorosis. Evidence-based clinical recommendations regarding fluoride intake from reconstituted infant formula and enamel fluorosis: a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc. 2011 Jan;142(1):79-87. doi: 10.14219/jada.archive.2011.0032.
Carey CM. Focus on fluorides: update on the use of fluoride for the prevention of dental caries. J Evid Based Dent Pract. 2014 Jun;14 Suppl:95-102. doi: 10.1016/j.jebdp.2014.02.004. Epub 2014 Feb 13.
Cerklewski FL. Fluoride—essential or just beneficial. Nutrition. 1998 May;14(5):475-6. doi: 10.1016/s0899-9007(98)00023-9.
Choi AL, Sun G, Zhang Y, Grandjean P. Developmental fluoride neurotoxicity: a systematic review and meta-analysis. Environ Health Perspect. 2012 Oct;120(10):1362-8. doi: 10.1289/ehp.1104912.
Demmer RT, Squillaro A, Papapanou PN, Rosenbaum M, Friedewald WT, Jacobs DR Jr, Desvarieux M. Periodontal infection, systemic inflammation, and insulin resistance: results from the continuous National Health and Nutrition Examination Survey (NHANES) 1999-2004. Diabetes Care. 2012 Nov;35(11):2235-42. doi: 10.2337/dc12-0072.
Desvarieux M, Demmer RT, Jacobs DR Jr, Rundek T, Boden-Albala B, Sacco RL, Papapanou PN. Periodontal bacteria and hypertension: the oral infections and vascular disease epidemiology study (INVEST). J Hypertens. 2010 Jul;28(7):1413-21. doi: 10.1097/HJH.0b013e328338cd36.
Duan Q, Jiao J, Chen X, Wang X. Association between water fluoride and the level of children’s intelligence: a dose-response meta-analysis. Public Health. 2018 Jan;154:87-97. doi: 10.1016/j.puhe.2017.08.013.
Fabiani L, Leoni V, Vitali M. Bone-fracture incidence rate in two Italian regions with different fluoride concentration levels in drinking water. J Trace Elem Med Biol. 1999 Dec;13(4):232-7. doi: 10.1016/S0946-672X(99)80041-8.
Farías P, Estevez-García JA, Onofre-Pardo EN, Pérez-Humara ML, Rojas-Lima E, Álamo-Hernández U, Rocha-Amador DO. Fluoride Exposure through Different Drinking Water Sources in a Contaminated Basin in Guanajuato, Mexico: A Deterministic Human Health Risk Assessment. Int J Environ Res Public Health. 2021 Oct 31;18(21):11490. doi: 10.3390/ijerph182111490.
Green R, Lanphear B, Hornung R, Flora D, Martinez-Mier EA, Neufeld R, Ayotte P, Muckle G, Till C. Association Between Maternal Fluoride Exposure During Pregnancy and IQ Scores in Offspring in Canada. JAMA Pediatr. 2019 Oct 1;173(10):940-948. doi: 10.1001/jamapediatrics.2019.1729.
Haguenauer D, Welch V, Shea B, Tugwell P, Adachi JD, Wells G. Fluoride for the treatment of postmenopausal osteoporotic fractures: a meta-analysis. Osteoporos Int. 2000;11(9):727-38. doi: 10.1007/s001980070051.
Haguenauer D, Welch V, Shea B, Tugwell P, Wells G. Fluoride for treating postmenopausal osteoporosis. Cochrane Database Syst Rev. 2000;2000(4):CD002825. doi: 10.1002/14651858.CD002825.
Hallanger Johnson JE, Kearns AE, Doran PM, Khoo TK, Wermers RA. Fluoride-related bone disease associated with habitual tea consumption. Mayo Clin Proc. 2007 Jun;82(6):719-24.
Hannan C, Espinoza L. Statement on the Evidence Supporting the Safety and Effectiveness of Community Water Fluoridation. Centers for Disease Control and Prevention (CDC). Department of Health and Human Services. 2021 Mar 2.
Helte E, Donat Vargas C, Kippler M, Wolk A, Michaëlsson K, Åkesson A. Fluoride in Drinking Water, Diet, and Urine in Relation to Bone Mineral Density and Fracture Incidence in Postmenopausal Women. Environ Health Perspect. 2021 Apr;129(4):47005. doi: 10.1289/EHP7404.
Iheozor-Ejiofor Z, Worthington HV, Walsh T, O’Malley L, Clarkson JE, Macey R, Alam R, Tugwell P, Welch V, Glenny AM. Water fluoridation for the prevention of dental caries. Cochrane Database Syst Rev. 2015 Jun 18;2015(6):CD010856. doi: 10.1002/14651858.CD010856.pub2.
Kriauciunas A, Gleiznys A, Gleiznys D, Janužis G. The Influence of Porphyromonas Gingivalis Bacterium Causing Periodontal Disease on the Pathogenesis of Rheumatoid Arthritis: Systematic Review of Literature. Cureus. 2019 May 28;11(5):e4775. doi: 10.7759/cureus.4775.
Lee N, Kang S, Lee W, Hwang SS. The Association between Community Water Fluoridation and Bone Diseases: A Natural Experiment in Cheongju, Korea. Int J Environ Res Public Health. 2020 Dec 9;17(24):9170. doi: 10.3390/ijerph17249170.
Lehmann R, Wapniarz M, Hofmann B, Pieper B, Haubitz I, Allolio B. Drinking water fluoridation: bone mineral density and hip fracture incidence. Bone. 1998 Mar;22(3):273-8. doi: 10.1016/s8756-3282(97)00273-1.
Levy SM, Eichenberger-Gilmore J, Warren JJ, Letuchy E, Broffitt B, Marshall TA, Burns T, Willing M, Janz K, Torner JC. Associations of fluoride intake with children’s bone measures at age 11. Community Dent Oral Epidemiol. 2009 Oct;37(5):416-26. doi: 10.1111/j.1600-0528.2009.00478.x.
Levy SM, Warren JJ, Phipps K, Letuchy E, Broffitt B, Eichenberger-Gilmore J, Burns TL, Kavand G, Janz KF, Torner JC, Pauley CA. Effects of life-long fluoride intake on bone measures of adolescents: a prospective cohort study. J Dent Res. 2014 Apr;93(4):353-9. doi: 10.1177/0022034514520708.
Luke J. Fluoride deposition in the aged human pineal gland. Caries Res. 2001 Mar-Apr;35(2):125-8. doi: 10.1159/000047443.
Maguire A. ADA clinical recommendations on topical fluoride for caries prevention. Evid Based Dent. 2014 Jun;15(2):38-9. doi: 10.1038/sj.ebd.6401019.
Marinho VC, Worthington HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2013 Jul 11;(7):CD002279. doi: 10.1002/14651858.CD002279.pub2.
Näsman P, Ekstrand J, Granath F, Ekbom A, Fored CM. Estimated drinking water fluoride exposure and risk of hip fracture: a cohort study. J Dent Res. 2013 Nov;92(11):1029-34. doi: 10.1177/0022034513506443.
Newbrun E. Effectiveness of water fluoridation. J Public Health Dent. 1989;49(5 Spec No):279-89. doi: 10.1111/j.1752-7325.1989.tb02086.x.
Nicole W. Denser but Not Stronger? Fluoride-Induced Bone Growth and Increased Risk of Hip Fractures. Environ Health Perspect. 2021 Jul;129(7):74001. doi: 10.1289/EHP9533.
Oweis RR, Levy SM, Eichenberger-Gilmore JM, Warren JJ, Burns TL, Janz KF, Torner JC, Saha PK, Letuchy E. Fluoride intake and cortical and trabecular bone characteristics in adolescents at age 17: A prospective cohort study. Community Dent Oral Epidemiol. 2018 Dec;46(6):527-534. doi: 10.1111/cdoe.12373.
Ozsvath DL. Fluoride and environmental health: a review. Rev. Environ. Sci. Biotechnol. 2008 Jul 31;8:59-79. doi: 10.1007/s11157-008-9136-9.
Palmer CA, Gilbert JA. Position of the Academy of Nutrition and Dietetics: the impact of fluoride on health. J Acad Nutr Diet. 2012 Sep;112(9):1443-1453. doi: 10.1016/j.jand.2012.07.012.
Pendrys DG. Risk of enamel fluorosis in nonfluoridated and optimally fluoridated populations: considerations for the dental professional. J Am Dent Assoc. 2000 Jun;131(6):746-55. doi: 10.14219/jada.archive.2000.0273.
Quock RL, Chan JT. Fluoride content of bottled water and its implications for the general dentist. Gen Dent. 2009 Jan-Feb;57(1):29-33.
Rezaee T, Bouxsein ML, Karim L. Increasing fluoride content deteriorates rat bone mechanical properties. Bone. 2020 Jul;136:115369. doi: 10.1016/j.bone.2020.115369.
Riggs BL, Hodgson SF, O’Fallon WM, Chao EY, Wahner HW, Muhs JM, Cedel SL, Melton LJ 3rd. Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis. N Engl J Med. 1990 Mar 22;322(12):802-9. doi: 10.1056/NEJM199003223221203.
Saha PK, Oweis RR, Zhang X, Letuchy E, Eichenberger-Gilmore JM, Burns TL, Warren JJ, Janz KF, Torner JC, Snetselaar LG, Levy SM. Effects of fluoride intake on cortical and trabecular bone microstructure at early adulthood using multi-row detector computed tomography (MDCT). Bone. 2021 May;146:115882. doi: 10.1016/j.bone.2021.115882.
Schluter PJ, Hobbs M, Atkins H, Mattingley B, Lee M. Association Between Community Water Fluoridation and Severe Dental Caries Experience in 4-Year-Old New Zealand Children. JAMA Pediatr. 2020 Oct 1;174(10):969-976. doi: 10.1001/jamapediatrics.2020.2201.
Siew C, Strock S, Ristic H, Kang P, Chou HN, Chen JW, Frantsve-Hawley J, Meyer DM. Assessing a potential risk factor for enamel fluorosis: a preliminary evaluation of fluoride content in infant formulas. J Am Dent Assoc. 2009 Oct;140(10):1228-36. doi: 10.14219/jada.archive.2009.0045.
Sowers M, Whitford GM, Clark MK, Jannausch ML. Elevated serum fluoride concentrations in women are not related to fractures and bone mineral density. J Nutr. 2005 Sep;135(9):2247-52. doi: 10.1093/jn/135.9.2247.
U.S. Department of Health and Human Services Federal Panel on Community Water Fluoridation. U.S. Public Health Service Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries. Public Health Rep. 2015 Jul-Aug;130(4):318-31. doi: 10.1177/003335491513000408.
Valdez Jiménez L, López Guzmán OD, Cervantes Flores M, Costilla-Salazar R, Calderón Hernández J, Alcaraz Contreras Y, Rocha-Amador DO. In utero exposure to fluoride and cognitive development delay in infants. Neurotoxicology. 2017 Mar;59:65-70. doi: 10.1016/j.neuro.2016.12.011.
Walsh T, Worthington HV, Glenny AM, Marinho VC, Jeroncic A. Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database Syst Rev. 2019 Mar 4;3(3):CD007868. doi: 10.1002/14651858.CD007868.pub3.
Wei W, Pang S, Sun D. The pathogenesis of endemic fluorosis: Research progress in the last 5 years. J Cell Mol Med. 2019 Apr;23(4):2333-2342. doi: 10.1111/jcmm.14185.
Whelton HP, Spencer AJ, Do LG, Rugg-Gunn AJ. Fluoride Revolution and Dental Caries: Evolution of Policies for Global Use. J Dent Res. 2019 Jul;98(8):837-846. doi: 10.1177/0022034519843495.
Whitford GM. Acute toxicity of ingested fluoride. Monogr Oral Sci. 2011;22:66-80. doi: 10.1159/000325146.
Whyte MP, Totty WG, Lim VT, Whitford GM. Skeletal fluorosis from instant tea. J Bone Miner Res. 2008 May;23(5):759-69. doi: 10.1359/jbmr.080101.
Xu K, An N, Huang H, Duan L, Ma J, Ding J, He T, Zhu J, Li Z, Cheng X, Zhou G, Ba Y. Fluoride exposure and intelligence in school-age children: evidence from different windows of exposure susceptibility. BMC Public Health. 2020 Nov 4;20(1):1657. doi: 10.1186/s12889-020-09765-4.
Yin XH, Huang GL, Lin DR, Wan CC, Wang YD, Song JK, Xu P. Exposure to fluoride in drinking water and hip fracture risk: a meta-analysis of observational studies. PLoS One. 2015 May 28;10(5):e0126488. doi: 10.1371/journal.pone.0126488.
Yu X, Chen J, Li Y, Liu H, Hou C, Zeng Q, Cui Y, Zhao L, Li P, Zhou Z, Pang S, Tang S, Tian K, Zhao Q, Dong L, Xu C, Zhang X, Zhang S, Liu L, Wang A. Threshold effects of moderately excessive fluoride exposure on children’s health: A potential association between dental fluorosis and loss of excellent intelligence. Environ Int. 2018 Sep;118:116-124. doi: 10.1016/j.envint.2018.05.042. Zoellner H. Dental infection and vascular disease. Semin Thromb Hemost. 2011 Apr;37(3):181-92. doi: 10.1055/s-0031-1273082.
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