An Insight on the Alternatives to Water Fluoridation

Tooth decay is one of the most prevalent dental health concerns that is spreading in the developed countries. Survey studies have revealed that dental caries affects around 60-90% of the children and the majority of the adults.

After several clinical studies and research, scientists found that the clinical effects of fluoride included remineralization of the teeth and a decrease in the risk of caries. Fluoride is an essential mineral that occurs naturally in the water.


Water fluoridation is a large-scale foundation that involves the addition of controlled amounts of fluoride to the community or public water supply. The concept of water fluoridation was adopted to reduce the incidence of caries and cavity formation among children and young adults.

However, the practice of water fluoridation is controversial as a public health measure. As an alternative to water fluoridation, manufacturers started developing products such as fluoridated salt, milk, and dental toothpaste. Today’s article will highlight the controversy related to water fluoridation. Moreover, we will also discuss alternatives to water fluoridation.

What is water fluoridation?

Water fluoridation is a process of adding controlled amounts of fluoride to the public and school water supply. It was initiated as a large-scale measure to prevent and reduce the incidence of caries or cavity formation worldwide. (1) Tooth decay is one of the most prevalent and widespread dental diseases that mainly affects infants and young children. It is a process of demineralization initiated by bacterial acid attack and plaque formation in the mouth.

Fluoride by nature comes with enamel remineralizing properties which help to prevent tooth decay in the following ways –

  • Strengthen tooth structure
  • Makes the tooth enamel acid resistant (2)
  • Removes plaque and inhibits the growth of harmful bacteria
  • Reverses early carious lesions

Typically, water fluoridation uses anyone among the three types of fluoride components, such as sodium fluoride, fluorosilicic acid, and sodium fluorosilicate. All of the three compounds are chosen for their solubility, safety, low cost, and easy availability.

The Centers for Disease Control and Prevention have specified the optimal level of fluoride to range from 0.7 – 1.2 mg/L (equivalent to parts per million).

What is the controversy related to water fluoridation?

Water fluoridation in public water supply was first practiced in the U.S. in 1945. Currently, 435 million people worldwide receive fluoridated water under the recommended level. (3)

The water fluoridation controversy started as an amalgamation of political, ethical, moral, economic, and health considerations towards the fluoridation of public water supplies. The conspiracies against water fluoridation exist since its initiation in the 1940s. While some theories support the process of water fluoridation, many other theories oppose its use.

Some of the conspiracy theories related to water fluoridation are as follows –

  • Water fluoridation is a communist plot to undermine public health in America. They believe it was a global measure that was adopted to deplete the brainpower of American children.
  • Proponents equate the benefits of fluoride to vaccinations and food fortifications for better dental health. They support the safety and efficacy of fluoridated water in eradicating caries among the people at high risk of tooth decay. (4)
  • A minority of scientists have challenged the medical consensus claiming that water fluoridation may cause serious health problems. Moreover, they argued that water fluoridation violates modern pharmacological principles. (5)
  • Systematic reviews have revealed the lack of high-quality research, which can weigh the benefits and risks of water fluoridation.

Even today, water fluoridation is a controversial aspect that requires solid research to prove its worth.

What are the alternatives to water fluoridation?

The mixed views on the efficacy of water fluoridation led to the discovery of alternative ways of achieving fluoride exposure in the community worldwide. Some of the alternative fluoride therapies that are equally effective in preventing tooth decay and cavity are listed below –

Milk fluoridation

Milk fluoridation was first initiated in some parts of Bulgaria, Chile, Russia, Peru, and Macedonia. It is a process in which calculated amounts of fluoride are added to the natural milk, powdered milk, or yogurt. Typically, milk fluoridation is used in rural areas where water fluoridation is not feasible. (6)

The main aim of milk fluoridation is to fulfill the daily dietary levels of fluoride among children to strengthen their bones and teeth. Moreover, it helps to reduce the risk of tooth decay and cavity.

Salt fluoridation

Like the water and milk fluoridation process, salt fluoridation is performed by adding fluoride compounds to salt. The concentration of fluoride in salt typically ranges from 90 – 350 mg/kg. Fluoridated salt is used worldwide by consumers at home, school meals, large kitchens, and also in the process of baking bread. (7)

It was initiated by a salt producer in the year 1987 in Jamaica to achieve a decline in cavities among the rural people. Later, salt fluoridation was adopted in Colombia and Germany giving consumers a choice to select between fluoridated and non – fluoridated salt.

Dietary fluoride supplements

Fluoride tablets and drops are other methods of increasing the nutritional uptake of fluoride in areas where water fluoridation is not practiced. These tablets usually contain 2.2 mg of sodium fluoride, which yields 1 mg of fluoride ion in each tablet. The dietary tablets and drops are ideal for infants, young children, and adults. The dietary recommendation for fluoride supplements is as follows –

  • Half a tablet per day for infants from birth to two years of age.
  • One tablet per day for young children above two years of age and adults provided that the water fluoride level is less than 0.3 mg/L. (8)

Fluoride toothpaste

Fluoride toothpaste is one of the most widely used fluoride supplements. It is a topical means of fluoride supply, which acts directly with the tooth enamel. Moreover, the instant and direct action of fluoride on the teeth became the main reason for rapid decline (around 25 – 30%) in tooth decay in the industrialized countries. (9)

Take away message

Fluoride is a natural mineral that his well known for its cavity-fighting properties. It is widely used in the process of water fluoridation wherein a calculated amount of fluoride between the range of 0.7-1.2 mg/L is added. Water fluoridation aimed to reduce the incidence of tooth decay and cavity formation among children and adults. However, many political, ethical, economic, and health administrations showed their concern about the efficacy and safety of water fluoridation.


Keeping the concerns in mind, alternatives of water fluoridation were initiated to provide controlled fluoride access to the people of the community. Some of these alternatives include salt, milk fluoridation, fluoride tablets, and fluoride toothpaste.

With the establishment of fluoridated products, consumers have a choice to select between fluoridated and non-fluoridated products. Moreover, they can effectively keep track of their daily dietary intake of fluoride.


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