What’s your stance on fluoride?

“What’s your stance on fluoride, Dr. B?”

My answer: I recommend a fluoride-free routine for kids and adults.

Here’s the short version of why…

• Those white or brown spots come from too much fluoride. Fluoride’s story started in the early 1900s, when a dentist in Colorado Springs noticed a whole community of kids with brown-stained teeth. Today, about 40% of US teenagers have dental fluorosis, and more recent national data puts it closer to 65%. Those spots can only form while teeth are developing in early childhood, which is exactly when the brain is developing too.

• Some dentists call fluorosis “just cosmetic.” But that’s not their choice to make. When I talk to other dentists about this, I hear the same thing: “Fluorosis is better than a cavity. It’s just aesthetics.” So we’re making that choice for the patient? I can’t get behind that. Plus, fluorosis can actually be hard and expensive to fix, undermining the strength of tooth enamel in areas that are hard-to-access clinically, making for compromised fillings.

• Higher fluoride exposure is linked to lower IQ in children. In 2024, the National Toxicology Program, part of the National Institutes of Health, concluded with moderate confidence that fluoride above 1.5 mg/L is associated with lower IQ in children. Tap water is set at 0.7 mg/L, but kids also swallow toothpaste, drink tea and drink formula mixed with tap water. The spots on their teeth tell us the total adds up. I can fix a tooth. We can’t fix a developing brain.

• Most of the studies proving fluoride works were done before fluoride toothpaste was common. When the Cochrane Collaboration reviewed the water fluoridation research in 2015, 71% of the studies predated 1975. They found “very little contemporary evidence” that it still prevents cavities today.

• Fluoride only needs to come into contact with the tooth, not be swallowed. Its benefit comes from contact with the tooth’s surface, so there’s no reason to swallow it. Whatever you swallow reaches your gut microbiome, and a 2025 systematic review of fluoride and gut bacteria found only four human studies.

• Why take all this risk when a safer alternative already exists? In head-to-head studies, nano-HAP has matched fluoride toothpaste, and even prescription-strength fluoride. Japan has used it in toothpaste since the 1980s. It can’t cause fluorosis, and there’s no Poison Control warning on the tube like the one printed on every fluoride toothpaste sold in the US. Why wouldn’t we use an alternative that doesn’t carry the risks of fluoride?

My 8 must-haves for a fluoride-free routine, for kids and adults

1)  Nano-hydroxyapatite toothpaste with no essential oils, emulsifiers, or surfactants. These counteract the oral microbiome, and there is no remineralization without the oral microbiome.  the alternative from above: it can’t cause fluorosis, and you don’t have to call Poison Control if it gets swallowed, which matters for kids who haven’t learned to spit. Skip formulas with essential oils. They kill the beneficial bacteria along with the bad, which is the same microbial imbalance that causes cavities in the first place. (Link)

2)  Spit, don’t rinse. You wouldn’t put on sunscreen and jump straight into the shower, so let your nano-Hydroxyapatite toothpaste sit on your teeth.

3)  Xylitol after meals. Fluoride hardens enamel against acid; xylitol goes after what’s producing it. Xylitol tricks cavity-causing bacteria S. Mutans into starving themselves; so every time you use xylitol, whether in gum, toothpaste, or a mint, you help to suppress the acid producers without harming the beneficial bacteria. (Link)

4)  Filter fluoride out of your water, then put the minerals back. Tap water is the biggest source of the fluoride that adds up. An under-sink reverse-osmosis filter removes it, but it also strips out the calcium and magnesium your saliva needs to rebuild enamel, so I add electrolytes to my water every morning. (Link)

5)  Green tea, but only third-party tested. I drink green tea because I love it, and because its EGCG interferes with the sticky biofilm S. mutans uses to anchor to enamel. But tea plants pull fluoride and heavy metals out of the soil, and matcha is the highest in fluoride because you’re drinking the whole leaf. That’s why the only tea I drink is third-party tested for heavy metals. (Link)

6)  Mouth tape at night, for kids and adults. Mouth breathing during sleep dries out your saliva, which is what neutralizes acid and carries the minerals that rebuild enamel. Taping keeps your mouth closed so you breathe through your nose all night. (Link)

7)  Silk floss every night. The acid producers that cause cavities collect between your teeth, where a brush can’t reach, and floss clears them out with no chemicals at all. It beats a water flosser, and silk avoids the PFAS coatings found on some conventional floss. (Link)

8)  Throw out the antiseptic mouthwash. Cavities start with an imbalance in your mouth’s microbes, and antiseptic mouthwash makes it worse by killing the beneficial bacteria your teeth need to remineralize. If it says antibacterial, throw it out. I use a stainless steel tongue scraper and an oil pulling blend instead. (Link)

What’s your family doing about fluoride? 

Best,
Dr. B