Updated: January 8, 2025

Fluoride is a mineral renowned for strengthening teeth and helping to prevent cavities and related diseases. It is a form of the chemical element fluorine and is widely used in medicine. Fluoride protects teeth from bacteria in plaque and promotes new bone formation. This differs from most medicines for weak bones (osteoporosis), which primarily fight the condition by preventing bone breakdown.

Fluoride can be administered in various ways, either topically (toothpastes, mouth rinses, varnishes, gels) or systemically (fluoride supplements, fluoridated water, salt). The post eruptive (topical) preventive effect of fluoride is considered more important than the pre-eruptive (systemic) effect. Topical fluorides have proven to be highly effective, with fluoride-containing toothpaste now being almost universally used. When daily toothbrushing with fluoridated toothpaste is not carried out, or when the risk of cavities increases, additional fluoride sources can be recommended.

Fluoride is also added to public drinking water to prevent tooth decay. Children who do not have access to fluoridated public water, such as those whose homes use private well water, often take fluoride tablets to prevent tooth decay. Fluoride is added to toothpaste and mouthwashes to be applied directly to the teeth for this same purpose. Additionally, fluoride is taken orally to treat weakened bones (osteoporosis) and prevent bone loss in individuals with rheumatoid arthritis and Crohn's disease. Fluoride supplements are available in forms such as lozenges, tablets, and liquids.

Dietary Sources

Fluoride tends to get concentrated in tea, coffee, shellfish, grapes (raisins, wine, grape juice), artificial sweeteners, sodas, potatoes, flavored popsicles, baby foods, broths, stews, and hot cereals made with tap water. Of these, water, tea, coffee, shellfish, potatoes, and grapes can be considered healthy. All other sources should be avoided. Further, sugary or carbonated drinks can lead to more tooth decay, wiping out any good effects from fluoride. For all these fluoride foods and drinks, if fluoride-fortified water were used in their creation, they would have even more fluoride.

Most fresh foods and fresh water contain very little fluoride. Therefore, one will receive very little fluoride when drinking spring water and eating unprocessed fruit, vegetables, grains, eggs, milk, and meat. However, some exceptions exist to seafood, tea, water from deep wells, and fresh fruit/vegetables sprayed with fluoride pesticides. Here is a list of sources of fluoride:

Tea Drinks

Tea plants absorb fluoride from the soil. As a result, tea leaves, particularly old tea leaves, contain high levels of fluoride. Brewed black tea averages about 3 to 4 parts ppm fluoride, while commercial iced tea drinks contain between 1 and 4 ppm. As a result of these elevated levels, there is a link between excessive tea consumption and bone disease (skeletal fluorosis) caused by too much fluoride intake. Also, the amount of tea's fluoride will depend on the water used to prepare it. Even commercial teas sold in bottles and cans will contain some fluoride.

Processed Beverages & Foods

Even if you don't live in a community that adds fluoride to its water supply, you will still be exposed to fluoridated drinking water. This is because once fluoride is added in mass to water, it winds up in almost all processed beverages and foods. In the US, studies have shown that sodas, juices, sports drinks, beers, and many other processed foods, including infant foods, now have elevated fluoride levels.

Dental Products

Many dental products now contain fluoride, including over 95% of toothpaste. Studies show that many children swallow more fluoride from toothpaste alone than is recommended for daily ingestion.

Pesticides

Due to its toxicity, fluoride is used in some pesticides to kill insects and other pests. As a result of fluoride pesticide use, some food products, particularly grape products, dried fruit, dried beans, cocoa powder, and walnuts, can have high levels of fluoride.

Mechanically Deboned Meat

Foods made with mechanically separated meat (e.g., chicken fingers, nuggets, etc.) contain elevated fluoride levels due to contamination from bone particles that occur during the mechanical deboning process. Mechanically processed chicken meats have the highest levels, with chicken sticks containing an average of 3.6 ppm.

Teflon Pans

Cooking food or boiling water in Teflon pans may increase the fluoride content of food. One study found that boiling water in a Teflon pan for just 15 minutes added two ppm of fluoride to the water, thus bringing the final concentration to 3 ppm.

Fluorinated Pharmaceuticals

Many pharmaceuticals are fluorinated, meaning they contain a carbon-fluorine bond. Although the carbon-fluoride bond in most drugs is strong enough to resist breaking down into fluoride within the body, this is not always the case. Research has found that some fluorinated drugs, including ciprofloxacin, break down into fluoride and can thus be a significant source of fluoride exposure for some individuals.

Industrial Use and Workplace Safety

Fluoride exposure concerns heavy industries like aluminum production, fertilizers, and semiconductors. Airborne fluorides in industrial settings necessitate robust safety protocols for workers and downstream users of industrial fluoride.

Companies supplying industrial fluoride must support clients with compliance documentation, exposure mitigation technologies, and workplace training programs

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Safety

Most people do not experience harm from the amount of fluoride used in public drinking water and dental products such as toothpaste and mouthwash or by dentists. Daily doses of up to 20 mg of elemental fluoride ingested orally appear harmless for most individuals. More significant amounts are toxic and can lead to osteoporosis, bone and ligament degeneration, muscle atrophy, and disorders of the nervous system. Fluoride in high concentration in children before the permanent teeth erupt through the mouth can lead to tooth staining. Neither the toothpaste nor fluoride rinses should be ingested on a regular basis and especially not by children. Knowing that children under six should use fluoride-containing toothpaste and that they might put it in their mouths and swallow some of it is good to ensure that it is just a pea-sized amount.

According to the National Library of Medicine (NLM), the amount of fluoride you need depends on your body mass (weight).

The following doses have been studied in scientific research and are recommended:

Dosing

In the US, fluoride is added to city water to a concentration of 0.7 to 1.2 parts per million (ppm).

To prevent dental caries in areas where the fluoride level in drinking water is less than 0.3 ppm (such as in healthy water),

• children 6 months to 3 years should receive a fluoride supplement of 0.25 mg per day

• children 3 to 6 years, 0.5 mg per day

• For children 6 to 16 years, 1 mg is taken per day.

For children living in areas where the fluoride level is 0.3 to 0.6 ppm,

• children 3 to 6 years old should receive 0.25 mg per day

• For children 6 to 16 years, 0.5 mg is taken per day.

No supplement is needed in areas where the fluoride in drinking water exceeds 0.6 ppm.

The daily Adequate Intakes (AI) for elemental fluoride from all sources, including drinking water, are:

• infants birth through 6 months, 0.01 mg

• babies age 7 through 12 months, 0.5 mg

• children 1 through 3 years, 0.7 mg

• 4 through 8 years, 1 mg

• 9 through 13 years, 2 mg

• 14 through 18 years, 3 mg

• men 19 years and older, 4 mg

• women 14 years and older, including those pregnant or breastfeeding, 3 mg.

The daily upper intake levels (UL) for fluoride, the highest level at which no harmful effects are expected, are

• 0.7 mg for infants from birth through 6 months

• 0.9 mg for infants 7 through 12 months

• 1.3 mg for children 1 through 3 years

• 2.2 mg for children 4 through 8 years 

• 10 mg for children older than 8 years, adults, and pregnant and breastfeeding women.

Sodium fluoride contains 45% elemental fluoride. Monofluorophosphate contains 19% elemental fluoride.

B2B Perspective: Healthcare and Pharma

In the B2B space, fluoride's role extends beyond its direct application in consumer dental products to encompass strategic opportunities in the healthcare and pharmaceutical industries:

Healthcare Applications

For public health initiatives, fluoride's inclusion in water supplies and dental care products represents a scalable solution for reducing dental caries on a community-wide level. This has led to partnerships involving local authorities, water treatment solutions suppliers, and oral health representatives. Opportunities for B2B partnerships include delivering fluoride-based formulations to governmental agencies for water fluoridation and creating a new generation of biochemical topical fluorides with a more lasting acting time for usage in clinical dental practice.

Pharmaceutical Innovations

Fluoride has been seen to have potential in the treatment processes of osteoporosis and other related diseases in the human body by some developed pharmaceutical drugs and companies. These innovations combine fluoride with current therapies, such as hormone replacement treatment, to improve bone density and the management of fractures.

Final Thoughts

Fluoride plays a pivotal role in maintaining oral health and beyond. Its ability to strengthen teeth, prevent cavities, and even contribute to bone health makes it a cornerstone of dental care and a valuable supplement in certain medical conditions. The various methods of fluoride administration, whether through topical applications like toothpaste and mouth rinses or systemic means like fluoridated water and dietary supplements, provide versatile and effective solutions to address public health needs.

Fluoride remains an essential component of the healthcare and pharma industry, especially as a dental agent, but it might also have other uses, such as promoting bone health. Potential areas of investment for the B2B stakeholders include fluoride product production, public health partnership, and industrial safety.