What’s at Stake and How to Protect Our Kids Without It

By Dr. Ashley Lerman, Board-Certified Pediatric Dentist

Fluoride is a proven way to prevent cavities in children, but what happens if it’s removed from public water? Pediatric dentist Dr. Ashley Lerman explains the risks, alternative fluoride options, and other science-backed strategies to protect little smiles in communities without water fluoridation.

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As a pediatric dentist and a mom of two little ones, I get it. The whirlwind of family life, combined with the challenges of keeping up with the basics of healthy habits, can make something as simple as brushing teeth feel like an uphill battle. And when it comes to oral health, there’s one important tool that has long been a key player in the fight against cavities—fluoride.

But in recent years, fluoride has become a political hot potato. Water fluoridation, a public health measure that has helped reduce cavities and improve oral health for generations, is now being scrutinized. Many communities have started debating whether to remove fluoride from their water systems altogether. It’s crucial that we look at the facts, not the fear-based rhetoric, to understand what’s really at stake—and more importantly, how we can continue to protect children’s oral health if water fluoridation is no longer an option.

The Proven Benefits of Water Fluoridation

Water fluoridation is one of the most effective and cost-efficient public health strategies to prevent cavities. Fluoride strengthens enamel, making it more resistant to acid attacks from plaque bacteria and sugars. In areas with fluoridated water, children have lower rates of dental decay compared to those who don’t have access to fluoridated water.

Take Calgary, Canada, for example. When the city removed fluoride from its water in 2011, the results were dramatic. Childhood cavities spiked. The city saw a 700% increase in the number of kids requiring IV antibiotics for dental infections at the Alberta Children’s Hospital. And perhaps most concerning, the children most affected were those from low-income families who had limited access to dental care and preventive treatments.

The good news? Calgary has since reinstituted fluoride in its water system, recognizing the negative consequences it experienced without it.

If fluoride were to be removed nationally—without addressing other risk factors like sugar consumption—the impact could be staggering. Research suggests that we could see a 20–50% increase in cavities, particularly in vulnerable populations. This is not a scare tactic. This is what the data tells us.

Alternatives to Water Fluoridation

While water fluoridation is a powerful tool, it’s not the only way to protect children’s teeth. In communities without fluoridated water, there are other ways to incorporate fluoride into children’s oral care routines, though none are as universally accessible as fluoride in drinking water.

1. Fluoride Varnish
   Fluoride varnish is a powerful preventive treatment, often applied by a dentist or hygienist. It’s highly effective at preventing cavities—research shows it can reduce the incidence of cavities by about 40%. Regular applications of fluoride varnish, especially for children who are at higher risk for cavities, can go a long way in filling the gap left by non-fluoridated water.
2. Silver Diamine Fluoride (SDF)
   SDF is an incredibly effective solution for treating early-stage cavities and arresting decay. It has been shown to have up to a 98% success rate in stopping the progression of early cavities, and it can even help with larger cavities in certain cases. SDF is a great option in communities without fluoridated water as it provides targeted protection and is especially useful for children who may not have access to routine dental visits.
3. Fluoride Supplements
   In some cases, fluoride supplements in the form of tablets or drops may be prescribed for children who live in non-fluoridated areas. These supplements, however, need to be used with caution to avoid the risk of overexposure, which can cause dental fluorosis—a condition that causes discoloration of the teeth.
4. Topical Fluoride Toothpastes and Gels
   For children, using fluoride toothpaste is a simple yet effective way to ensure fluoride exposure. When brushing twice a day with fluoride toothpaste, children are getting a significant amount of fluoride directly to their teeth. Additionally, fluoride gels, available through your dentist, can offer an extra layer of protection.

Beyond Fluoride: Other Proven Oral Health Tools

While fluoride remains the cornerstone of cavity prevention, it’s important to remember that there are other science-backed methods to maintain oral health, particularly when combined with fluoride.

• Sugar-Free Gum: Sugar-free gum has been shown to stimulate saliva production, which helps neutralize acids and wash away food particles. The act of chewing can also help remineralize tooth enamel.
• Cheese: Yes, cheese—specifically cheddar—can help protect teeth! It’s rich in calcium, stimulates saliva production, and contains casein phosphopeptides that help support enamel health.
• Povidone-Iodine: This antiseptic solution has been shown to reduce cavity-causing bacteria by up to 60% when used consistently. While it may not be suitable for all children, it’s an option to discuss with your dentist, particularly if your child is at high risk for decay.
• Vitamin B6: Studies have shown that vitamin B6 can inhibit the bacteria responsible for cavities, making it a beneficial supplement when paired with fluoride treatments.

The Bottom Line: Access to Fluoride is Critical

The truth is, fluoride is one of the most effective ways to prevent cavities and improve oral health for children—especially for those in low-income communities with limited access to regular dental care. While alternatives like fluoride varnish, SDF, and fluoride supplements are useful, they don’t replace the structural prevention provided by fluoridated water systems.

Oral health impacts more than just teeth—it affects school attendance, chronic disease prevention, and overall quality of life. As we continue to navigate the debate over water fluoridation, let’s ensure we have the facts straight and work to protect the most vulnerable populations.

By advocating for equitable access to fluoride and supporting preventive dental care for all children, we can ensure that oral health remains a priority for families, regardless of where they live.

Dr. Ashley Lerman is a board-certified pediatric dentist and the founder of Firstgrin, an online resource dedicated to providing evidence-based oral health advice for parents and caregivers. With a passion for educating families on preventing cavities, Dr. Lerman combines her expertise in pediatric dentistry with real-world parenting insights to help create strong foundations for lifelong oral health. Follow her on Instagram at @pediatric.dentist.mom for tips on raising healthy, happy smiles.

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Sources:

Public Health Agency of Canada. "Fluoride and Oral Health." Public Health Canada‍

Mayo Clinic. "Fluoride and Dental Health." Mayo Clinic

American Dental Association. "Fluoride Varnish: An Effective Way to Prevent Cavities." ADA‍

National Institute of Dental and Craniofacial Research. "Fluoride and Dental Health." NIDCR

FAQs:

Q: Why is fluoride important for children’s teeth?‍

A: Fluoride strengthens tooth enamel and makes it more resistant to acid attacks caused by bacteria and sugars. Children’s developing teeth are particularly vulnerable to cavities. Research consistently shows that communities with fluoridated water have lower rates of tooth decay in kids compared to areas without fluoridation.

Q: What happens when fluoride is removed from public water?

A: Removing fluoride can lead to higher cavity rates, especially among children in low-income communities who may have limited access to dental care. For example, after Calgary, Canada, stopped water fluoridation in 2011:

• Childhood cavities increased significantly.
• IV antibiotic treatments for dental infections at Alberta Children’s Hospital rose by 700%.
• Children with the least resources were the hardest hit.

These findings demonstrate the protective effect of fluoride on public health.

Q: What are safe ways to get fluoride if water isn’t fluoridated?

A: Even without fluoridated water, children can receive fluoride safely through:

• Fluoride varnish: Applied at dental visits; prevents about 40% of cavities.
• Silver diamine fluoride (SDF): Stops early decay with up to 98% effectiveness.
• Fluoride toothpaste and gels: Daily home use provides routine protection.
• Fluoride supplements: Tablets or drops prescribed for high-risk children (must be monitored to avoid excess exposure).

Q: Are there other ways to protect teeth besides fluoride?

A: Yes! Evidence-based strategies include:

• Sugar-free gum: Stimulates saliva, which neutralizes acids and washes away food particles.
• Crunchy vegetables: Raw carrots and celery help clean teeth mechanically.
• Cheese: Rich in calcium and casein phosphopeptides, which support enamel health.
• Povidone-iodine treatments: Reduce cavity-causing bacteria; typically applied by a dental professional.
• Topical vitamin B6: Inhibits acid production by cavity-causing bacteria when applied directly to teeth.

Q: Is fluoride safe for children?

A: Yes. Fluoride is safe at recommended levels—0.7 parts per million in water systems and standard dental products. Overexposure is rare but can cause mild dental fluorosis (tooth discoloration). Following recommended usage guidelines ensures safety and maximum cavity prevention.

Q: How can parents maintain oral health for kids in non-fluoridated areas?

A: Parents can help children maintain strong, healthy teeth by:

• Brushing twice daily with fluoride toothpaste.
• Scheduling regular dental visits for checkups, fluoride varnish, or SDF treatments.
• Limiting sugary foods and beverages.
• Offering sugar-free gum and teeth-friendly snacks like cheese and vegetables.
• Supporting overall healthy habits that reduce cavity risk.

Q: Why does oral health matter beyond cavities?

A: Healthy teeth impact more than just smiles. Poor oral health is linked to missed school days, chronic diseases later in life, and complications in overall well-being. Prioritizing preventive care ensures children grow up healthier and more confident.

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