March 29, 2017

Dr. Hardy Limeback BSc PhD (Biochemistry) DDS — Do you want some fluoride with your salt or milk?

The decay rates in children have declined dramatically all over the world in developed countries.

How was this achieved?

Was it because of fluoridation? No. Fluoridation is not practiced in Europe except in Ireland (where it is mandatory) and a few small pockets of the UK. All other European countries either never started or stopped adding fluoridation chemicals to the drinking water years ago. In fact, the practice was ‘banned’ in some countries. See

Proponents of fluoridation say that dental decay rates will skyrocket if fluoridation is halted. The exact opposite has happened. When they stopped adding fluoride to the drinking water dental decay rates continued to decline sometimes faster than in control cities that still fluoridated. See

Here is a composite graph indicating the overall trend to dental decay in fluoridated and non-fluoridated counties.

There are so many reasons for the decline of dental decay in the developed world.

When the electric refrigerator was introduced fresh fruit and other foods were possible and there was less reliance on fruits preserved in jars with sugar.

Penicillin was introduced just in time to save countless of lives during WWII. Penicillin also kills the bacteria that cause dental decay.

Vitamin D is essential for strong teeth and bones. A deficiency in Vitamin D not only causes rickets but increases dental decay. Rickets is less common these days because of milk that is fortified with Vitamin D but some parents feel that the natural way to get Vitamin D (outdoor exposure to sun) is best for their children. Aboriginal peoples really don’t need Vitamin D because they get enough sun and eat Vitamin D rich foods in the winter. Recently there has been a trend to increasing dental decay in fluoridated cities because of the substitution of milk with sugar-laden soda pop and sport drinks.

Before fluoridation was introduced, artificial sweeteners made their debut. Replacing raw sugar in the diet drastically curtails dental decay (as demonstrated by the dashed black line in the diagram – Japan’s decay rate went to nil during WWII when their sugar supply was cut off).

Most experts now believe that fluoridated toothpaste was an important factor in the non-fluoridated countries in lowering decay rates, but that was not the only factor. Better diets, improved dental hygiene and better access to dental care (and professional preventive dentistry) played important roles (Bratthall et al, 1996).

Products containing chlorhexidine (an antibacterial agent) and xylitol (a natural anti-cavity sugar substitute) were also introduced in the 70’s and 80’s in addition to fluoridated toothpaste.

Finally, dental sealants, especially those placed on highly susceptible pits and fissures (those surfaces that usually decay), made a significant contribution to declining dental decay.

[A detailed discussion with references can be found in Limeback et al, 2012]

Current studies suggest that fluoridation might have contributed to perhaps a savings of 0.5 tooth surfaces from needing dental treatment. One has to weigh health risks of twenty years of fluoridating the entire population in order to save 0.5 tooth surfaces.

Is it worth it?

When it is pointed out to fluoridation supporters that Europeans experience better dental health than North Americas without fluoridation, it is often claimed that they get their fluoride from ‘other’ sources, such as fluoridated salt, milk and supplements.

It is important to remember that fluoride does NOT work by ‘strengthening’ the enamel from within. You don’t have to swallow it (see previous blog). Fluoride, if anything, works topically AFTER the tooth appears in the mouth. Ingested fluoride is actually quite useless.

Add to this that when fluoridated water (or milk or salt) is ingested from birth until age 6 years it causes dental fluorosis. It is hard to understand, then, why dental researchers continue to try to inject fluoride into the food system in Europe. Even if people were willing to accept permanent ‘scarring of the teeth’ to achieve some minor benefit against dental decay, there is no evidence that fluoridated salt works and there is only ONE study that suggests fluoridated milk might provide a slight benefit to the primary dentition. (Cagetti et al, 2012).

I received this interesting email from Declan Waugh, an environmental risk assessor in Ireland, who wrote a detailed critique of Ireland’s fluoridation policy:

Milk fluoridation programmes targeted at children are currently in operation in Bulgaria and the UK. ( In Bulgaria where, in addition to milk, yogurt is fluoridated in a few regions of the country. The total number of children receiving these products is 5000 [this program has ceased to operate]. In the UK there were in 2004 eleven education authorities in England offering fluoridated milk, with approximately 32,000 children drinking it (Riley et al, 2005), and in June 2005 this number amounted to over 40,000 children in 510 establishments. [The figures for 2012 are 30,000 children age 3-11 years]. Hungary attempted a trial on a small level in 1978 but subsequently discontinued it. That’s it- no other country [in Europe]. To read more see WHO Report:

Challenge to the reader: Question when proponents of fluoridation say adding a toxic byproduct to the drinking water is ‘safe and effective’. Remember that dental decay is not a fluoride-deficiency disease. Learn about the other ways that we have achieved better dental health in developed countries. Don’t let fluoridation proponents bully you and tell you that fluoridation is necessary- it’s not.

Take home message for the reader: The next time you hear someone claim that the Europeans have better dental health than us in North America because they consume fluoridated salt and milk, tell them they are wrong and point them to this blog.


1. Hardy Limeback, Jim Yuan Lai, Grace Bradley, and Colin Robinson. A brief introduction to oral diseases: caries, periodontal disease, and oral cancer. (2012) in: Comprehensive Preventive Dentistry (H. Limeback ed), Wiley-Blackwell (Ames Iowa, USA).

2. Cagetti MG, Campus G, Milia E, Lingström P. A systematic review on fluoridated food in caries prevention. Acta Odontol Scand. 2012 Jul 25.

3. Bratthall D, Hänsel-Petersson G, Sundberg H. Reasons for the caries decline: what do the experts believe? Eur J Oral Sci. 1996 Aug;104(4 ( Pt 2)):416-22; discussion 423-5, 430-2.

4. Riley JC, Klause BK, Manning CJ, Davies GM, Graham J, Worthington HV. Milk fluoridation: a comparison of dental health in two school communities in England. Community Dent Health. 2005 Sep;22(3):141-5.