Do you prefer dental fluorosis or tooth decay?

Anti-fluoride propagandists often use the incidence of dental fluorosis as an argument against community water fluoridation. However, they exaggerate the problem by misrepresenting the issue in two ways:

1: They present the issue as if the figures for the incidence of dental fluorosis relate to the severe forms when they don’t. Most cases of dental fluorosis in areas using CWF are classified as questionable or mild. Yet the anti-fluoride people will present images of severe dental fluorosis which is never caused by CWF (see ). Severe forms are caused by excessive toothpaste consumption, high natural fluoride levels or industrial contamination. Never by CWF.

The figure below shows the incidence of the different dental fluorosis categories in New Zealand (data taken from 2009 New Zealand Oral health Survey – see Our Oral Health).

And here are some accurate images of dental fluorosis provided by the Centers for Disease Control and Prevention (CDC).


 (Double click to enlarge)

2: They will then go on to claim that dental fluorosis is disfiguring and destroys the quality of life of the afflicted. Of course this may be true in countries where severe dental fluorosis occurs,* but not in countries like New Zealand where CWF is used.

A recently published study objectively determined the effect of dental fluorosis and dental decay on 5,474 North Carolina schoolchildren and their families – Effects of Enamel Fluorosis and Dental Caries on Quality of Life. It found no statistically significant association between dental fluorosis and oral-health related quality of life scores. Probably what one would expect because the incidence of dental fluorosis was about 28% and most of this was questionable or very mild.

But what about the effect of tooth decay on quality of life? In this case the results were statistically significant showing that dental caries does decrease the quality of life.

Their overall conclusions – a child’s caries experience negatively affects oral health-related quality of life, while fluorosis has little impact.

I think many of us can relate to this from our own childhood experience.

*The mainly poor quality IQ studies anti-fluoridation activists like Paul Connett love to quote were made in areas of high natural fluoride where dental and skeletal fluorosis is endemic. Such studies are not relevant to the issue of CWF, but they do raise in my mind the effect of severe dental fluorosis on quality of life, learning problems and hence possibly IQ measurements (see my article Confirmation blindness on the fluoride-IQ issue). Personally I think any disfiguring oral defect like bad tooth decay or severe dental fluorosis would effect a child’s quality of life and potentially cause learning defects and so drop in IQ.

In countries like NZ such effects on quality of life and learning are much more likely to result from bad dental decay than severe dental fluorosis. If anything, perhaps CWF actually reduces learning problems and potentially prevents decreases in IQ.


Another study invesdtigatign the influence of tooth decay and dental fluorsis on quality of life is described in the paper by Do, L. G., & Spencer, A. (2007). Oral Health-Related Quality of Life of Children by Dental Caries and Fluorosis Experience. Journal of Public Health Dentistry, 67(3), 132–139.

This also concluded that caries and less acceptable appearance showed a negative impact, while mild fluorosis had a positive impact on child and parental perception of oral health-related quality of life.

See also:

New report from the National Fluoridation Information Service – Dental fluorosis – is it more than an aesthetic concern? Its key findings are:

“Evidence does not indicate there are any health risks associated with CWF at the levels of 0.7 to 1.0 mg/L in New Zealand, and no severe dental fluorosis, or skeletal fluorosis, has been found. While fluoride is incorporated into teeth and bones, there is no robust evidence of toxic accumulation of fluoride in other tissues in the body. CWF in New Zealand has been found to not lead to anything more than very mild or mild dental fluorosis for a small “

Similar articles

13 responses to “Do you prefer dental fluorosis or tooth decay?

  1. You are exactly on target, Ken. I have practiced dentistry for 32 years in a North Carolina community which has been fluoridated for over 40 years. It is surrounded by communities which have been fluoridated for similar lengths of time. I have as yet to see one, single case of dental fluorosis, in any manner attributable to water fluoridation, which would even be detectable outside of close examination in my dental chair. Anecdotal, sure, but anecdotal from a dental provider who has treated thousands of patients per year in his state and 6 others.

    The brazen hypocrisy of Connett and his followers is nothing short of astounding…..and despicable. They constantly fear-monger about barely detectable, benign, mild dental fluorosis for the sole reason that everything else they have attempted in order to impose their ideology on the populace, has been repeatedly rebuked by facts supported by valid scientific evidence. Meanwhile, they totally discount the lifetimes of extreme pain, debilitation, disfigurement, and life-threatening infection of untreated dental decay which is preventible with fluoridation.

    Instead of running around the world spewing uninformed nonsense about fluoridation, the self-serving Connett and his minions need to spend some time in free and/or low-cost dental clinics, as I have done my entire career. Seeing what I and countless other dental providers have seen in these settings, might, just might give these hypocritical zealots a strong dose of reality.

    Steven D. Slott, DDS


  2. Isn’t it nice to have personal preferences , , , , shame you don’t allow others who disagree with you to have that same privilege . . . hypocrisy?


  3. Greenbuzzer – you aren’t another silly Trevor Crosbie clone, are you? Come on, front up.



  4. That should, if course, be “prevalence” rather than “incidence”, but you make a very apposite point, something that the tin hat brigade neglect to mention.


  5. Thanks, Murray. I’ll claim a senior moment although English is not my strongest point, and will correct things.



  6. Making Sense of Fluoride

    “But what about the effect of tooth decay on quality of life? In this case the results were statistically insignificant showing that dental caries does decrease the quality of life.”

    Shouldn’t that be “statistically significant”?


  7. You are right. Thanks. I have corrected.



  8. Well as someone that has dental fluorosis I would totally disagree – it has a BIG affect on quality of life. Why is it fair that my teeth were ruined?? Stop mass medicating everybody – kids that are getting rotten teeth are not drinking water – they are drinking fizzy drink and other sugary drinks and lollies etc – ban that rubbish – put fluoride in those drinks if you want to – but keep pesticide runoff (because that’s the type they use in our water) out of our drinking water so that the people that actually drink water are not poisoned (it’s a neurotoxin).


  9. Some questions for you, Joanne:

    1: What classification of dental fluorosis do you have and was it diagnosed professionally?

    2: What is you source of information that fluoridating chemicals used for water treatment is “pesticide runoff? That is a new one on me.:-)

    3: Do you have any evidence at all that fluoride is a neurotoxin and the extremely low concentrations used in community water fluoridation? I haven’t see any and I have looked extensively.

    I am always open to new information – but it must be evidence, not opinion.


  10. Steve slott


    If you have been accurately diagnosed, by a qualified dental professional, as having dental fluorosis, and if it is noticeable to the extent that it has negatively affected your quality of life, then you have moderate/severe dental fluorosis. This level of DF does not occur attributable to optimally fluoridated water. During your teeth developing years of 0-8, you either improperly ingested fluoridated toothpaste on a regular basis, or were chronically exposed to high levels of environmental or well-water fluoride. Removal of the 0.7 ppm fluoride in fluoridated water would not have prevented you from incurring this level of dental fluorosis.

    It is, therefore, unfair to deprive an entire population of the dental decay preventive benefit of optimally fluoridated water simply because you may be erroneously convinced that this was the cause of your problem.

    Steven D. Slott, DDS


  11. “kids that are getting rotten teeth are not drinking water – they are drinking fizzy drink and other sugary drinks and lollies etc – ban that rubbish – put fluoride in those drinks if you want to –”

    Ken and Steve seem to accept that point.

    Coca Cola Amatil have a big factory at Putaruru – very soft water: (works in google chrome for me.)

    As for the fluoride pesticide – cryolite, I am assuming that that washes into rivers/catchments, and that it may form part of the Waikato River fluoride at some 0.2 ppm before more is added.

    This bargaining process is like many where the selling party asks for a ridiculously high price and the buying party asks for a ridiculously low one, and some sort of average results.

    Cryolite: sodium aluminium fluoride, can be used in large quantities on lettuce.

    Eating large amounts of foods by some idiosyncratic people is supposed to be allowed for when safety limits are set.

    Another idiosyncratic thing would be someone preparing most of their food by boiling till the water gets low as in soups, stews, maybe porridge. A level of fluoride in water should be set to allow for that, or people should be educated not to boil down the water for baby’s bottle &c, using a bit out of the pot and adding more.

    I wrote before of evaporation of water from horse drinking troughs. In hot weather maybe 10mm could evaporate in a day? 5mm can from a reservoir. So owners should be told to have a deep trough or reservoir rather than a shallow one with a big surface area. If water is short and a horse is drinking the last of the trough it may be concentrated. Since a horse needs some 40L water per day they would get 40mg fluoride even at 1 ppm.


  12. Steve slott

    Well, soundhill, I suppose it’s somewhat entertaining that you construe my sheer boredom with your overflow of irrelevant drivel to somehow be my acceptance of any “point” you purport to make, but the truth is there is little, if anything, in your posts with which I agree…..although, I suppose I may have missed some things while yawning and attempting to keep my eyes open while reading……..

    Steven D. Slott, DDS


  13. I have both and I hate both equally.


Leave a Reply: please be polite to other commenters & no ad hominems.

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s