Jeffrey A. Singer
On May 13, the Food and Drug Administration announced plans to pull fluoride supplements, such as tablets and drops, off the market. FDA Commissioner Marty Makary stated that if people want their children to avoid dental caries, they should have them eat less sugar and practice good dental hygiene. While Dr. Makary emphasizes diet and hygiene, both important, his approach ignores the evidence that fluoride, used appropriately, plays a crucial preventive role.
There is inconclusive evidence that fluoride might cause cognitive deficits in the developing young brain. While some observational studies have suggested a possible link between high fluoride exposure and cognitive deficits, most involve levels far above those found in US water systems. At the standard level of 0.7 mg/L, leading public health authorities—including the CDC and Health Canada—find no convincing evidence of neurotoxicity. The National Toxicology Program’s 2020 review concluded that high-level exposure might pose a risk but found little evidence of harm at levels used in fluoridation or supplements.
There is even less conclusive evidence that fluoride ingested orally might affect the diversity of the gut microbiome, a concern that Dr. Makary cited.
People should weigh the unconfirmed risks of high fluoride exposure against the well-established benefits of low-dose fluoride in preventing tooth decay.
Nevertheless, as I have stated here, with numerous alternative sources of fluoride available to consumers today, it is reasonable and proper for government-monopoly water companies to cease adding fluoride to the water supply to respect the preferences of those who do not wish to consume it.
It’s one thing when government-monopoly water companies stop fluoridating the water, allowing people uncomfortable with consuming fluoridated water to opt out. It’s an entirely different matter to deny access to fluoride for those who wish to consume it.
If people wish to enjoy its benefits, there are many ways to obtain fluoride: from bottled fluoridated water to fluoride tablets and drops, varnish, and toothpaste. The FDA’s proposal to remove drops and tablets from the market undermines patients’ autonomy by denying them the right to consume a product with benefits that, for them, outweigh its risks.
In my book, Your Body, Your Health Care, I list various ways the government ignores our self-ownership and infringes on our right to make our own health care decisions. If the FDA’s proposed ban on fluoride tablets and drops is adopted, this must be added to the list.