“I want to live rurally, and raise my kids with a little village of friends on a permaculture farm.” I’m hearing this ‘dream’ voiced more and more often, and I fully support it. I hope that as many people as are called to do this make themselves the opportunity, and follow through.
Having grown up in a little village on a permaculture farm myself, there is approximately ONE thing I wish my parents had done differently—I wish they’d given me fluoridated water when I was 0-9.
In doing the research for this post, I found that fluoridating municipal water has some vocal opponents. I abstain from that entire ball of wax, so please don’t engage me on it. This post is only “so you have well water with no natural fluoride, and you either already know you want to, or are considering at-home fluoridation. Here's how to roll your own.”
I started this post several months ago, and am suddenly racing to finish it before its honoree is born, so I apologize that the reference section is unsorted.
How we came to fluoridate
The just-so story:
Once upon a time there was a dentist who practiced on a mountaintop. His patients lived on both sides of the watershed, and after years of practice, he continually noticed that while some of his patients had good teeth, there were two “types” of problem teeth he’d see. Some people had lots of cavities. Other people had fluorosis (a cosmetic flecking of teeth). He never saw fluorosis AND cavities in the same person. After sorting his fluorosis patients and his cavities patients, and comparing street addresses, he discovered that one watershed was home to a large percent of the cavity-havers, and the other watershed was home to a large percent of the fluorosis-havers.
Experiments were conducted. It turns out that fluoride (naturally occurring in some water sources but not others) contributes to stronger tooth enamel. For this to work best, fluoride needs to be available systemically: within the jaw of a toddler as adult teeth are developing.
In the dentist’s two watersheds, one had too much fluoride, and the other had too little.
The drawbacks of too much fluoride are purely cosmetic. The drawbacks of too little fluoride are (if you have good genetics) nothing, or (if you have poor genetics) cavities, deep cavities requiring root canals (and potentially the associated/compounding risks of inflammation, extra head x-rays, gum disease, heart disease, loss of jaw bone density under lost teeth which are not replaced with implants, &c).
So, after weighing the pros and cons, most municipalities opted to add a “right level” dose of fluoride to their water supplies.
Does it matter for my kids?
Some people have hardy tooth enamel genetics, and others have wimpy tooth enamel genetics. Fortunately for most Americans, the majority of municipal water supplies have been fluoridated for 2+ generations, so most people no longer have an intuitive sense of whether they have hardy or wimpy tooth enamel genetics.
Fluoridated drinking water is irrelevant for people with hardy genetics, but it makes a huge improvement in lifetime dental expenditures and health for those with wimpy genetics. (There was a year in my twenties when I spent more money on root canals than on rent, despite a diligent brushing and flossing routine.)
If you are certain that you and your spouse both have great tooth enamel genetics, you can ignore all the rest of this information. But if you, your parents, and your grandparents had fluoridated water in their critical development period, then you don’t actually know whether your genetics are hardy, since the fluoride protected you from finding out the hard way.
What are my options?
Buy bottled fluoridated water for your babies/toddlers/kids until all adult teeth have emerged.
drawbacks: bulky, takes up pantry space, you’re using the FDA’s default dosing
benefits: don’t have to spend cognitive overhead on dosing; available at most rural grocery stores
Get a prescription for systemic fluoride supplements. Your local dentist should be familiar with this table1, and provide a prescription accordingly. You will need to test your own well’s water (I like the W3: Water Quality package from Midwest Labs—because why not make sure your water doesn’t have coliform, e. coli, or nitrate nitrogen at the same time as you’re evaluating your natural fluoride level?) to help your dentist prescribe a correct dose.
Purchase Sodium Fluoride powder and fluoridate your own water.
drawbacks: measuring and dosing take time
benefits: exact control over dosing, lower cost than prescription supplements
Apply topical fluoride throughout the mouth or specifically to demineralizing areas (ie ACT fluoride rinse or Varnish Pens)
drawbacks: not systemic, only works on emerged teeth, basically “damage control”
benefits: hey, at least there’s some damage control you can do!
On Dosing
The CDC states “An optimal level of fluoride in drinking water provides enough fluoride to prevent tooth decay in children and adults while limiting the risk of dental fluorosis, which is the only unwanted health effect of community water fluoridation.” Coupled with that statement, in 2022, the CDC replaced their previous guideline of "between 0.7 and 1.2mg/L of NaF" for bottled water with a new guideline of "a maximum of 0.7mg/L".23 Their stated reason is "because of the availability of fluoride rinses and toothpastes."
In my layman’s opinion, given that adult teeth are forming within the jaw and thus aren’t receiving contact applications of fluoride, and given that I’ve (in my low-naturally-occurring fluoride geographic region) never met anyone with fluorosis, and given that I in particular know that I have poor enamel genetics, I plan to dose to
Of course, feel free to dose to 0.7mg/L (CDC) or 0.6mg/L(ADA), or 0mg/L, at your prerogative.
In conclusion,
Welcome to the world, to all your little ones—and may their teeth turn out better than mine!
“Reference” section
I’m so sorry about the state of this section.
https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/fluoride-topical-and-systemic-supplements
https://my.clevelandclinic.org/health/diseases/23227-fluorosis
https://www.colgate.com/en-us/oral-health/mouth-and-teeth-anatomy/odontogenesis-5-stages-of-tooth-development#
https://en.wikipedia.org/wiki/Human_tooth_development
https://www.dph.ncdhhs.gov/oralhealth/library/includes/IMBresources/2020-FluorideSupplementation.pdf
https://www.fda.gov/food/bottled-watercarbonated-soft-drinks-guidance-documents-regulatory-information/letter-manufacturers-distributors-or-importers-bottled-water-update-fluoride-added-bottled-water#_ftn1
https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/fluoride-topical-and-systemic-supplements
https://www.cdc.gov/fluoridation/pdf/communitywaterfluoridationfactsheet.pdf
https://www.cdc.gov/fluoridation/faqs/public-service-recommendations.html
https://www.cdc.gov/fluoridation/guidelines/index.htm
https://www.fda.gov/food/bottled-watercarbonated-soft-drinks-guidance-documents-regulatory-information/letter-manufacturers-distributors-or-importers-bottled-water-update-fluoride-added-bottled-water
https://www.cancer.gov/about-cancer/causes-prevention/risk/myths/fluoridated-water-fact-sheet
https://www.cdc.gov/fluoridation/basics/index.htm
https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/fluoride-topical-and-systemic-supplements