Politicians are fighting to remove fluoride from the public water supply. Without passive protection, some Americans are at risk of losing a form of defense against dental caries. What should you tell your patients about protecting their teeth? This week, Dentistry 411 gives advice on how to have conversations about the fluoride debate with patients looking for alternatives.
The Fluoride Debate
Fluoride and dentistry have been closely linked for the past century, but now within an entirely new context. Recent conversations in politics and media have brought the safety of the mineral into question. Some say the risks to younger children and rumored long-term health effects are too high. Others argue that removing this protection when 72 million Americans are without dental insurance and more are losing access to Medicaid is dangerous. In March 2025, Utah became the first state to impose a statewide ban on its use in community water supply. The American Dental Association said the bill “ends one of the most equitable, trusted, and tested public health strategies in the arsenal of preventive medicine.”
According to a recent study, 81% of people either support fluoride in public drinking water or feel neutral about the topic and 96% trust their healthcare providers for accurate information. However, 6% support banning the substance from community supply.
Of course, the first line of defense is knowledge. Share reliable information from trusted sources like the ADA. You could also bring up case studies on communities that have made the change. Bans within the U.S. have been in place under a year, and although removal effects can be seen within months, there’s little literature on the changes as of today. However, in Canada, Calgary removed fluoride from their water in 2011. After over 10 years of increased dental caries, they voted to reverse the change.
Not all opposition is backed by health concerns. Some simply They find the mandatory medication to be invasive and are concerned about the effects on the environment.
Alternatives
So, what do you do if a patient wants to live fluoride-free and asks for recommendations? For these patients, having alternatives to maintain oral hygiene and keeping their minds at ease may be the best choice.
Hydroxyapatite
Hydroxyapatite is a popular alternative to fluoride. Like the former, it supports remineralization by bonding with the tooth enamel, fighting against decay and acid erosion. It also has antimicrobial properties, absorbing pathogens like p. gingivalis and candida. It can reach deeper in the enamel and remineralize the tooth directly, making it a great option for patients with sensitive teeth. It’s most popular in the form of toothpaste.
However, it’s relatively new to the dental scene, just 50 years old and lacks the extensive catalog of research fluoride has. It also does not carry the ADA’s Seal of Acceptance or FDA approval. Because of this, it’s not as readily available in local stores and may have to be ordered online at a higher price, not ideal for patients on a budget.
Xylitol
Xylitol is a naturally occurring, sugar substitute. Like hydroxyapatite, it is new, with limited dental-related research available. Early studies show that the ingredient can decrease acid-producing bacteria in your mouth by up to 90% and stop dental caries in their tracks. Luckily, this ingredient is easily found among many sugar-free snacks. Some of the most popular items include gum, mints, hard candies, and drinks. Having one of these treats after a meal can starve cariogenic bacteria and protect teeth.
This ingredient is best consumed in moderation. High blood concentrations are associated with cardiovascular risk and digestive issues. Non-ingestible products like toothpaste or mouthwash may be a better recommendation for those concerned.
Other Alternatives
Homeopathic practices are circulating online as stand-ins for fluoride. Studies show oil pulling may reduce dental caries and gingivitis but more research is needed. There is concern that it may dislodge dental work, such as crowns or fillings. Overall, professionals say this practice is a low-risk addition, but not a substitution for approved oral hygiene routines. Baking soda scrubs are also used for oral health. But some methods are safer than others. Toothpastes with the ingredient have antibacterial properties, but a scrub mixture of baking soda and water alone is abrasive and can wear down enamel if used too frequently, which is how to achieves the whitening affect it’s praised for.
In Summary
Although fluoride has been repeatedly backed by professionals, it’s under attack in politics and the media. As healthcare providers, it’s important to provide patients with the facts, but also with tools they can confidently use to protect themselves. Discussing options with your patients with an open mind when they’re in the chair maintains trust and allows them to make good decisions between appointments.
This content is intended for educational purposes only and does not substitute for clinical judgment. Treatment decisions should be based on individual patient needs, professional guidelines, and a comprehensive clinical evaluation.
