THE NEW YORK TIMES: Why the United States’ latest fluoride move has doctors worried

The announcement came on Halloween, just hours before trick-or-treaters started collecting candy: The Food and Drug Administration issued new recommendations about fluoride supplements and sent warning notices to four companies that sell them.

The agency urged doctors to refrain from prescribing fluoride tablets and drops to children younger than 3 and to older children who are not at high risk for tooth decay.

Paediatricians and dentists consider fluoride supplements a critical tool for combating cavities, especially for children who live in areas without fluoridated water, as roughly 40 per cent of the US population does.

But over recent months, scepticism around fluoride has intensified, as officials have cast doubt on a mineral that has been added to the US water systems since the 1940s with the aim of preventing dental decay.

Health Secretary Robert F. Kennedy Jr. has called fluoride “neurotoxic and carcinogenic” and called for states to ban fluoride in drinking water; in March, Utah became the first to do so.

In the spring, the FDA threatened to ban fluoride supplements, arguing that they could alter the gut microbiome, though there is not significant evidence in humans to back up that claim.

The agency also cited concerns about a link between high levels of fluoride and lower IQs in children, based on research that outside experts have called flawed, and it pointed to an unproven connection between fluoride and thyroid issues.

The new guidelines fall short of a ban; doctors and dentists will still be able to prescribe fluoride supplements. But the recommendations discourage them from doing so for very young children.

Doctors already typically avoid giving fluoride supplements to children with a low risk for tooth decay so that they are not exposed to excessive amounts, which could lead to tooth staining and, in rare cases, bone disease.

“When all is said and done, the recommendations are more limited and less restrictive than I was afraid they would be,” said Dr. Steven Levy, a public health dentist at the University of Iowa.

But even if dentists and paediatricians largely do not change their prescribing practices, the move will most likely sow more fear and anxiety around fluoride, doctors said.

“The concern is that the bluster, the sizzle, the storm, really brews concern among our patients about what is known to be a safe and effective tool,” said Dr Susan Fisher-Owens, a paediatrician who advises the California Department of Public Health on fluoride.

In Hawaii, where the water is fluoridated only on military bases, many providers rely on fluoride supplements. Dr Regina Nguyen, the dental director at Waianae Coast Comprehensive Health Centre, said that over the last year or so, dental residents she works with have faced more parents turning down fluoride offerings during check-ups than in years past.

“There is a lot of what we call fluoride hesitancy, because the families and parents don’t know who to believe,” said Dr Paul Casamassimo, a paediatric dentist at Nationwide Children’s Hospital in Columbus, Ohio.

Many doctors agree that evidence is lacking to support limiting the use of fluoride supplements and that the established risks of tooth decay, including infections and tooth loss, outweigh unproven concerns about the supplements.

“Patients are coming in asking about nonfluorine containing toothpaste,” said Dr Scott Tomar, a public health dentist and oral epidemiologist at the University of Illinois Chicago. “They don’t want fluoride treatment for their child — they’re hearing these things, and they’re scared.”

“It’s unnecessary,” he added. “And frankly, based on misinformation.”

Dr Mark Stapleton is a paediatric dentist in Eugene, Oregon, where the water supply is not fluoridated. He has treated children with severe dental disease, he said, who had to go under general anaesthesia to get surgery for their painful, infected teeth.

“I think people who have not had that experience really can’t imagine it happening for a very, very young child,” he said. “But it does.”

Both paediatricians and dentists prescribe fluoride supplements. If they follow the FDA’s recommendations and stop offering the supplements to children under 3, those children could still get fluoride from varnish treatments. But those treatments do not replace the daily amount of fluoride that doctors say can prevent tooth decay.

The children who will be most affected by the new policy are “the most vulnerable of the vulnerable,” said Dr Ryan Spotts, a paediatrician at Penn State Health Golisano Children’s Hospital.

Those who cannot access or afford regular dentists’ and doctors’ visits will most likely experience worse oral health outcomes.

Children can also get fluoride from toothpaste, but very young children struggle to brush their teeth properly, even with help from parents, said Dr Steven Chapman, a general paediatrician at Dartmouth Health Children’s.

That’s part of why children younger than 3 are at such high risk of developing cavities.

Chapman said making sure children are eating a healthy diet and helping them keep up good oral hygiene, including regular brushing, was important. “But to say that’s the only thing that’s important seems silly,” he said. “That seems like saying, if I follow the speed limit then I don’t need to wear a seat belt.”

This article originally appeared in The New York Times.

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