What Floridians should know without fluoride in water

Gov. Ron DeSantis on Thursday signed a bill that will stop local governments from adding fluoride to water, prompting Florida dentists to brace for what’s next.

“It may take a few years, but we expect to see more tooth decay,” said Jeff Ottley, president of the Florida Dental Association and a family dentist in Milton.

All water has some fluoride, but many cities and counties in the state add more to help prevent tooth decay. However, by July 1, when the new law becomes effective, local governments in Florida won’t be able to add extra fluoride to the water.

Florida dentists believe now is the time to step up dental education and community outreach. They want individuals to consider fluoride supplements, eat less sugary foods and opt for diet choices naturally high in fluoride. The key, they say, is to be proactive about oral health.

“Seeing a dentist regularly is going to be more important than ever,” said Beatriz Terry, a Miami dentist and immediate past president of the Florida Dental Association.

Fluoride helps protect teeth by making the outer layer of enamel more resistant to acid attacks by bacteria and sugars. Dentists say that without the added fluoride in the water, the mineral has little opportunity throughout the day to get on surfaces that are susceptible to cavities.

Ottley said after July 1 in Florida, as municipalities restrict the added fluoride, dentists expect to see a significant increase in tooth decay in the general population within two to three years. However, individuals who don’t have good oral hygiene habits and have other factors, such as high-sugar diets or dry mouth, could see new cavities in six to eight weeks.

What Floridians can do

Terry said everyone should diligently brush twice a day with fluoride toothpaste.  Fluoride is especially important to young children whose teeth are developing and who may have relied on fluoride in the water as their only source of preventive dental care. She said recommendations have been for children to see a dentist by age 3, but that guidance could become younger once Florida’s fluoride ban is in effect.

The Florida Dental Association is working on developing a page for its website with a variety of sources of fluoride, such as fluoridated bottled water and chewables. Fluoride tablets require a prescription from a doctor or dentist. Kids too young for chewables might instead be prescribed drops or gels. Mouth rinses with fluoride can also be helpful for adolescents with braces who might have a harder time reaching all their teeth with toothpaste.  Terry recommends looking for the American Dental Association seal of acceptance on products.

In addition, some foods are naturally high in fluoride such as tea, shrimp, crab and spinach. Cavities are mainly caused by eating excess sugar and refined carbohydrates, so diet becomes even more important without added fluoride in water.

Dentists say after July 1, older adults will need to be more cautious. Seniors often experience dry mouth due to medication or medical conditions, increasing their risk of tooth decay. When drinking fluoridated water, their saliva bathes the teeth in fluoride throughout the day and makes them stronger.

“They need to make sure they brush well before bed and no snacking in the middle of night,” Ottley said.  “The most vulnerable time is when you are sleeping and there is nothing to wash the plaque away.”

For anyone at high risk of tooth decay, fluoride varnish can be painted directly on the tooth surface and help protect against cavities. However, as with anything, there’s such a thing as too much fluoride.  “If there’s too much, it can stain teeth brown,” Terry said.

Dentists often prescribe fluoride supplements to at-risk children who have high amounts of plaque, don’t regularly see a dentist, or have family members with dental disease. These supplements are designed to provide a similar amount of fluoride to what children would get from drinking water. However, the Food and Drug Administration announced Tuesday it will conduct a scientific review by Oct. 31 of children’s chewable fluoride products for a range of health concerns with the aim of removing them from the market.

Why DeSantis signed the bill

DeSantis said the bill he signed Thursday was not about fluoride per se, but rather informed consent, and letting people choose what to do with their health.

“We have other ways where people can get access to fluoride,” DeSantis said at a public event earlier this month. “When you do this in the water supply, you’re taking away a choice of someone who may not want to have overexposure to fluoride.”

According to the Centers for Disease Control and Prevention, fluoride has been added to drinking water in most of the U.S. for generations to strengthen teeth and reduce cavities by replacing minerals lost during normal wear and tear.