When we discuss fluoride, two common themes emerge: its proven benefits for oral health and concerns about potential developmental risks. Understanding the balance between these is particularly important for our Raleigh community. Below, we break down the evidence and share what you need to know about fluoride in our local water and why it matters to your family's dental health.
Why Fluoride in Water Matters for Your Teeth
Fluoride is a naturally occurring mineral found in water, soil, and some foods. Humans need minerals for functioning bodies, specifically to strengthen our bones and teeth. In the same way that calcium is important for bone development and strength, fluoride benefits our teeth by strengthening the enamel. Tooth enamel is the thin, hard layer that covers your teeth and helps to prevent cavity-causing bacteria.
Fluoride isn't just useful; it is a significant public health success. Applied topically in rinses and toothpaste, it's been shown through numerous randomized studies to reduce cavities by making teeth more resistant to decay and by interfering with harmful oral bacteria. Fluoride in municipal water provides this protective benefit systemically instead of topically, by incorporating itself into developing teeth before they have even erupted into the mouth. Water fluoridation has limited benefits for adults, but its benefits for children' s oral health cannot be overstated. This is especially beneficial in lower-income areas where dental care access may be limited. This equity benefit is a cornerstone of water fluoridation's success.
Historically, studies demonstrate significant cavity reductions following the introduction of water fluoridation. More recently, Calgary, Canada, removed fluoride from the drinking water in 2011, but following a decade of increasing dental issues and infections in children, Calgary is restarting its water fluoridation program, a strong sign that water-based fluoride continues to make a difference. These findings align with decades of dental research.
Can fluoride in water impact IQ?
Much of the conversation surrounding fluoridated water centers on its potential impact on childhood development and IQ. Research indicates that extremely high levels, typically above 3.7 mg/L, found in certain parts of India and China, may be associated with lower IQ scores. The high-fluoride water levels are typically caused by high levels naturally occurring in groundwater. By comparison, studies in areas with fluoride levels closer to 0.9 mg/L (more typical in the U.S.) show no statistically significant effect on children's IQ.
A 2025 meta-analysis reinforced this finding: while overall data suggested possible impacts, when limiting the analysis to fluoride levels of 1.5 mg/L or below, no adverse effects on IQ were observed. The takeaway: At the controlled levels used in U.S. municipal systems, there's no credible evidence of risk, only proven preventive benefits.
What About Pregnancy and Expectant Moms?
One Canadian study linked prenatal fluoride exposure to lower IQ, but a deeper examination revealed limitations. Specifically, some participants had unusually high exposure, results emerged only in male children, and results shifted when adjusting for socioeconomic factors. Given its small sample and single-study nature, it's better viewed as a starting point, not a conclusion. The comprehensive body of research reveals no reliable evidence that fluoride at current U.S. drinking water levels poses developmental concerns during pregnancy or childhood.
Monitoring Safeguards: Keeping Fluoride Levels Safe
Water fluoridation levels are monitored at a community level, and the CDC tracks these levels. The United States aims for levels of 0.7 mg/L and not to be above 2 mg/L.
Here in North Carolina, regulations ensure fluoride is carefully maintained:
- North Carolina State rules require a daily monitoring regimen, keeping fluoride levels in the 0.6–1.0 mg/L operational control range, with monthly averages and 80% of daily readings required to stay within that band.
- The CDC's systemic report covering 2016–2021 found fluoride levels exceeding 2 mg/L in just 0.01% of measurements, and often trends were toward levels being too low rather than too high.
Fluoride Levels in Raleigh's Water
Raleigh takes water quality seriously. According to the City's public utility, fluoride is added to drinking water as hydrofluorosilicic acid (H₂SiF₆), aiming for a consistent concentration of 0.7 mg/L, aligning with EPA recommendations. Monthly water reports are available to the public.
The Bottom Line for Raleigh Families
- Yes, fluoride in water works. Decades of research show it effectively reduces cavities and promotes oral health, boosting equity in dental care access.
- No, U.S. levels don't pose developmental risks. Neurodevelopmental concerns only emerge at much higher fluoride levels, not those present in your local tap water.
- Yes, monitoring is robust. North Carolina's regulatory framework and Raleigh's utility ensure fluoride is maintained safely at around 0.7 mg/L.
- Topical fluoride remains important. Alongside fluoridated water, brushing with fluoride toothpaste, flossing, and regular dental visits continue to be essential.
Water fluoridation may seem complex, but its story is simple: it is one of the most significant public health successes of the 20th century. And right here in Raleigh, every glass of tap water is a step toward a healthier smile.
If you'd like help structuring family oral care or discussing fluoride usage, Peace Street Dental is here to help.
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