These countries don't fluoridate their water – here's why

Fluoride is a mineral that has been added to drinking water in many countries to help prevent tooth decay. It works by strengthening the enamel, which is the hard outer layer of teeth, and by helping to replace minerals lost due to acids from food. This practice, known as water fluoridation, has been credited with reducing cavities, especially among children. However, not all countries fluoridate their water supplies, and some have even stopped the practice. This article explores the reasons behind these decisions and the effects they have had.

In the United States, about 63% of the population receives fluoridated water. The practice began after scientists noticed that people living in areas with natural fluoride in their water had fewer dental problems. Fluoride can be applied topically through toothpaste, but drinking water provides a low, constant dose that benefits everyone in the community. This is especially helpful for children and people from lower-income backgrounds who may not have regular access to dental care.

Despite the benefits, some people oppose water fluoridation. Concerns include potential health risks from too much fluoride, such as dental fluorosis, which causes white spots on teeth, or more serious bone problems at very high levels. Some countries avoid adding fluoride because their natural water already contains high levels of the mineral. Others have stopped fluoridation due to public complaints or because their populations receive fluoride through other means, like fluoridated salt or milk. For example, Thailand provides fluoridated milk to children in schools, which has been effective in reducing tooth decay.

Different countries have adopted various methods to deliver fluoride to their populations. While water fluoridation is common, some countries add fluoride to table salt or milk instead. These alternatives can be useful where water fluoridation is not practical or where natural fluoride levels are already high. Access to dental care also influences these decisions. In countries with good dental coverage, fluoridation may be less necessary. However, experts warn that stopping fluoridation can increase health inequalities, as disadvantaged communities often suffer the most from tooth decay. Overall, fluoride remains an important tool in public health for preventing dental disease, but its use must be carefully managed to ensure safety and effectiveness.