You may brush and floss consistently and visit the dentist twice a year, but without enough fluoride, your teeth could still be in trouble.
Here’s What Happens When You Don’t Get Enough Fluoride, Says a Dental Health Expert
Published on Jun. 06, 2025
What is fluoride and why is it important?
“Fluoride is a naturally occurring mineral that helps prevent tooth decay and keep your bones strong,” says Scott L. Tomar, DMD, DrPH, a spokesperson for the American Dental Association (ADA) and professor and associate dean for Prevention and Public Health Sciences at the University of Illinois Chicago College of Dentistry.
Fluoride’s oral health benefits are based on sound science. According to the Cleveland Clinic, fluoride’s key role is to help reduce tooth decay (prevent cavities) while strengthening tooth enamel.
The ADA states, “Fluoride can be delivered topically and systemically.” Ingesting it through drinking water or supplements is systemic and can strengthen teeth from the inside out. On the other hand, applying fluoride to your teeth with toothpaste or during a professionally-applied dental treatment is topical, strengthening the teeth to help prevent cavities.
What happens when you don’t get enough fluoride?
Most people in the U.S. get enough fluoride from a combination of diet (including beverages) and dental product use…but not everyone. Additionally, there’s growing concern that some will lose access to fluoridated tap water.
Tomar shares, “According to the CDC, in 2022, 72% of the U.S. population on public water systems—or a total of 209.1 million people—had access to fluoridated water.” However, just this year, Utah became the first state to ban CWF—and Florida just recently became the second.
Perhaps surprisingly, national data shows dental caries (cavities) are considered to be “the most chronic disease” in American children ages 6 to 19. “Studies show that children and teenagers who drink fluoridated water have fewer cavities than those who drink water with insufficient fluoride,” says Tomar. “Also, adults who drink fluoridated water experience less tooth decay and lose fewer teeth.”
Fluoride is vital for oral health. Without adequate amounts, you’re at greater risk for:
- Tooth decay: Too little fluoride makes your teeth more susceptible to developing cavities.
- Dental problems caused by cavities: Cavities can lead to pain, tooth loss and infections.
- Bone fractures: Fluoride isn’t just tooth-friendly; it’s bone-friendly.
- Weaker tooth enamel: Without enough fluoride, the enamel is more susceptible to erosion.
- Weaker teeth: Too little fluoride when young can lead to weaker teeth when older.
- Higher dental costs over time: This is due to fillings, cleanings, and restoration procedures.
- Kids missing school: Tomar says that dental problems are among the leading causes of missed school days.
Who might be at risk of low fluoride intake?
It’s important to be aware of the growing potential for inadequate fluoride levels. If you’re in one of these categories, it’s possible you may have a lower fluoride intake:
- Individuals in non-fluoridated communities: CWF brings water to optimal fluoride levels for dental health, greatly benefiting those without regular dental care access.
- People who drink bottled or specialty filtered water only: Bottled water may have sub-optimal fluoride levels. In-home reverse osmosis and distillation systems—but not carbon/charcoal filters—can reduce fluoride, according to the ADA.
- Those using only fluoride-free toothpaste: Sodium monofluorophosphate, sodium fluoride, and stannous fluoride in your toothpaste help prevent cavities. The ADA Seal of Acceptance means a toothpaste contains fluoride.
- Kids with restricted diets or poor dental hygiene: Low dietary fluoride intake coupled with low fluoride-containing toothpaste use can cause dental issues.
How to make sure you’re getting enough fluoride
Aim for a balanced approach to fluoride—more isn’t always better. These are all common methods of getting fluoride:
- Drink fluoridated tap water.
- Brush your teeth with fluoridated toothpaste.
- Rinse with a fluoridated mouthwash.
- Get a topical treatment, like a fluoride varnish, which can be applied by a dental professional.
- Consume dietary sources of fluoride, such as tea, coffee, and raisins.
For some, a higher fluoride level may be required. Tomar says that high concentration fluoride toothpaste, fluoride supplement drops, chewable tablets, or lozenges are all potential methods for dentists (or pediatricians) to treat these individuals.
Is it possible to get too much fluoride?
It’s possible to get too much fluoride, though it’s uncommon in America. Fluoride levels are carefully regulated in the U.S. for safety, significantly limiting any risk of kids getting fluorosis (tooth discoloration) or adults getting skeletal fluorosis (a bone and joint condition). And over-the-counter dental products only contain low levels of fluoride, according to the Cleveland Clinic.
Why is there confusion in the U.S. about fluoride and fluoridation benefits?
Unfortunately, the combined effects of misinterpretation of research, rapid spread of misinformation, and mistrust of medicine create some confusion about fluoride. But Tomar says the verdict of the scientific community is clear: “Fluoridation safely helps prevent tooth decay.”
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