Fluoride is a naturally occurring element, abundant in the Earth’s crust. It is not essential for growth and development of humans or other organisms. Most fluorine occurs as insoluble fluorides, but there is some ionised fluoride in soil and groundwater.
There are large differences in the amount of fluoride found naturally in water supplies. Observation of large populations suggested that people drinking water high in fluoride have better dental health, and less tooth decay, than those consuming less fluoride as they drink. As a result, some countries have added fluoride to drinking water as a public health measure. This remains controversial. Some suggest that it is unnecessary, because most people receive enough fluoride from other sources. These now include fluoridated toothpastes and mouthwashes, which are widely used. In addition, there have been suggestions that adding fluoride to drinking water can produce adverse health effects, and that the environmental risks of the most common fluoridating agents have not been fully assessed.
Concentration of fluoride in groundwater in the EU is generally low, but there can be large variation in the levels in natural drinking water between and within countries. In Ireland, for example, levels vary between 0.01 parts per million (ppm), or mg/L and 5.8 ppm, in Finland between 0.1 and 3.0 mg/L and in Germany between 0.1 and 1.1 mg/L.
In Europe, Ireland and some regions in Spain and the UK currently add fluoride to drinking water, at levels ranging from 0.2 to 1.2 mg/L.
People’s exposure to fluoride varies a lot, depending on levels in water, what toothpaste they use, and other factors like use of mineral water and some kinds of tea. The existing collection of risk assessments suggests that there is quite a narrow gap between the fluoride intake recommended to safeguard teeth and the maximum recommended exposure.
In Europe, exposure assessments have been made by the European Food Safety Authority (EFSA). The Authority has set upper tolerable intake levels related to levels in natural mineral waters and other common sources of fluoride. The Commission Scientific Committee on Consumer Products has also set levels for fluoride in dental products.
As questions continue to be asked about water fluoridation in countries where it is added to the water supply, the Commission asked the Scientific Committee on Health and Environmental Risks (SCHER) for updated advice on the latest research findings.
This report reviews these findings and assesses the risks and benefits of fluoridation in the light of estimates of fluoride intake by different groups of people.