This article was previously published February 19, 2019, and has been updated with new information.

According to the U.S. Centers for Disease Control and Prevention,¹ 40% of children between the ages of 3 and 6 use potentially dangerous amounts of toothpaste.

The CDC and American Dental Association (ADA) recommend using no more than a pea-sized amount for children in this age group, and those younger than 3 should use no more than the size of a rice grain on their toothbrush.

The problem with using excessive amounts of toothpaste has to do with the fluoride it contains. If you look closely, you’ll find fluoride-containing toothpastes have a warning on their label stating that “If you accidentally swallow more than used for brushing, seek professional help or contact a poison control center immediately.”

This warning was made mandatory for fluoride-containing dental products by the U.S. Food and Drug Administration in April, 1997.² Ironically, while swallowing toothpaste is recognized as a cause for concern, we’re supposed to believe that drinking fluoridated water at any quantity is not only safe but beneficial for our teeth.

Too Much Fluoride Causes Dental Fluorosis

The fact of the matter is that fluoride is a toxic substance with no known biological imperative. Researchers have even questioned its efficacy as a topical anticaries prophylactic.³

Dental caries is caused by demineralization of your teeth by the acids formed during the bacterial fermentation of dietary sugars. Demineralization is countered by the deposit of minerals from your saliva. However, the remineralization process is a slow one, and fluoride is said to prevent dental caries by enhancing this remineralization.

The problem is, your teeth do not actually rely on fluoride for remineralization. What’s more, research⁴ has concluded that the protective shield fluoride forms on teeth is up to 100 times thinner than previously believed. It has long been believed that fluoride changes the main mineral in tooth enamel, hydroxyapatite, into a more-decay resistant material called fluorapatite.

However, the researchers found that the fluorapatite layer formed in this way is only 6 nanometers thick — meaning it would take almost 10,000 such layers to span the width of a human hair. As noted by the authors, “it has to be asked whether such narrow … layers really can act as protective layers for the enamel.”

Meanwhile, fluoride has been shown to cause significant systemic harm when ingested, which is part and parcel of the CDC’s 2019 warning against using too much toothpaste. As reported by the Chicago Sun Times:⁵

“Brushing with too much toothpaste can damage enamel, as children could swallow too much fluoride while their teeth are developing, the CDC says. This can cause dental fluorosis, white marks and discoloration of teeth.”

However, dental fluorosis is just the tip of the iceberg when it comes to fluoride damage. For example, evidence shows fluoride is an endocrine disruptor that can affect your bones, brain, thyroid gland, pineal gland and even your blood sugar level.⁶ Importantly, it’s a known neurotoxin, shown to lower IQ in children.⁷

Over Half of US Kids Have Fluoride-Damaged Teeth

According to research⁸ presented at the April 2017 National Oral Health Conference in Albuquerque, New Mexico, 57% of youth between the ages of 6 and 19 years have dental fluorosis, a condition in which your tooth enamel becomes progressively discolored and mottled.

When Fluoride Action Network (FAN) researchers analyzed the same set of data, they found over 21% of adolescents had moderate fluorosis and 2% had severe fluorosis.⁹

According to FAN, “The data suggests that up to 24 million adolescents now have some form of dental fluorosis, with over 8 million adolescents having moderate fluorosis, and 840,000 having severe fluorosis.” Incredibly, the situation is still worsening. According to the most recent data, which has yet to be published, the dental fluorosis rate in the U.S. may now be a staggering 65%.¹⁰

In stark contrast, when water fluoridation was first started in the U.S. in 1945, it was promised that only 10% of people would suffer from mild dental fluorosis at the then-recommended levels.¹¹ Clearly, they were wrong.

In 2011, concerns over escalating fluorosis rates prompted the U.S. Department of Health and Human Services to lower the recommended level of fluoride in drinking water, from a previously recommended range of 0.7 to 1.2 mg/L to 0.7 mg/L.

However, adverse effects, including reduced IQ, behavioral alterations, neurochemical changes, hypothyroidism and attention deficit hyperactivity disorder (ADHD) have been demonstrated even at that lower level, so while it reduced exposure for many, the most serious risks remain.

What’s more, reduced IQ has been seen in study participants with higher urinary fluoride concentrations even when no dental fluorosis was present, which suggests the doses of fluoride that impair cognitive ability are far lower than those that cause severe dental fluorosis.¹²

Fluoridated Water Is Likely a Far Greater Concern

Unfortunately, public health officials often brush off fluorosis as a purely aesthetic issue, one they believe is an okay trade-off for the supposed benefits of fluoride. In reality, dental fluorosis is an outward sign that fluoride is damaging the body in other ways as well.

Research has found impairment in cognitive abilities among children with fluorosis (even mild fluorosis) compared to children with no fluorosis, for example. Studies have also found that children with higher levels of fluorosis have increased rates of cavities^13,14 — a finding that suggests more is definitely not better, not even when it comes to protecting against cavities.

Importantly, the CDC completely ignores the role fluoridated water plays in this epidemic, as toothpaste is by far not the only source of fluoride for young children, and probably isn’t the most significant source either.

In a January 2019 study¹⁵ in the Journal of Clinical and Experimental Dentistry, the prevalence of dental fluorosis among 10- to 12-year-olds in three Ecuadorian provinces was nearly 90%. According to the authors, “A positive statistical relationship and statistical significance was detected between dental fluorosis and consumption of bottled beverages.”

A “low negative” relationship between fluorosis and brushing with adult toothpaste without help suggests fluoridated water (used in bottled beverages) is likely to be a greater risk factor than toothpaste exposure, although toothpaste ingestion may still play a role.

CDC and Mainstream Media Ignore the Elephant in the Room

In response to the CDC’s toothpaste warning, FAN writes:¹⁶

“A spate of news stories … focused on kids swallowing too much toothpaste. But according to Paul Connett, Ph.D., FAN Director, ‘The defenders of water fluoridation are missing the real story. Dental fluorosis is a biomarker of over-exposure to fluoride and the ‘elephant in the room’ is what damage fluoride is doing to other tissues.’

Recent scientific research indicates that exposure to fluoridated water may lower thyroid function^17,18 and 350 published studies indicate that fluoride can damage the brain … While it is understandable that die-hard promoters of fluoridation should be fixated on any study dealing with teeth, it is less understandable why the media should ignore fluoride’s impact on the brain.

The fetal brain is under attack from several environmental toxins¹⁹ but only one, fluoride, is deliberately added to our water. There are safer ways to prevent dental caries than exposing the fetus to a neurotoxicant … Repeating the dogma that fluoridation is “safe and effective” many times does not make it so.

Connett urges more scientists to overcome this dogma and intimidation and review the brain studies themselves … fluoride-brain studies are readily accessible.²⁰ Connett added that, ‘I believe that the intellectual ability of future generations depends on their willingness to do this. Neither intimidation nor dogma has a place in science or public health.'”

Protecting Your Dental Health Has Nothing to Do With Fluoride

When it comes to good oral hygiene and preventing cavities, it’s important to realize that drinking fluoridated water and brushing with fluoridated toothpaste is not the answer. It’s far more important to address your nutrition and basic oral care. Here’s a five-step plan that can help you improve your oral health, without the use of toxic agents such as fluoride:

Children Should Avoid Fluoride From All Sources

For instructions on how to brush and floss properly, as well as oil pulling guidelines, see “Dental Dedication: Improve Your Oral Health.” In the video above, Bill Osmunson, a practicing dentist and staunch advocate against fluoride, also discusses some of the variables that contribute to good oral hygiene (summarized above).

Remember, by avoiding sugars and processed foods, you prevent the proliferation of the bacteria that cause decay in the first place. Following up with proper brushing and flossing and getting regular cleanings with a mercury-free biological dentist will ensure that your teeth and gums stay healthy naturally.

Many natural substances, such as vitamins C and K2, Coenzyme Q10 and homeopathic tissue salts such as silica, calcarea fluorica (calcium fluoride, not to be confused with sodium fluoride found in toothpaste), calcium phosphate and calcium carbonate, also have the power to improve the health of your teeth and gums.

Fluoride really has no major advantage, only hazards. And those hazards go far beyond the visible signs of dental fluorosis. Far worse is the damage that occurs inside the body, which you cannot see.

So, in addition to teaching your children about proper nutrition and oral care, be mindful about limiting their fluoride exposure from all sources, including toothpaste and other dental products, fluoridated water, fluoridated pesticides (and hence pesticide contaminated foods), bottled beverages such as juices and teas, fast food packaging, non-stick pots and pans, fluorinated drugs, fluoridated table salt and mechanically deboned chicken.

Just four weeks after we celebrated our 10th annual Mercury Awareness and Mercury-Free Dentistry Week, the U.S. Food and Drug Administration released a long-overdue safety communication on amalgam.

In an astounding about-face to its previous stance, the FDA issued a warning that mercury fillings may adversely affect pregnant women, children and other susceptible individuals, and should be avoided by these groups.

The safety communication¹ was posted September 24, 2020, and with this, we have suddenly achieved an incredibly important goal that we’ve had our sights on for the last decade!

Goal Achieved: FDA Releases Amalgam Safety Communication

As noted in the FDA’s statement:²

“Today, the FDA is issuing updated recommendations concerning dental amalgam and potential risks to certain high-risk individuals that may be associated with these mercury-containing fillings …

The FDA has found that certain groups may be at greater risk for potential harmful health effects of mercury vapor released from the device [amalgam]. As a result, the agency is recommending certain high-risk groups avoid getting dental amalgam whenever possible and appropriate.”

Groups identified by the FDA as being at increased risk for harmful effects from dental mercury fillings include:

FDA Admits Amalgam Dangers

After years of pressure from Consumers for Dental Choice and its allies, the FDA finally admits the unvarnished truth about amalgam, noting³ that “Dental amalgam is a mixture of mercury and a powdered alloy made up of silver, tin and copper” that “releases small amounts of mercury vapor over time.”

The FDA has found that certain groups may be at greater risk for potential harmful health effects of mercury vapor released from the device [amalgam]. As a result, the agency is recommending certain high-risk groups avoid getting dental amalgam whenever possible and appropriate.

The agency also admits there are “uncertainties” and risks associated with this mercury vapor release, especially for the high-risk groups listed. In particular, there is “the potential for mercury in dental amalgam to convert to other mercury compounds in the body,” and mercury could potentially accumulate in body fluids and tissues, resulting in “unintended health outcomes.”

“These uncertainties in the most vulnerable patients are why today we are recommending people who may be at high risk for adverse health effects of mercury exposure use non-mercury alternatives to dental amalgam, such as composite resins and glass ionomer cement fillings,” the FDA states.⁴

While the FDA downplays the importance of its changed recommendation by stressing that the benefits of dental amalgam likely “outweigh their risks for most patients,” this update is nothing short of monumental, and opens the door, finally, for the elimination of dental mercury for all patients in the U.S., as has been done in many other countries already.

I want to take this opportunity to thank all of you who have supported Consumers for Dental Choice during these past 10 years, as it is this organization’s unwavering dedication that has now borne fruit.

Consumers for Dental Choice Sued FDA — and Won

The FDA is legally required to classify — that is, issue a rule for — all medical devices, including dental amalgam. But for 30 years, FDA dodged its legal duty to classify amalgam.

Consumers for Dental Choice put an end to FDA’s negligence when, in 2008, this dynamic nonprofit organization assembled plaintiffs and sued FDA, demanding that amalgam be classified. The judge agreed and told FDA to sit down with Consumers for Dental Choice to determine a deadline. FDA was compelled to commit to classifying amalgam by July 2009.

But when July 2009 came around, it was clear the FDA had not considered the science — especially the evidence of harm amalgam can cause vulnerable populations like children, pregnant women and breastfeeding mothers.

Its abysmal rule reflected this shortcoming, as it did not restrict the use of amalgam for these most vulnerable individuals. The rule did not even require that patients be told that amalgam is made of mercury. Nonetheless, FDA’s 2009 rule did acknowledge that amalgam could be harmful, and that there was no proof of safety for the populations most susceptible to this toxin.

In response, Consumers for Dental Choice challenged FDA’s rule, while simultaneously pursuing other opportunities to advance mercury-free dentistry, like defeating pro-mercury state dental boards, fighting for amalgam fact sheet laws for patients at the state level, and getting amalgam into the Minamata Convention on Mercury.

As Consumers for Dental Choice racked up win after win — regaining licenses for mercury-free dentists persecuted by state boards, gaining fact sheets to protect dental patients, achieving an amalgam reduction requirement in the Minamata Convention — the FDA’s rule was looking increasingly archaic.

Decade-Long Wait Is Over

Nearly a decade after the FDA issued its flawed amalgam rule, Consumers for Dental Choice launched a nonstop campaign focused on getting the FDA to move on amalgam.

They assembled an accomplished team of experts to approach the FDA, and in 2018, unveiled the “Chicago Declaration to End Mercury Use in the Dental Industry” at the University of Illinois School of Public Health.

This declaration, signed by more than 50 heavy-hitter environmental groups, called on the FDA “to bring its policies in line with the Federal Government as a whole and with its responsibilities under the Minamata Convention and to publicly advise a phase down of the use of mercury amalgams with the goal of phasing out entirely.”

The declaration also called for the immediate ban on amalgam use in children, pregnant women and breastfeeding mothers. Working with key signatories to the “Chicago Declaration,” Consumers for Dental Choice were able to secure meetings with top officials at the FDA, during which they were able to submit scientific studies for the FDA to review.

The first sign of progress came with the FDA’s September 2019 scientific review⁵ of amalgam, “Epidemiological Evidence on the Adverse Health Effects Reported in Relation to Mercury from Dental Amalgam,” which recognized that the elemental mercury in dental amalgam can convert inside the body into toxic methylmercury — the same type of mercury that the FDA warns about in fish.

The FDA also recognized bioaccumulative effects of mercury. Since patients are exposed to many sources of mercury — including high-mercury fish in their diets, occupational exposures and environmental mercury from waste incinerators — the mercury from amalgam could be the proverbial straw that breaks the camel’s back.

FDA Reverses Stance on Amalgam

Consumers for Dental Choice also organized a strong showing of public support from you. Its online petition, which had nearly 50,000 signatures, was presented to the FDA in person at its first meeting with the agency. Many of you also submitted public comments on patient preferences to the FDA.

FDA was also made aware of the changes to amalgam rules in other parts of the world, such as amalgam phase-out dates set by the Philippines, Ireland, Slovakia, Finland, Nepal, Moldova, Czech Republic and New Caledonia, and the bans on amalgam use in children issued by the European Union, Vietnam and Tanzania.

Having finally reached the top of the FDA, Consumers for Dental Choice succeeded in persuading the agency to reopen and take another in-depth look at the amalgam policy.

A scientific advisory committee meeting — which included testimonies by 16 experts from the Children’s Environmental Health Network, Tuskegee University, the International Indian Treaty Council, the Organic & Natural Health Association and the Connecticut Coalition for Environmental Justice, as well as city and county commissioners, a physician expert in environmental justice, a pharmacist specializing in toxicology and several attorneys — took place in November 2019.

You can see Consumers for Dental Choice’s team and their colleagues in action in the video below, which features highlights of the advisory panel meeting.

Ultimately, the FDA advisory committee members recommended the agency provide information to patients about the risks of dental amalgam, especially for vulnerable populations. Many even agreed that the use of amalgam needs to end, which has been the goal of Consumers for Dental Choice all along.

Final Step Ahead

Now that the FDA has finally broken its silence on the dangers of mercury for pregnant and nursing mothers, children and people with certain underlying conditions, the final step — a full ban on amalgam for all — looms near.

The American Dental Association, which has long defended amalgam’s safety, is now running out of allies. For now, however, the ADA still maintains its contrarian view.

In response to the FDA’s updated recommendations, the ADA stated⁶ that there was “no new scientific evidence cited as part of the FDA recommendation,” and that the ADA “reaffirms its position that dental amalgam is a durable, safe and effective cavity-filling option.”

On the upside, the ADA affirmed its support of patient decision-making, agreeing with the FDA’s statement that “all dental restorative decisions and treatment options should be made by the patient and the dentist.”

Seeing how the ADA’s ethical rules in the past were used by state dental boards to bar dentists from even informing patients about the fact that mercury is a key ingredient in amalgam, and how the ADA deceptively promoted amalgam as “silver fillings,” this shift, while small, is better than nothing.

In its September 24, 2020, safety communication on dental amalgam,⁷ the FDA specifically advises dentists against using the term “silver filling,” “as this may imply the filling is made solely from silver and does not accurately convey the mercury component of this restorative material.” The FDA also highlights this in its Dental Devices description page for amalgam, which received its last update September 29, 2020, noting that:⁸

“Dental amalgam is a mixture of metals, consisting of liquid (elemental) mercury and a powdered alloy composed of silver, tin, and copper. Approximately half (50%) of dental amalgam is elemental mercury by weight. The chemical properties of elemental mercury allow it to react with and bind together the silver/copper/tin alloy particles to form an amalgam.

Dental amalgam fillings are often referred to as ‘silver fillings’ because of their silver-like appearance, although the use of this term in not recommended because the term does not correctly explain the materials in amalgam.”

Most of us who have fought for this updated FDA amalgam policy for the past decade are still in shock that it finally happened, and without any significant forewarning. That said, it is fantastic good news, and we extend our thanks to all of you who have fought this battle with us.

The FDA’s updated recommendations change everything, because once amalgam is recognized as a hazard for specific high-risk groups, it doesn’t take much to expand that logic to include all people.