The Tokkels: stop tooth decay

You can stop tooth decay by following a few simple rules. Use fluoride toothpaste; spit, don't rinse; brush before, not after, meals.

Media last reviewed: 14/11/2013

Next review due: 14/11/2015

Dental advice for children

  • Children up to three years of age should use toothpaste with a fluoride level of at least 1,000ppm (parts per million).
  • After three years of age, children should use toothpaste with a fluoride level of 1,350-1,500ppm. The level of fluoride can be found on the pack.
  • Children should be supervised when brushing their teeth until about seven years of age.
  • The amount of toothpaste your child uses is important. Up to the age of three, a smear of toothpaste is sufficient, and from age three to six, a pea-sized amount is recommended.
  • Encourage your child to spit the toothpaste out after brushing their teeth rather than swallowing it.

Your dentist will be able to answer any further concerns or questions about caring for your child's teeth.

Find your nearest dentist.

Fluoride is a naturally occurring mineral found in water in varying amounts, depending on which area of the UK you live in.

It's also found in certain foods, including tea and fish.

Fluoride’s main benefit is in helping reduce the risk of tooth decay, which is why it's added to many brands of toothpaste and, in some areas, to the water supply through a process called fluoridation (see below).

Tooth decay

Tooth decay, also known as dental decay or dental caries, is a major health concern worldwide and it's still a big problem in the UK.

For example, tooth decay is one of the most common causes of hospital admission in children. While levels of decay have fallen in recent years, significant inequalities between communities remain.

Tooth decay occurs when acid in your mouth attacks the outer layers of your teeth. The acid is produced by bacteria that form a layer called plaque on the surface of your teeth. Eating and drinking sugary food and drink is the main cause of acid formation in plaque.

If you're at risk of tooth decay a cavity (hole) may develop in your tooth. If the decay spreads further into the tooth, the tooth can become infected, which can be painful. A dental abscess (a collection of pus that forms in the teeth or gums) may also develop.

How does fluoride protect teeth?

Fluoride disrupts the process of tooth decay by:

  • changing the structure of developing enamel, making it more resistant to acid attack – these structural changes occur if a child consumes fluoride during the period when enamel develops (mainly up to seven years of age)
  • encouraging better quality enamel to form that's more resistant to acid attack
  • reducing plaque bacteria’s ability to produce acid, which is the cause of tooth decay


Most water supplies contain some fluoride and around half a million people in the UK receive naturally fluoridated water.

Another 5.5 million people receive water that has had the fluoride concentration raised to around one part per million (1ppm). This level of fluoridation has been shown to have the most benefit for reducing decay levels.

The maximum amount of fluoride permitted in drinking water is 1.5 mg/l (milligrammes per litre).

The West Midlands has the biggest water fluoridation scheme in the UK, which serves over three-quarters of the local population. There are also smaller schemes in operation in other parts of the country, including the North East, the East Midlands, Eastern England, the North West and Yorkshire and Humber.

In the early 20th century, levels of tooth decay were found to be associated with fluoride levels in drinking water. This led to the introduction of water fluoridation schemes to add fluoride to water supplies where the level was low.

The first fluoridation scheme was introduced in the US in 1945, in the city of Grand Rapids, Michigan. Following pilot schemes, the first substantive UK scheme was in Birmingham in 1964. There are extensive schemes in Australia, Ireland and the US.

Over the past 50 years, there have been several reviews of the safety and effectiveness of water fluoridation schemes. Recent reviews have been carried out by the:

Overall, the reviews have found that water fluoridation contributes to reduced decay levels in populations, although the amount of reduction varies depending on the measures used.

Your local water supplier should be able to tell you how much fluoride is present in your water supply and whether fluoride is being added.

Fluoride treatments

Dentists recommend that children and adults should brush their teeth using toothpaste that contains fluoride. For those who are particularly prone to tooth decay, mouthwash, gels, tablets or toothpastes containing higher concentrations of fluoride are also available. Ask your dentist for advice before using these treatments.

Fluoride varnish is another treatment that can be used to help protect against tooth decay. The varnish contains high levels of fluoride and is painted onto the surface of both baby and adult teeth. It works by strengthening the tooth enamel, making it more resistant to decay.

Read more about fluoride varnish and how to look after your child’s teeth.

Safety and risks

There have been some concerns that fluoride may be linked to a variety of health conditions. Reviews of the risks have found no evidence to support these concerns and the general consensus is that water containing the correct amount of fluoride and fluoride toothpaste have a significant benefit in reducing tooth decay.

However, a condition called dental fluorosis can occur, particularly if a child’s teeth are exposed to too much fluoride when they're developing.

Mild dental fluorosis can be seen as very fine pearly white lines or flecking on the surface of the teeth. It can often only be diagnosed by a dental expert because other conditions may give a similar appearance. Severe fluorosis can cause the tooth’s enamel to become pitted or discoloured.

Fluorosis that might be of concern from an aesthetic perspective is rare in the UK because levels of fluoride in water, both natural and added, are carefully monitored and if necessary adjusted. 

Because fluorosis can be difficult to spot and record consistently, new research methods are being used to photograph children’s teeth in studies looking at levels of fluorosis in populations.

The Drinking Water Inspectorate (DWI) is an independent organisation that checks that the water companies in England and Wales supply safe drinking water that meets legal standards.

Read more about the DWI’s latest research findings.

Page last reviewed: 08/01/2014

Next review due: 08/01/2016


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The 19 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Civitatis said on 23 August 2014

The following countries banned or outlawed the addition of "fluoride" to drinking water (with dates).

Federal Republic of Germany (1971)
Sweden (1971)
Netherlands (1976)
Czechoslovakia (1990)
German Democratic Republic (1990)
Soviet Union (1990)
Finland (1993)
Japan (1972)
China (2002)
Israel (2014)

The following countries have rejected artificial fluoridation of public water supplies: Austria, Belgium, Finland, France, Germany, Hungary, Luxembourg, Netherlands, Northern Ireland, Norway, Sweden, Switzerland, Scotland, Iceland and Italy. India has legislation to require the removal of fluoride as a toxic waste industrial by-product from water supplies.

Countries that still add the "fluoride" chemical compound to the tapwater, bottled water, table salt and milk supplies of their populations to "medicate" the people are: The United Kingdom; United States of America, Canada, Australia, Hong Kong and Vietnam.

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Civitatis said on 23 August 2014

Did you know that "fluoride" added to your tapwater, bottled water, toothpaste, salt and milk is not the mineral or nutrient known as calcium fluoride but is in fact "fluoride" a generic industry name for a cocktail of toxic chemicals and acids whose names include:
fluorosilicic acid, sodium fluorosilicate and sodium fluoride. Sodium fluoride is a synthetic toxic waste known to cause cancer. Fluorosilicic acid is a waste product of the phosphate fertilizer industry and is heavily contaminated with toxins and heavy metals (including the cancerous arsenic, lead and cadmium) and radioactive materials. The fluoride added to 90% of drinking water is hydrofluoric acid which is a compound of fluorine that is a chemical byproduct of aluminum, steel, cement, phosphate, and nuclear weapons manufacturing industries that are too toxic to release into the atmosphere as a gas so are liquified and sold as "fluoride"
Hydrofluoric acid is used to refine high octane gasoline, to make fluorocarbons and chlorofluorocarbons for freezers and air conditioners, and to manufacture computer screens, fluorescent light bulbs, semiconductors, plastics, herbicides and toothpaste.

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Rosielea7 said on 21 July 2014

This website tells you to give your opinion but when you do and it is against fluoride being added to the water and saying why, they wipe your comments off, so people can not read them because they want you to believe only that fluoride is natural and good for your teeth when it is Toxic by product waste from aluminium, read up on Sodium fluoride and judge for yourself!!!!

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Miss Common Sense said on 24 June 2014

If fluoride was so effective for reducing tooth decay then explain to us why in the world is the state of people's teeth so miserable? There is no evidence whatsoever that fluoride benefits us in any way. In fact, there are countries in Europe that have recognised the toxicity of floride and for that reason do not add that to their drinking water. When will 'the bright heads' of UK wake up?

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CllrChris said on 15 February 2014

Wasn't so very long ago dentists and doctors were sagely advising us to smoke particular brands ofcigarettes! Nothing changes. Now, and more dangerously in my view, they tell us fluoride (a deadly poison) is good for us (or at least for our children's teeth). Their "science" is observational "junk" science. It's like some sort of institutionalised, professional insanity has gripped the health world. Still, with what we know of hexafluorosalic acid and it's other industrial waste dirivitives (they call it "fluoride"), it will provide a lifetime of extra business for the health services for all the "unexplained" modern diseases fluoride may lead to.

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liamb87 said on 31 December 2013

We should have the choice to decide if we want to take fluoride or not. I shouldn't have to buy an expensive filter to get rid of it. If you want it buy products that have fluoride in it. Fluoride, regardless of if it helps dental health or not, is not meant to be ingested so putting it in our tap water is stupid and reckless considering the conflicting studies. I agree with the conclusion at: http://www.breathmd.com/fluoride.php

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areyouselfempowered said on 11 December 2013

Fluoride is bad news people take it out now!

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Sexchef said on 23 July 2013

Calcification of the pineal gland, is the main reason to add this poison they call fluoride. This is an effective way to 'Dumb-down," the population and weaken the immune system.
Next on the assault are Chem-Trails. GM foods, processed foods and additives.
There is no argument for tooth protection. Hear is the truth 'CLEAN TEETH DON'T DECAY.' If you give your kids candy, soda drinks, ice cream, cakes and refined sugar, then you have found the problem. Fix the Problem.
They put the poison in our air, the poison in our water and the poison in are food; then come up with a study to say, "It is Good for You."
Hear is one report, that said half the UK will have cancer by 2020. http://www.bbc.co.uk/news/health-22796220
Rich people do not expose themselves to these poisons, it is only for the masses. Wake up it and refuse to be poisoned.

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Orange Squeeky said on 30 March 2013

Please read this inreresting article on this subject: http://greenparty.org.uk/files/reports/2004/fluoride%20%281%29.htm

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Upset_Chap said on 27 February 2013

A few more facts for consideration are the positive correlation between fluoride and calcification of the pineal gland (https://www.ncbi.nlm.nih.gov/pubmed/?term=11275672) and a recent study showing a drop in IQ for children exposed to fluoride (http://ehp.niehs.nih.gov/2012/10/developmental-fluoride-neurotoxicity-a-systematic-review-and-meta-analysis/).

Which in turn corresponds with research into the effects of a damaged pineal gland (http://www.ncbi.nlm.nih.gov/pubmed/17097768, http://www.ncbi.nlm.nih.gov/pubmed/7556503) and that severe damage can result in "accelerated development of the sexual organs, increased growth of the skeleton and precocious mentality" (http://www.theodora.com/anatomy/the_pineal_body.html).

How long will we continue to ignore the evidence that fluoride is dangerous and detrimental to our health in the pursuit of dental hygiene?

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De THeodoppolus said on 25 February 2013

You can get a Dr from anywhere in the world, with any incentive, with any amount of experience, with any level of interest to give a professional opinion or do a study.

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fluoridecommunity said on 24 February 2013

i have looked ver your website and provided the real facts for you to change and update,

A few quick questions and answers about fluoride!

I was asked how can I understand this matter and be able to think about all the jargon to make it simple. Well I had to think about that as I was relying on environmental scientists and chemical personnel to help, then I had a thought this might help.
A few questions and answers:

1. When was fluoridating the water started and when?
It was started back in the 1938 USA, Dr Gerald cox of the Mellon institute (the Mellon’s were owners of the aluminium company of America) they began promoting the addition of fluoride in the water in 1944 making the claim it will reduce tooth decay.
2. What chemical did they use? What is the quantity used?
Well that’s a good question in the UK we started with some towns having naturally-occurring fluoride called calcium fluoride or sometimes called fluorspar. This being natural in form with half being calcium and the other half being fluoride, when you drink fluoride it’s a toxin but mixed with calcium it becomes a form of natural antidote, this lead to people in the chemical industry pushing to promote dosing the water for medical reasons “dental caries on mass” and they used a man-made chemical which never occurs in nature and contains no calcium. It is a liquid, corrosive acid which comes from the wet scrubbers of phosphate fertilizer industry, where noxious hydrogen fluoride gas fumes are collected in an aqueous mixture of industrial by-products normally in phosphate fertilizer, aluminium production.
The waste chemical used is part of the halogen group are iodide and chloride (ion)
• Hydrofluosilicic acid.
• Silicofluoride.
• Sodium fluoride.
• Hexafluorosilicic acid.
• Fluorosilicic acid.
• fluosilicic acid.
• silicofluoric acid.
this is just some facts for you to cinsider.

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cheesy smile said on 12 December 2012

it appears to me that this site does not want anyone know the damage fluoride can do to us especially young children. I have tried to post a link to a video but it was rejected with this message,

Thank you for contributing to the NHS Choices website. We do not allow messages offering medical advice or directing others to sites where such advice is given. All medical advice on NHS Choices has been signed off as clinically accurate by medical professionals. Please consider re-submitting your message without offering any 'advice' to other users

why then was `Zeee` on the 3rd Dec allowed to direct people another site about the dangers of fluoride, perhaps the video i tried to post had too much conclusive evidence about fluoride being used as a tool to control the population.

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jlm20012 said on 06 December 2012

I have recently had a baby and been advised to give him flourise supplements by family but have been given conflciting advise from different people, including dentits. The water compnay in our area does not add fluoride to the water they supply to customers and have no plans to do so. Should i give him supplements or not?

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Zeee said on 03 December 2012

Just go and read some facts on this page http://www.fluoridealert.org/articles/fluoride-facts/
Why put fluoride in the drinking water, when it's not meant to be swallowed? It protects the teeth only if you put it on them, otherwise it has risks. Specially to babies, and I can see that someone already complaint here about that. We live in a democratic country, why put medicine in water? As western Europe has demonstrated, there are many equally effective and less-intrusive ways of delivering fluoride to people who actually want it. So please NHS stop putting fluoride into water, exposing lives at health risk!

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nuisance said on 10 October 2012

My daughter who is 8 has white spots on her front teeth, we went to the dentist and said it was because of the fluoride in water and toothpaste, she said there's nothing they can do because the nhs wont cover "cosmetic treatment", i always thought i did the right thing in brushing her teeth with fluoride toothpaste, and even thought drinking water was good for our health, then what? Should the water company or the toothpaste factory should pay for the cost of treatment? What about my daughter's self esteem, we can not afford this expense.

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Simon Khoury said on 25 September 2012

Fluoride is not only safe its also a tried and tested method of massively reducing your risk of tooth decay.

I spent many years as a child in an army family where we were given fluoride supplements and as a 34 year old adult I have no fillings, no gum disease and my mouth is healthy. However a lot of this is due to eating healthily and brushing well.

Fluoride is so widespread in use in so many countries if there were associations with disease it would be very, very obvious. No significant, well conducted research shows fluoride to be harmful, whereas hundreds of well conducted scientific studies have shown the benefits of fluoride.

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mumnatasha said on 27 August 2012

I found my baby record book from 1988 , & found i was given fluoride & vitamins every day with my lunch from 1 month old... later at 3yrs old my teeth had crumbled and had to go through an ordeal of having 8 top teeth removed.. i feel my mother was mislead to give me fluoride which i believe was not needed and lead to my teeth going bad , also a thyroid problem

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jebd40 said on 07 July 2011

why can't I read comments made by other people??

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From brushing their first tooth to their first trip to the dentist, here's how to take care of your children's teeth

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