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Facts on fluoride: Q&A with Dr. George Koumaras

If you go online for health information — like many of us do — you know it’s as easy to find myths and conspiracy theories as it is scholarly articles and medical data. Now, don’t get me wrong. A free exchange of ideas is what our country was built upon and we should not seek to silence the diversity of opinions on the Internet. That said, when theories and urban legends become mainstream, it is helpful to go back to the data to separate fact from fiction.

One topic that has heated up in some corners of the internet is fluoride. Yes, the stuff that’s in our water and your dentist applied on your teeth when you were a kid, is now believed by some to cause everything from cancer to early adolescence.

To separate fluoride fact from fiction, I ran a few questions past Anthem Blue Cross and Blue Shield’s dental director, Dr. George Koumaras.

Nobile: First, what’s fluoride?

Koumaras: Fluoride is one of the best ways to prevent cavities. It is a mineral that can stop or even reverse tooth decay. Fluoride makes the outer surface of your teeth, the enamel, more resistant to the acid that attacks, causing tooth decay.

Nobile: Do we only come into contact with fluoride when we go to the dentist?

Koumaras: No. Some cities add fluoride to tap water, but be aware that some bottled water does not include fluoride. You can also get fluoride from many brands of toothpaste. In fact, we recommend parents use fluoride toothpaste when their children’s teeth are developing. Parents should use a small smear of fluoride toothpaste on children once the first tooth appears. Slightly older kids, those three to six years of age, should brush twice a day with a pea-sized amount of fluoride toothpaste. Remember, the purpose of the fluoride is to prevent cavities, and regular tooth brushing goes a long way toward doing that.

Nobile: What about these rumors and theories that claim fluoride is dangerous?

Koumaras: Health rumors and theories can be scary – especially when they involve kids. What parents need to know is that fluoride has been studied and deemed to be safe for kids and adults. In fact, the American Dental Association reports that there have been more than 70 years of research done on fluoride and that fluoride in water actually prevents tooth decay by 25 percent or more.

Nobile: In other words, fluoride isn’t going to turn me into a zombie or ruin my chances of playing in the professional basketball?

Koumaras: (Laughs) No! You may never play pro ball, but fluoride will have nothing to do with it.

Nobile: How does fluoride affect health care costs?

Koumaras: According to the ADA’s comprehensive Fluoridation Facts report, most cities that add fluoride to drinking water find that each dollar invested saves approximately $38 in dental costs.

Nobile: That’s a pretty good return on investment…

Koumaras: It certainly is and fluoride isn’t anything to fear. That same ADA report points out that adding fluoride to water isn’t really all that different from fortifying salt with iodine, milk with vitamin D and orange juice with vitamin C.

Nobile: I wouldn’t give up any of those things. I wouldn’t be able to have breakfast!

Koumaras: Right!

Nobile: OK, so I shouldn’t be scared to send my kids to the dentist.

Koumaras: No. Going to the dentist can be scary for kids but it shouldn’t be for parents. Dental care is extremely important and is one of the best ways you can help your kids avoid unnecessary illnesses and pain. For example, according to the Centers for Disease Control and Prevention (CDC), tooth decay is one of the most common chronic conditions of childhood in the U.S. An unhealthy mouth can cause kids to miss school, impair speech development and lead to difficulty eating.

Nobile: What’s involved in a fluoride treatment at the dentist?

Koumaras: A fluoride treatment is quick and painless. The dentist paints the fluoride varnish onto the teeth. The varnish stays in contact with the tooth, providing longer lasting protection. The CDC says fluoride varnish can prevent about one-third of decay in baby teeth.

Nobile: What can parents do at home to make visits to the dentist less scary?

Koumaras: I know firsthand that part of a dentist’s responsibility is to create a positive experience and make sure children are comfortable in the dentist chair, especially during those initial visits.

However, parents have a responsibility at home, too. You should talk to your kids about good oral health in a way they can understand that can help ease their fears. In particular, I recommend parents do two things:

  • Take your child to the dentist when their first tooth appears and no later than the child’s first birthday. Your dentist will assess your child’s susceptibility to cavities. Starting young will also make the idea of going to the dentist less scary.
  • Be a good role model. To establish the importance of a daily hygiene routine for your kids, let them watch you while you brush and floss. Make it fun with entertaining activities, like a song, that can teach kids to brush the correct way. And remember to brush the teeth for at least 2 minutes.

Nobile: And trips to the dentist aren’t just for kids, right?

Koumaras: Right. Adults should make sure they visit the dentist regularly too. Regular trips to the dentist can help catch potentially serious health conditions such as diabetes or heart disease early, so you can take action. Oral health truly is part of overall health. It should not be ignored at any age.


To learn more about the importance of regular tips to the dentist and how oral health is connected to overall health, please visit

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Nobile is a 20-year veteran of the insurance industry whose experience includes time with Rush Prudential Health Plans, Aetna, and United Healthcare. Prior to joining Anthem, Nobile served as the Director of Sales and Account Management for the Midwest region at UniCare, a health benefits company based in Chicago and owned by Anthem’s parent company and also ran UniCare’s Eastern Region with offices.

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