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Fluoride in drinking water

Fluoride in drinking water: evidence, controversies and your options

Fluoride: one of the most controversial topics amongst health-conscious people for decades

The fluoride question has seen experts in conflict with each other and the public confused by contradictory research. As 2022 saw the passing of the Health and Care Bill, which makes it easier for the government to roll out water fluoridation, we explore the issue. We also look at the options for people concerned about what’s in their drinking water.


Around 1 in 10 people in England drink water containing fluoride. It varies by area: some of it is present naturally, some is added to the water supply to help prevent tooth decay in children. It’s also found in bottled waters. Fluoridation is a controversial topic; some people are concerned that the evidence for preventing tooth decay is limited. At the same time, others worry that fluoridation is linked to a higher risk of various diseases. More areas of the country may have fluoride added to their water soon. If you don’t want to drink fluoride, install a PureH2O reverse osmosis water purifier.

Are you concerned about fluoride in your tap water?
What’s in your water?

What is fluoride and why is it in drinking water?

It’s a naturally occurring mineral found in water and some foods. It’s present in the rock beds of rivers, lakes and streams and therefore makes its way into drinking water – both tap and bottled – to varying degrees, depending on where you live.

Around 5.8 million people in England drink water containing fluoride, some of which is present naturally. That’s just over 10% of the population, or around 1 in 10 people. In some areas of England it’s added to tap water to help prevent tooth decay in children. This is called ‘community fluoridation’. Where added, it’s brought up to 1mg per litre. That’s one part fluoride to one million parts water.

The UK sets maximum levels at 1.5mg per litre in line with World Health Organisation (WHO) guidance. The Drinking Water Inspectorate (DWI) monitors water utility companies in England to make sure they comply with this level.

What’s the problem with fluoride?

We understand that many health-conscious people are uncomfortable with the ‘permitted levels’ of a great variety of substances found in drinking water, including fluoride. Especially when there is limited or conflicting research on their effects.

More on fluoride research, why bottled water isn’t the answer, but reverse osmosis water purification might be right for you, later in this article. But first, do you want to know if there’s fluoride in your water?

Does my tap water contain natural or added fluoride?

This DWI map shows typical fluoride levels around the UK, but it does not differentiate between natural and added fluoride:

Fluoride in the UK, DWI 2020
Fluoride levels in the UK, DWI 2020
The following areas of the UK currently have added fluoride in tap water:
  • West Midlands
  • North East
  • East Midlands
  • Eastern England
  • North West
  • Yorkshire and Humber
Local health authorities currently require these water companies to fluoridate drinking water:
  • United Utilities
  • Northumbrian Water
  • Anglian Water
  • Severn Trent Water
  • South Staffordshire Water

The NHS advises: ‘

‘Your local water supplier should be able to tell you how much fluoride is in your water supply and whether any is added. Most companies have an online facility where you can use your postcode to check the water in your area.’

Will more areas have fluoride added to their drinking water soon?

It’s likely. Historically, local health authorities decided whether drinking water should be fluoridated. And they had to carry out a public consultation exercise before telling water utility companies to fluoridate the water supply.

But all that is changing. That’s because in 2022 the Health and Care Bill received Royal assent and introduced measures to:

 ‘level-up health disparities in oral health and obesity through making it simpler to [add] fluoride to water in more areas across England, and regulating unhealthy food and drink advertising.’ (DHSC, 28.04.22)

In short, the Bill allows the Secretary of State, rather than local health authorities, to decide on water fluoridation.

Fluoride is added to drinking water to prevent tooth decay in children
Fluoride: does it reduce childhood tooth decay and is it worth the possible risks?

Is community water fluoridation an effective public health measure against childhood dental decay?

Tooth decay is the most prevalent disease affecting children and the most common cause of hospital admissions for children in England. So how do fluoridated water and dental products help? Fluoride interferes with enzymes oral bacteria use to convert sugar from food and drink into acids that demineralise the tooth surface. Demineralisation allows bacteria to invade and destroy tooth tissue – known as tooth decay.

However, improving dental health in children isn’t as simple as adding fluoride to drinking water. That’s because several factors affect dental health, including socioeconomic status. In fact: ‘tooth decay is strongly associated with poverty.’ (Pretty, 2022)

So, researchers question whether fluoridation is so advantageous that it can overcome other factors:

‘We found insufficient information to determine whether fluoridation reduces differences in tooth decay levels between children from poorer and more affluent backgrounds.’ (Iheozor‐Ejiofor Z, 2015)

Some countries, such as Canada and Finland, abandoned community water fluoridation schemes due to a lack of evidence that it helped decrease childhood dental decay. And after stopping, rates did not increase.

Fluoride adverse effects on brain
Some research links fluoride to disease.

Why are some people concerned about fluoride in water?

1. Neurotoxicity

Back in 2006, a study identified fluoride as a developmental neurotoxicant (Grandjean, 2014). In adults, extremely high levels  (higher than those in drinking water) are known to cause neurotoxicity. Furthermore, some studies conclude that naturally high levels in drinking water are linked to lower IQ levels in children:

‘A meta-analysis of 27 cross-sectional studies of children exposed to fluoride in drinking water, mainly from China, suggests an average IQ decrement of about seven points in children exposed to raised concentrations…

Children in high-fluoride areas had significantly lower IQ scores than those who lived in low-fluoride areas.’ (Grandjean & Landrigan, 2014 referring to Choi et al, 2012)

Senior study author and adjunct professor of Environmental Health Harvard School of Public Health, Philippe Grandjean commented:

“Fluoride seems to fit in with lead, mercury, and other poisons that cause chemical brain drain… The effect of each toxicant may seem small, but the combined damage on a population scale can be serious, especially because the brain power of the next generation is crucial to all of us.” (Dwyer, HSPH 2012)

Fluoride accumulates in the pineal gland
Fluoride accumulates in the pineal gland, which regulates melatonin
2. The pineal gland: reproductive health, immunity and age-related disease

Others are concerned because ‘fluoride readily accumulates in the human pineal gland’ (Luke, 2001). The pineal gland deals with the hormone melatonin. Melatonin regulates our circadian rhythm (the sleep-wake cycle), and it is an antioxidant.

One study found that ‘F [fluoride] is associated with low circulating levels of MT [melatonin] and this leads to an accelerated sexual maturation in female gerbils’ (Luke, 1997). Naturally, people worry the same may be true in humans, particularly as:

‘studies have shown that girls in the US – the world’s most heavily fluoridated country – are reaching puberty earlier and earlier’ (Woffinden, 2003).

Additionally, ‘research has also shown correlations between dysregulated melatonin production and age-related neurodegenerative conditions, like Alzheimer’s disease and Parkinson’s disease’ (Health Desk, 2022).

3. Hip fractures and bone cancer

Because fluoride accumulates in bones, researchers examined the risks of fractures, defects and osteosarcoma (bone cancer). Some studies found evidence of elevated risks, others did not (RSNZ, 2014). Risks tend to differ according to age and gender. For example, a US study found:

‘an association between fluoride exposure in drinking water during childhood and the incidence of osteosarcoma among males but not consistently among females.’ (Bassin, 2006)

The researchers explained that boys exposed to common fluoride levels in drinking water between the ages of five and 10 suffered an increased rate of bone cancer between the ages of 10 and 19.

And a 2018 report found:

‘In both females and males aged 80 years and older, there was a slightly increased risk of hip fracture in mid-range fluoride concentrations, compared to the lowest concentration.’ (OHID, 2022)

4. Thyroid disorders and high blood pressure

Some studies found evidence of links between fluoride and thyroid disorders, others advised caution on interpreting those findings (OHID, 2022). A recent scholarly review found risks of elevated blood pressure in ‘fluoride endemic areas’ (places with naturally high levels in the drinking water). However, the authors said more research is needed (Davoudi, 2021).

5. Dental fluorosis

Mottles and flecks on teeth caused by fluoride is an adverse effect there’s no debate about. Some people find it unsightly and undesirable. A recent UK report found that:

‘dental fluorosis surveys… have shown greater levels of dental fluorosis in fluoridated areas.’ (OHID, 2022)

In conclusion

All in all, this topic is steeped in controversy and confusion. Unhelpfully, research seems to be conflicting and is still emergent. Meanwhile, further rollouts of community water fluoridation in England are now more likely following the Health and Care Bill 2022.

Drink fluoride free water with a PureH2O home water purifier
The quality and purity of your drinking water can be a personal choice.

Fluoride in drinking water can be a personal choice with a PureH2O reverse osmosis purifier

At PureH2O Ltd, we are happy to provide a solution that empowers you to make health decisions that are right for you and your family. Perhaps you live in an area that already has fluoride added to its tap water, or you’re anxious about future fluoridation.

If you’e concerned about what’s in your tap water, there’s a simple fix. All you need to do is get a PureH2O water purifier for your home. Our super compact RODI+ water purifier removes 99.99%, and our PurityPRO removes 97% of fluoride from tap water. That means you’ll be drinking water that’s purer than any bottled water!

Why choose a PureH2O drinking water purification system?

They’re the eco-responsible choice

Even if you can find bottled water that’s fluoride-free (some are, some are not), it’s likely to be more contaminated with microplastics, for example, than tap water. Also, you’re contributing to the global plastics problem. Plastics use and pollution, natural resource degradation and high carbon footprint associated with food miles are urgent issues of our time. PureH2O purifiers help minimise your environmental impact by giving you the eco-friendly answer to quality drinking water – no more plastic bottles! And did you know we recycle all annual service filter modules?

Our water purifiers remove more than fluoride

They’re also very effective at removing all naturally occurring impurities and man-made contaminants found in UK tap water. These include pesticides, fertilisers, microplastics, PFAS ‘forever chemicals’, THMs, hormones, drug residues, toxic heavy metals and flame retardant.

Pure, healthy drinking water that’s safe for all the family is the result It tastes delicious! What’s more, you can use it for hot and cold drinks, food preparation, cooking and making ice. Our purifiers come with a standard PureH2O faucet, but if you’d like pure boiling, chilled and/or sparkling water, choose a Quatreau tap.

PureH2O purifiers and taps are versatile
We have a range of water purifier and kitchen tap options to suit your needs

Find out more and order your water purifier today

To find out more download our brochure here. You can also see your reverse osmosis water purifier options in our ‘For Home’ section. (Click here for business and commercial water purification and bottling systems.)

To order or ask a question call 01483 617000 Alternatively, fill out our contact form and our Customer Service team will get back to you as soon as possible.

Pure H2O products are made in the UK & Kiwa KUKreg4 approved
Made in the UK, WRAS compliant and KUKreg4 approved



A – D

Choi A, et al Developmental fluoride neurotoxicity: a systematic review and meta-analysis. Environmental Health Perspectives 2012; 120 (10) pp.1362-1368 accessed 29.03.23

Davoudi, M et al. ‘Relationship of fluoride in drinking water with blood pressure and essential hypertension prevalence: a systematic review and meta-analysis.’ International Archives of Occupational and Environmental Health 94,6 (2021): pp. 1137-1146. accessed 30.03.23

DHSC ‘Health and Care Bill granted Royal Assent in milestone for healthcare recovery and reform’ accessed 29.03.23

The DHSC ‘Water Fluoridation Statement from the UK Chief Medical Officers’ 23.09.21 accessed 29.03.23

DHSC ‘Water Fluoridation: Seeking Views on Future Consultation Process’ 08.04.22 accessed 29.03.23

DWI ‘Fluoridation of drinking water’ accessed 17.03.23

DWI ‘Typical flouride [sic] levels in zones during 2020’ accessed 17.03.23

Dwyer, M ‘Impact of fluoride on neurological development in children’ Harvard School of Public Health Featured News Stories July 2012 accessed 29.03.23


Grandjean, P & Landrigan, P ‘Neurobehavioural effects of developmental toxicity’ The Lancet Neurology Review Vol 13, issue 3 pp.330-338, March 2014 accessed 29.03.23

Health Desk What do we know about the impact of toothpaste fluoride on melatonin levels?
20.01.22 accessed 29.03.23

Iheozor‐Ejiofor Z, et al ‘Water fluoridation for the prevention of dental caries’. Cochrane Database of Systematic Reviews 2015, Issue 6. accessed 17.03.23

Luke, J ‘Fluoride Deposition in the Aged Human Pineal Gland’ Caries Research 35 (2) March 2001 pp. 125-8 accessed 29.03.23

Luke, J ‘The Effect of Fluoride on the Physiology of the Pineal Gland’ Dissertation submitted to School of Biological Sciences, University of Surrey, in fulfilment of the requirements for the Degree of Doctor of Philosophy, 1997 accessed 29.03.23


NHS ‘Fluoride’ accessed 17.03.22

Office for Health Improvement and Disparities ‘Water fluoridation: Health monitoring report for England 2022’ 21.03.22 accessed 30.03.23

Pretty, I ‘An evaluation of a water fluoridation scheme in Cumbria’ National Institute for Health and Care Research, November 2022 accessed 30.03.23

Royal Society of New Zealand & Office of the Prime Minister’s Chief Science Advisor ‘Health effects of water fluoridation: a review of the scientific evidence’ August 2014 accessed 30.03.23

Scottish Water ‘Fluoridation in Scotland’ accessed 29.03.23

Woffinden, B ‘Fluoride Flaws’ Guardian 25.06.03 accessed 30.03.23


PureH2O Ltd manufactures, installs and maintains the world’s most innovative water purification systems and the most technologically advanced boiling, chilled and sparkling water taps. Since 1991 we have been committed to providing our domestic and commercial customers with the purest, safest, most sustainable choice of drinking water, which helps them reduce their environmental impact by avoiding single-use plastic bottled water.

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