BONUS: Dental Dilemmas – Extended Fluoride Interview

We loved our conversation with Dr. Jayson Chalmers, DDS so much that we’re sharing the full, never‑before‑heard interview. It goes deeper than our last episode “Dental Dilemmas” on the history of fluoridation, chemistry, dosing, safety signals, and what clinicians should actually recommend. 

** No CE credit for this bonus episode. (CE returns with our next regular episode on cold & flu.) **

 What you’ll learn:

• How fluoride prevents cavities (the hydroxyapatite → fluorapatite story) 
• Where the 2025 JAMA Pediatrics metaanalysis on fluoride exposure and children’s IQ fits (signal vs causality; exposure thresholds; study bias).  
• Practical guidance on OTC (~900 ppm) vs prescription (5000 ppm) toothpaste and counseling tips for kids and high-risk adults.  
• Community water fluoridation: historical context (Grand Rapids), outcomes, and how programs are tuned to ~0.7 mg/L today. 

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TRC Healthcare Editor Hosts:  

• Stephen Small, PharmD, BCPS, BCPPS, BCCCP, CNSC  
• Don Weinberger, PharmD, PMSP 

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Guest:  

• Jayson Chalmers, DDS 

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The clinical resources related to this podcast are part of a subscription to Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights:  

• Chart: Alcohol and Drug Interactions
• FAQ: Management of Opioid Use Disorder
• Chart: Analgesics for Acute Pain in Adults
• Toolbox: Antibiotic Stewardship

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Chapters

• 0:00 Introduction
• 0:20 Welcome
• 1:28 Extended Fluoride Interview
• 14:59 Summary
• 16:14 Find us on YouTube!

Transcript

This transcript is automatically generated. 

00:00:05 Narrator

Welcome to Rumor vs Truth, your trusted source for facts… where we dissect the evidence behind risky rumors and reveal clinical truths.  

00:00:13 Narrator

On this episode... open wide, for a bonus round of dental insights. 

00:00:20 Don Weinberger

Hey, Steve, you up for trying something new?

00:00:22 Steve Small

Depends Don, if the change is jaw-dropping.

00:00:26 Don Weinberger

Love those puns. Well, good. We're about to sink our teeth into something different. A special bonus episode of Rumor vs Truth. Right here, right now.

00:00:34 Steve Small

Right, in our last episode, Dental Dilemmas we brought in Dr. Jayson Chalmers, DDS, as our dental expert for two of our claims.

00:00:41 Don Weinberger

If you missed that episode, don't brush it off. Start there, then come back for this deeper dive.

00:00:46 Don Weinberger

To get all that great content, I recorded a longer video with Dr. Chalmers. A lot of excellent material didn't fit into the main show.

00:00:52 Steve Small

Yeah, this extended cut drills even deeper on fluoride… into the history, chemistry, dosing and what the latest evidence is really saying. And we found it fascinating and think you will too.

00:01:04 Don Weinberger

And just a heads up, since this episode isn't one of our regular episodes, there is no CE credit available. CE will be back with our next full episode on cold and flu remedies on November 18th.

00:01:15 Steve Small

Looking forward to it. So without further ado, here's our extended interview with Dr. Jayson Chalmers, DDS, on history, efficacy, and importance of fluoride in dentistry.

00:01:28 Don Weinberger

OK, so for this claim we have here that fluoride toothpastes and mouthwashes are harmful. We have an expert with us today. Doctor Chalmers. So, Doctor Chalmers, what do you think about this claim about the harmful…

00:01:41 Jayson Chalmers

Well, first of all, Don, thanks for having me here, and the claim that it's harmful. Some new research came out in the last year, there was a meta-analysis of…

00:01:50 Jayson Chalmers

I believe it was 74 studies around the world looking for, you know, some link between fluoride and it harming people in some way. The meta-analysis came back that there was a link, I think a lot in the news lately has been correlation versus causality.

00:02:09 Jayson Chalmers

And this is one of those, like you know, that's been a lot in the news, so this is one of those things as well.

00:02:15 Jayson Chalmers

Like, yes, there is a link somehow between elevated fluoride levels in drinking water and a slight dip in IQ points basically. And that came out in this meta-analysis how, how accurate it is, how it how it is to be determined.

00:02:32 Jayson Chalmers

I was doing kind of a deep dive into this part of it with the NIH and of the 74 studies, I believe it was close to 50, were flawed or biased in some way. 

00:02:41 Jayson Chalmers

So that takes a large chunk of that now. So if you look at that, then we're dealing with 20 studies, not as many people also, it's hard to to judge the studies.

00:02:53 Jayson Chalmers

Because they they were taking mostly groundwater, which not additive fluoride, but fluoride naturally found in water. And that's what most of the studies. 

00:03:03 Jayson Chalmers

And those are unregulated numbers of… amounts of fluoride. They're in the water. So it's hard to judge how much fluoride was the issue, right?

00:03:12 Jayson Chalmers

And is the fluoride… is it directly correlated to this as a neurotoxin, right?

00:03:18 Jayson Chalmers

So it is difficult to determine that, but it is an interesting study and it brings up some really good points that so we do need to be cautious with how much is in the water, how much are we getting, how much is beneficial, how much is harmful. 

00:03:30 Jayson Chalmers

And so it does bring up those which are good conversations to have. I think. So I kind of went through a deep history of fluoride too. 

00:03:38 Jayson Chalmers

So if you want to go back 120 years with me, we can start talking about… like fluoride. 

00:03:42 Don Weinberger

Jump on that time machine.

00:03:44 Jayson Chalmers

What? Yeah, it's a interesting. It was a a young dentist just out of school from the East Coast. Traveled to Colorado Springs.

00:03:53 Jayson Chalmers

He started his dental practice there. He saw this whole population of of kids, adults with these really modeled brown, white, yellow spotted teeth. 

00:04:03 Jayson Chalmers

Very few cavities, though, very few cavities, but discolored teeth, like grossly discolored, like where was obvious. He even described it as a a chocolate brown teeth that the teeth looked like they were made of chocolate, you know.

00:04:16 Jayson Chalmers

So that discolored and so he works with another young dentist, a person by the name of G V Black who is famous at dental circles. He is the father of modern dentistry, came up with how we prep our fillings, how we do these things. 

00:04:31 Jayson Chalmers

And now that's a little bit older. Now, those are the silver fillings that we're talking about. He kind of came up with the design and prep for those.

00:04:38 Jayson Chalmers

So JV Black and Doctor McKay work together to kind of figure out what's going on here. Where is it coming from? What's what's in the environment? What's happening? 

00:04:45 Jayson Chalmers

Doctor McKay searched for 30 years before they actually found… it was fluoride in the water that was causing this. So they worked in Colorado. They worked in part of Idaho had this issue as well. 

00:04:57 Jayson Chalmers

And then, in Arkansas, around the Alcoa aluminum plant a bunch of people had problems with the same thing and it was realized it was fluoride as a byproduct of aluminum manufacturing that was getting in the water and staining their teeth.

00:05:13 Jayson Chalmers

And Alcoa was the the group that finally was able to find it was fluoride. Dr. McKay didn't have the the equipment the knowledge to to isolate the fluoride ion, but Alcoa did.

00:05:26 Jayson Chalmers

So Alcoa. He knew there was something he knew it was related to the water, but he just didn't know what it was. Took 30 years to figure it out until the 1930s.

00:05:36 Jayson Chalmers

In 1945, Grand Rapids, MI ended up with their first trial of fluoride, adding it to the water. They realized that anywhere about one of milligram per liter was about the right level where it wouldn't stain the teeth. You wouldn't get the discoloration, but you would get the beneficial effects of fluoride.

00:05:55 Jayson Chalmers

Now we talked about the beneficial effects. What is that, right? The tooth is made-up of hydroxyapatite. That's the main building block. That that's a protein that the tooth is made of. A mineral that the tooth is made-up rather so it's made of hydroxyapatite.

00:06:08 Jayson Chalmers

Acids break it down. Acids in our in our you know, if you drink a a sparkling water that's got citric acid in it, that's going to break down the tooth a little bit. If you eat sugar, the the bacteria creates acids which break down the tooth a little bit. So over decades or years, that acid breakdown causes demineralization of the hydroxyapatite.

00:06:28 Jayson Chalmers

So what fluoride does is it kind of comes in, attaches itself to the hydroxyapatite, and it becomes a new mineral called fluorapatite. Now fluorapatite is much harder to break down than hydroxyapatite. 

00:06:39 Jayson Chalmers

So the acids in the mouth and our drinks and our food created by the bacteria, they just can't seem as easily to pull off that fluoride.

00:06:48 Jayson Chalmers

Off the fluorapatite, so the mineral remains intact. And that's how fluoride helps. That's one of the ways the fluoride helps.

00:06:55 Jayson Chalmers

Other ways when we ingest in the water, when we have the under you know 1 milligram per liter amount in our water, it doesn't stain our teeth, it doesn't affect our bones. 

00:07:04 Jayson Chalmers

It's just it's harder to break down basically the fluorapatite. So we can have more acid, you can have more of this and the tooth stays healthy, but it's a very fine line in the amount of fluoride and this is where I think this debate is coming into effect. How much fluoride are we supposed to have?

00:07:19 Jayson Chalmers

I think most people in the industry realize that fluoride is a benefit to fluoride, but how much right?

00:07:25 Jayson Chalmers

So as of October 31st this year, they're going to, I think, eliminate these high additive prescription types of fluoride. 

00:07:33 Jayson Chalmers

We would have known them when we were kids, those little like, they look like a Flintstone tablet, like a little almost candy kind of thing that you chew on and your parents give it to the kids, and that's going to be kind of going by the wayside, I believe, with with the new guidelines.

00:07:48 Jayson Chalmers

And I think for the most part, most dentists, at least in the circles I run in, they haven't been prescribing that for a couple decades anyway. Like that's kind of been out of favor. 

00:07:59 Jayson Chalmers

I can't remember the last time I prescribed fluoride tablets to somebody.

00:08:03 Don Weinberger

I haven't seen it in 20 years myself. So yeah.

00:08:05 Jayson Chalmers

It's been forever, right? And so now we kind of just tell parents with their kids, like, yeah, you know, flavor, the toothbrush with a little bit of toothpaste brush their teeth.

00:08:14 Jayson Chalmers

The young children, can't spit… they don't have the dexterity at the mouth to spit it out. They're going to swallow a little bit of it, a little swallowing. A toothpaste is not harmful. 

00:08:23 Jayson Chalmers

It it you're not going to, you have to. A little kid would have to eat half a tube of toothpaste for it to be toxic, right? So our recommendation is to make sure that the toothpaste is out of reach for the children that the parents are the ones kind of controlling it, right?

00:08:36 Jayson Chalmers

And then it should be fine and very safe. It's a very safe, effective product. Ah, very inexpensive products for what it does like the benefit you get and the price for the benefit. 

00:08:48 Jayson Chalmers

Oh my gosh, I mean, you can't get a much better benefit. I think it's under a dollar per person in the United States to fluoridate the, the, the Community water.

00:08:57 Jayson Chalmers

That’s, cheap… that is really cheap. And what it save you on the back end there to give you an idea. Calgary, Canada. Got rid of their fluoride, I think it was… I want to say it was 2011. 

00:09:12 Jayson Chalmers

They removed fluoride and fluoridation. It was getting too expensive. They're going to have to kind of refurbished their fluoridation system and it was going to be millions of dollars and they were like, oh, we just can't afford it right now.

00:09:23 Jayson Chalmers

So they eliminated fluoride from their community water systems just a few years later, they added it right back in. 

00:09:31 Jayson Chalmers

Because… so what they were thinking really obviously was the price of dentistry go, just go through the roof in that area, all of a sudden, everybody started getting cavities.

00:09:39 Jayson Chalmers

And they're like, Oh my gosh, it's more expensive to treat the cavities than it is to put the fluoride back. So they ended up putting a fluoride back in the water. They spent the millions of dollars. They put the fluoride back in the water and they're going to see over time, those cavities go away and it'll be cheaper for the community and healthier for the community. 

00:09:54 Jayson Chalmers

I think one of the things people don't realize is, like, let's say you're a young child. You're three years old. You're you get a cavity for the first time. That's not a real cooperative child. Usually 3 year old child in the dental chair is not your best patient. Right. So we often have to sedate these patients.

00:10:11 Jayson Chalmers

And now there are risks. With sedation, right, the risks go up. Incredibly. So here you have a young child with a small cavity, and in some cases you're having to do general anesthesia on this child to fix small things that the risk is huge there. I mean, you know, so the risk of a little bit of fluoride, you know?

00:10:31 Jayson Chalmers

Versus possibly general anesthesia and fixing. I mean it's a no brainer, right?

00:10:38 Jayson Chalmers

So the benefits far outweigh the risks here. 

00:10:43 Jayson Chalmers

So right in Grand Rapids, I'm gonna go back to Grand Rapids real quick. So they added the fluoride in 1945 to Grand Rapids. It was a supposed to be, I think, a 15 year study originally for this and that being about 30 years altogether. 

00:10:54 Jayson Chalmers

It was a 60% reduction in the number of cavities from adding fluoride in Grand Rapids. 60% OK. Now this was at a time when fluoridated toothpaste weren't really that common. You know you weren't seeing fluoridation in other parts of your life, right? 

00:11:09 Jayson Chalmers

You were just getting it through the water that you drank. So of course, there was a big, big up to a 60% massive. That's huge, right?

00:11:17 Jayson Chalmers

Nowadays we see about a 25% reduction in cavities with community fluoridated water, right? So so we're not seeing the 60% that they saw in the 1940s. We're seeing about 25% drop. There was 2 studies recently, one in 2022 in the UK.

00:11:34 Jayson Chalmers

One in 2016 in Australia, both of them saw with infants at 35% drop in cavities. So still very effective, very helpful and 35% drop that's huge.

00:11:47 Don Weinberger

That's. Yeah, that's pretty good.

00:11:49 Jayson Chalmers

Right. So we still see to this day massive benefits in low levels of fluoridation in the water under 1 milligram per liter.

00:11:58 Jayson Chalmers

So, in our industry, that's kind of what we're sticking with is we're sticking with about that level or less some places in in Asia have up to 30 milligrams per liter. 

00:12:09 Jayson Chalmers

So they have to defluorinate their water, they have to like cycle it and get all that out of it, right. So some places add some places take away.

00:12:18 Jayson Chalmers

Right, but trying to get under 1 is is is where the sweet spot is.

00:12:24 Don Weinberger

I feel like I feel like got a master class in fluoride alone. I and I appreciate it. I know our audience will appreciate it. I do love the point about keeping the toothpaste from children up and high away from because.

00:12:36 Don Weinberger

I accidentally used my daughter's toothpaste, which is like a Unicorn kind of flavored toothpaste, and it is tasty, so I could see how these kids can can really like get into it and maybe consume more than they should be because of just the candy sugar factor of it. So yeah, I do. I also do like that point of just storing that stuff up and away from kids.

00:12:55 Jayson Chalmers

Absolutely, and the mouthwashes and everything else too. Although the mouthwash have a little Zing to them, so most kids won't go twice to that if they get a hold of him. But the toothpaste.

00:13:05 Jayson Chalmers

And then I don't know how old your kids are, but for young kids, they tend to do non fluoridated toothpaste in the beginning, just to kind of get them used to the taste, the flavor, the process.

00:13:13 Don Weinberger

Yeah.

00:13:14 Jayson Chalmers

And then later as they get a little bit older and can manage to spit a little bit easier, then we kind of add fluorinated toothpaste into the mix. So that's kind of my rec.

00:13:21 Don Weinberger

Right. I think it's one of those. Yeah. It's like 1/2 strength fluoride or something along those lines. 

00:13:25 Jayson Chalmers

Right, yeah.

00:13:26 Don Weinberger

For kids. Yeah, yeah.

00:13:27 Jayson Chalmers

Now, something else we didn't really talk about yet or the prescription fluorides that are not just the tablets that we give to the kids, but let's say, you know, you're an at risk patient, maybe you have very dry mouth for medications that you're taking or just as we get older, our mouth gets a little bit drier and we become more susceptible to cavities.

00:13:47 Jayson Chalmers

With many patients will prescribe a high fluoride toothpaste.

00:13:51 Jayson Chalmers

So the toothpaste that you're probably using is about 900 parts per million. That's a pretty standard Colgate, Crest, whatever other, you know what you're using, that's about what they have. And then the prescription toothpaste that your dentist is going to write a script for. It's going to be about 5000 parts per million. So about five times. What's your standard over, off the shelf, you know toothpaste is.

00:14:12 Jayson Chalmers

Still, super beneficial. Still don't want to swallow it. Still don't want to eat it. Don’t consume it. Yeah, you use it, you spit it, you leave it, right? But those I don't believe are are being targeted at all with the changes.

00:14:26 Jayson Chalmers

Coming up over 31st, I think those aren't going to be just as they were prescription based. So that's you know, but it is a huge benefit too to that, so.

00:14:36 Don Weinberger

Yeah. And that's where the 5000 comes from with those brand name kind of toothpaste. Yeah. So it's something else good to know. So yeah, thank you for that. I do appreciate the master class in fluoride.

00:14:47 Jayson Chalmers

Yeah. Knowing we were doing this, I'm like, I wanna dive deep into this and it's stuff that we've learned maybe 30 years ago in dental school, but I'm like, I need to, like, refresh a little bit and remember my history here.

00:14:59 Steve Small

Nice. I really liked that info on the history of fluoride there. Learn something new and we hope you enjoyed this special bonus episode of Rumor vs Truth as well. We'd love to hear what you thought. 

00:15:09 Steve Small

Should we do more bonus interviews, try other experiments, or stick with the classic Rumor vs Truth format that you know and love? Let us know. e-mail us at rumorvstruth@trchealthcare.com.

00:15:20 Steve Small

Or send us a text right from the show notes.

00:15:23 Don Weinberger

And a huge thank you to Dr. Chalmers, for sharing such valuable insights and taking time to join us.

00:15:28 Don Weinberger

And don't forget, there are plenty of goodies in the show notes, including that special 10% discount code, good on new and upgraded subscriptions. The code is RVT1025.

00:15:39 Steve Small

And Mark your calendar, our next full episode drops on our regular day.

00:15:43 Steve Small

The third Tuesday of the month, we're going to tackle cold and flu claims with natural meds, with another special guest expert and it's sure to go viral in the best way.

00:15:54 Don Weinberger

Thanks for joining us on Rumor vs Truth, your trusted source for facts, where we dissect the evidence behind risky rumors and reveal clinical truths.

00:16:14 Narrator

Want to put faces to these voices? Catch the video version on YouTube - just search 'TRC Healthcare' or click the link in our show notes. 

00:16:23 Narrator

While you're there, check out our other TRC podcasts like Medication Talk and Clinical Capsules.