Why is tap water in France not treated with fluoride?

For the majority of Americans, drinking water with fluoride in it is a given. Odorless, tasteless and colorless, this compound is added to water to prevent tooth decay. 

It is up to individual states and localities in the US to decide whether their public water systems will be treated with the compound, but around three out of five Americans who get their water from these systems drink treated water, according to the American Cancer Society. There is currently no conclusive evidence to link fluoride to cancer, according to the society, but some studies have been done on a possible connection. 

Unlike the US, France has never fluoridated its water. While it was briefly considered in the 80s, in 1985 the Académie nationale de médecine officially advised against it. 

For Americans in France concerned about this change, dentist-surgeon Dr Christophe Lequart offered the following advice: “don’t panic.” 

“In reality, there is fluoride in our tap water - less fluoride than in some tap water you'd find in American states, but our tap water isn't fluoride-free,” Dr Lequart, spokesperson for the Union Française pour la Santé Bucco-Dentaire, told The Connexion. “The advice is to use a fluoride toothpaste, which will really help prevent the onset of cavities.” 

The advice comes at a time when the fluoridation of water is increasingly under fire from top American officials. It is important to keep in mind that fluoride helps build enamel in children’s still-growing teeth and that helps restore enamel in adult teeth. The World Health Organization is also among many health authorities that recommend water fluoridation to protect populations’ dental health. 

In France, the naturally-occurring level of fluoride in local water systems varies by region. For some regions like Normandy, you can check this information using the Agence Régionale de Santé website’s map and checking your commune’s water quality report (infofacture).  

Since 1986, French grocery stores have also offered fluoridated table salt, sel fluoré, which people may buy to supplement their intake of the compound. That was the government’s collective prevention plan, rather than fluoridating the public water supply, because the naturally occurring levels were already too variable across the territory, Dr Lequart added. 

The salt option does not exist in the US. 

The backbone of France’s cavity prevention policy – carried out on an individual level – is toothpaste. Around 90% of toothpastes have fluoride in France, Dr Lequart said. 

“Why was toothpaste chosen over increasing water fluoridation? Because we now know that fluoride's best anti-cavity action happens through what's called a topical action, not a systemic one,” Dr Lequart said. 

Topical action refers to the fact that the toothpaste is in direct contact with tooth enamel – not to mention it has a higher concentration of fluoride – which makes it more effective.

Like the US, the level of fluoride in French toothpaste varies. For children six months to six years old, 1,000 parts per million of fluoride is recommended, after age six it is 1,450. For people at a heightened risk for cavities there are toothpastes with more fluoride in pharmacies. Toothpaste is not reimbursed by the French health service. 

This is relevant for bakers and pastry chefs who work in an environment with more sugar and flour which contributes to worse dental health - even if the sugar remains airborne -  Dr Lequart said. 

“With these fluoride concentrations as recommended in France, and with the regulations regarding tap water, there is no risk of fluorosis [a disease caused by consuming too much fluoride],” he said.

Beyond treating teeth with fluoride, Dr Lequart said that dental health rests heavily on your diet. Limiting sugar, snacking and sodas can all help preserve healthy teeth. There are also fluoride-rich foods you can eat such as spinach, grapes, potatoes, and saltwater fish as well as dried foods like beans, lentils, raisins and tea. 

“Prevention also relies very heavily on this dietary hygiene,” he said.

For more on dentistry and the French health system in general see our dedicated Healthcare in France help guide here.