Tooth Decay Higher in Children Who do not Drink Tap Water, But Blood Lead Levels Lower

A new study appearing in the American Journal of Preventive Medicine has shown that American children who do not drink tap water are much more likely to have tooth decay than those who do, but also less likely to have elevated levels of lead in their blood. Due to some dangers reported from drinking tap water which includes fluoride and potentially other contaminants, some parents have opted to not give it to their child and instead have opted for bottled or filtered water for drinking. See for more information on the dangerous of fluoride for young children.

According to the Centers for Disease Control and Prevention (CDC), adding fluoride to the water supply has dramatically reduced the prevalence of tooth decay over the past 70 years. Even so tooth decay is still a large problem affecting the primary teeth of over 20% of U.S. preschoolers in 2011 to 2012.

Researchers from the Department of Dental Ecology, University of North Carolina at Chapel Hill, analyzed a nationally representative sample of nearly 16,000 children and adolescents aged two to 19 years who participated in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2014. The researchers found more than 12,000 records included data on blood lead level and about 5,600 records had data on dental caries. NHANES is the U.S. benchmark for national surveillance of blood lead levels and is the sole national source of dental examination data. Several studies using data from NHANES has been cited on the risks of keeping wisdom teeth page located at

In the NHANES study, individuals visited a mobile examination center where they completed a dietary interview, donated a blood sample, and received a dental examination. About 15% of the children involved said that they did not drink tap water. According to the results of the study, children and adolescents who did not drink tap water were more likely than tap water drinkers to have tooth decay. Those who drank tap water had significantly higher prevalence of elevated blood lead levels than children who did not drink tap water. Overall, almost 3% of children and adolescents had elevated blood lead levels and 49.8% had tooth decay. An elevated blood lead level was defined as having at least three micrograms of lead per deciliter of blood. Tooth decay was defined as the presence of one of more tooth surfaces affected by dental caries as determined on the dental examination. The study used a statistical analysis which took into account other factors that could account for the relationship between drinking tap water and tooth decay and blood lead levels .

One limitation of the study was that the fluoridation status of participants’ tap water was unknown. Tooth decay in children can cause pain and problems and be costly to treat. Even though elevated blood levels only affects a small amount of children, the effects can be permanent. The researchers feel their study shows a trade-off between drinking tap water and not drinking tap water. The researchers feel that water fluoridation is beneficial and having parents decide that their water is harmful and not give it to their children is to their detriment.

Source: Anne E. Sanders and Gary D. Slade, Blood Lead Levels and Dental Caries in U.S. Children Who Do Not Drink Tap Water, American Journal of Preventive Medicine, 2017.

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