Water fluoridation: Just the facts?

Feb. 7, 2002
An RDH exclusive by Connie Sidder, RDH

Across the United States, communities from Allentown, Pa., to Ft. Collins, Colo., have raised the question of continuing water fluoridation. While it is generally recognized not to be a connected to any Communist plot, some stories related to fluoride poisoning in the post-World War II era do conjure up images of "The X-Files."

People's passions and emotions run high when discussing the addition of fluoride to the local water supply. It sometimes pits the dental community against the rest of the citizens. Yet some of the most vocal opponents of water fluoridation have crossed over from the dental side. Dr. Hardy Limeback, head of preventive dentistry at the University of Toronto, considers himself as having changed sides. Others such as the late Dr. John Yiamiouyiannis from Japan (who conducted research into the link between fluoride and bone cancer) and Dr. John Colquhoun from New Zealand also were trained as dentists before gaining fame in their quests to see fluoride removed from municipal water supplies.

There is voluminous material dating back to the 1940s about studies linking fluoride to cancers, osteoporosis, thyroid problems, air pollution, and poisoning. On Aug. 17, 2001, the Center for Disease Control (CDC) published its paper on fluoride recommendations. It covers all forms of fluoride -- water, topical, rinses and toothpastes.

I will attempt to disseminate facts and maintain a neutral position to allow the reader to draw their own conclusions. However, one must realize that what is factual to one side may be fodder to the other. I will begin with a brief history of fluoridation.

Fluorine, from which fluoride is derived, is the 13th-most abundant element on Earth. It is released naturally in both air and water. When added to community water, the recommended level is 0.8-1.2ppm (it takes into account the expected amount of consumption as well as naturally existing fluoride). It is considered an inexpensive (average cost in the U.S. was $0.51 per person) modality to reach all socioeconomic and age groups.

Fluoride in drinking water was introduced in Grand Rapids, Mich., more than 50 years ago. The success of water fluoridation in preventing and controlling dental caries led to the development of other fluoride-containing products, including toothpastes, mouthrinses, and dietary supplements, as well as professional products of gel, foam, and varnish. With 43 of the 50 largest cities having fluoridated water, it is reasonable to suspect that processed foods also contain fluoride, though no levels have been established. Yes, even soft drinks may contain fluoride!

Eleven researchers from various leading dental schools compiled the CDC Report across the U.S. The purpose was to establish a "Recommendation for Fluoride Usage to Control and Prevent Dental Caries in the U.S." The report used existing analysis on the multiple sources of fluoride. The safety of fluoride, which was documented by other scientific and public health organizations, was not addressed. Much of the research on the effectiveness of individual fluoride modalities in relation to dental caries was conducted before 1980.

The position of the CDC in relation to enamel fluorosis and fluoride states that it is a minor consequence balanced against the protection from dental caries from drinking water. It is recognized that fluorosis has increased in both fluoridated and non-fluoridated communities, indicating an increase in total intake of fluoride. It is believed that, by ingesting fluoride, the saliva is able to maintain a certain level and thereby work to lower the pH and aid in remineralization. This is most effective when other sources of fluoride are also used since the saliva concentration is too low on its own.

One of the new recommendations of the paper is to develop lower fluoride toothpaste for children under 6 years of age, so as to prevent enamel fluorosis. Basically, water fluoridation offers frequent exposure to small amounts, which minimizes caries. The fluoridated water doesn't discriminate, it is inexpensive to use, and harmless to one's health. Or is it?

My first introduction to the "other side" was through our own RDH website. An article entitled, "Little Evidence Fluoridation Reduces Tooth Decay" written by Roger D. Masters of Dartmouth College and Myron Coplan. It was written for the Fluoride Action Network opposed to fluoridation in the state of New York. They quote from the CDC report that, "fluoride works primarily after teeth have erupted?" Summarizing their work, Masters says, "Where silicofluorides are in use, there are higher risks of behavioral problems linked to lead toxicity. In other words, if topical application of fluoride works better, then do that and not add silicofluoride to the water.

It is interesting to note that the FDA now requires warnings on toothpastes to avoid over ingestion of fluoride. When the excessive amount of toothpaste is compared to water, it would take 500mL in a day. That's not very much! Surprisingly, the FDA has never been petitioned for approval of fluoride supplements in 50 years! Luckily, the CDC has suggested no supplement is safe, even in unfluoridated areas due to the increased risk of fluorosis.

Some opponents to water fluoridation claim the decline in decay began before the use of fluoride. They attribute the improvement to better diets and the consumption of more cheese, which contains an anti-decay property. Still other opponents question the safety of fluoridation. The EPA says fluoridation chemicals, silicofluorides, have never been tested for safety. Yet fluoride gases are considered to be the sixth-leading pollutant, according to the EPA.

When fluoride was introduced to water supplies, it was believed that being systemic was advantageous. Proponents claim that fluoride in water and toothpaste along with sealants is all that's needed. Opponents point to other studies that raise questions of fluorosis, increase in osteoporosis, and bone cancer.

If the "water wars" have not surfaced in your hometown, it is probably being debated somewhere in your state. I hope you continue to learn more about this topic with another Web article that will debut on the RDH site next week.

For more information, Connie Sidder, RDH, can be reached by e-mail at [email protected].