Fluoridation Debate Rages On Across US

Fluoridation--to date, there isn’t a clear consensus regarding the real benefits or dangers of this intervention among dental professionals and members of the public. This issue appeared in the news again after several communities across the United States began debating, again, whether fluoride should continue to be added to public drinking water systems. While it’s certainly not the first time this debate has occurred, recent research is fueling the argument that the benefits of fluoridation don’t outweigh the risks.

Fluoridation’s History

The history of fluoridation in America began in 1901, when a dentist in Colorado discovered that many patients living in the area around his practice had prominent brown stains on their teeth that could not be removed. Through collaborative efforts, dental researchers discovered that the stains were caused by excessive exposure to fluoride in the area’s water supply. It was also discovered that patients with the prominent stains also had teeth that were remarkably resistant to decay.

After more research, cities and towns started adding fluoride to drinking water supplies in 1945. Scientists measured rates of tooth decay among populations with access to fluoridated water, and they noted that these populations had a lower incidence of decay compared to people with no access to fluoride treatment. This was a great scientific breakthrough, and the results compelled dental organizations to recommend exposure to fluoride through drinking water and additives in oral health products, like toothpaste.

Does Fluoride Cause More Harm than Good?

Thanks to the Internet, the public has more access to medical and scientific information than ever before. Certain interest groups have formed, sharing the opinion that fluoridation is not a necessary or even beneficial treatment. In fact, they claim that the treatment does more harm than good, and that efforts to expose the American public to fluoride should be stopped.

One such group, the Fluoride Action Network, questions the need for the public to be exposed to continued fluoridation, especially since fluoride is available in multiple products, from toothpaste to mouth rinses. On their website, the group claims that, as of September 2016, 50 out of 57 separate studies conducted in China, India, Iran, and Mexico have shown a relationship in humans between elevated fluoride exposure and a reduced intelligence quotient (IQ). The human studies were based on IQ examinations in more than 12,000 children, but it was also noted that many of the studies failed to control for other key factors that could be relevant, including parental education level, socioeconomic status, and exposure to other environmental contaminants like lead or arsenic.

In addition to decreased IQ, other people claim that exposure to fluoride contributes to increases in hip and other non-vertebral fracture rates. Some research has found that fluoride has potent effects on bone cell function, bone structure, and bone strength--in quantities that far exceed those found in drinking water.

Some dental practitioners say fluoride actually causes more harm to teeth than benefit. David Kennedy, DDS, notes that “fluoride is harmful to teeth. It does not make the enamel more resistant to decay. Any dentist that’s looked at dental fluorosis finds that it crumbles off--it’s weak, crumbly enamel that causes teeth to chip and break.”

Low-income People and Fluoride

Proponents of the treatment argue that one of the main benefits of fluoridation is the positive impact it has on the oral health of low-income children and adults who might not otherwise have access to dental interventions. In a report by Kaiser Health News, Katherine Weno, oral health director at the Centers for Disease Control and Prevention (CDC) said that “a big thing about community water fluoridation is that it’s a passive intervention … you don’t have to buy a product or access to a dental professional. It benefits people who don’t have money to go to a dentist or don’t have any insurance.”

However, according to 2011/2012 statistics provided by the CDC, the rate of tooth decay in low-income and minority children actually increased substantially despite record numbers of Americans being exposed to fluoride in water, foods, and other dental products. Kennedy notes that “problems caused by fluoridation disproportionately affect African-Americans and Hispanics.” According to the CDC’s 2011-2012 NHANES survey, up to 58% of all children have fluorosis, with African-American children being more affected. “The argument that’s made is that this is for the greater good. But more damage is caused by putting a chemical in the water that African-American children are particularly sensitive to” said Kennedy.

Fluoridation Efforts Continue

Fluoridation efforts continue today and are touted as a cornerstone treatment in the prevention of tooth decay. About 74% of the population of the United States receives fluoridated water from community water systems. The CDC has named fluoridated water as one of the 10 greatest public health achievements of the 20^th century.

According to a March 2016 report by the American Dental Association, about 214.2 million people in the United States received the benefit of fluoridated water in 2014. Statistics on the ADA’s website claim that fluoridation in community drinking water has been effective in preventing tooth decay by at least 25% in children and in adults, and there is a tremendous amount of information related to fluoride that is available to the public through the ADA and the CDC.

The debate over the benefits of fluoridation is far from over, and it’s likely that research into fluoridation will continue on both sides of the argument. What is clear is that this passive public health intervention is going to continue in communities across the US, at least for now. Decisions on the continued use of fluoridation have to be made on the basis of scientific merit, not popular opinion and, in order to do so, research must continue.