Fluoridation means adjusting the fluoride content of water to a concentration of about 1 part fluoride per million parts of water (1 ppm). The word does not refer to natural waterborne fluoride, fluoride toothpastes, mouth rinses, or supplements. The term "adjusting" is appropriate because "adding" would imply putting something in the water that is not already there. Most ground water contains fluoride, but usually not the right amount for optimal effectiveness against tooth decay without fluorosis.
How fluoride's dental benefits were discovered.
Dr. Frederick McKay, a dentist who began practicing in Colorado Springs in1901, became concerned about a dental condition known locally as "Colorado brown stain." This is now known to be extreme dental fluorosis, a condition that discolors, disfigures, and weakens the teeth. Nobody knew its cause, but McKay suspected it was something in the water. Unfortunately, the analytical chemistry technology of the era was unable to discern any differences between water samples from regions with or without brown stain. Despite this, McKay persisted with his theory that something in the water was causing brown stain. He convinced the people of Oakley, Idaho, a region also troubled by brown stain, to change from wells to mountain run-off water. In a few years the condition disappeared, providing evidence that his theory was sound. It wasn't until 1931 that Alcoa chemist H.V. Churchill, using the new method of spectrographic analysis, determined that water samples from brown stain areas had up to 14 ppm fluoride. The initial reaction was to ask whether the high fluoride ingestion caused other undesirable effects. Studies of people in the brown-stain regions could find no adverse health effects other than dental fluorosis (although it is known that high levels of fluoride can cause skeletal fluorosis as well). It was eventually determined that lower levels of fluoride protected teeth from decay without objectionable fluorosis. Continued research eventually led to the public health practice of fluoridation.
Why use the public water system?
Fluoride's most important derives from exposure from birth to age 6 when teeth are being formed. Fluoride becomes part of the structure of teeth, making them harder and more acid-resistant. This is called the systemic effect of fluoride. Waterborne fluoride is most effective because this method maintains the most consistent serum levels over time. Fluoride supplements also provide systemic effects, but pills do not maintain as consistent serum levels, are more expensive, and are less likely to be used effectively because pill-taking requires repeated action and supervision. After the teeth are formed, maintaining the serum levels helps supply fluoride needed for teeth and bones to remain healthy. Benefits from brushing with fluoride toothpaste, rinsing with fluoride solutions, or fluoride applications at a dentist's office are called topical effects.
Fluoride: a super element.
Fluoride is a stable, dissociated, ionized form of fluorine, the 17th most common element, 13th most common element in the earth's crust (averaging 290 ppm in the 10-mile deep crust), and 12th most in the ocean water. Fluoride is most abundant in regions that have experienced volcanism in their geological pasts. Fluorine never occurs in nature in its elemental form because, as the most electronegative and reactive of all elements, it combines readily with other natural substances -- most often calcium. The phenomenal power of the fluoride ion is attested to by the very narrow range in which its effects are seen. At 0.3 ppm, waterborne fluoride does not protect against tooth decay, whereas at 1 ppm it can reduce tooth decay significantly without objectionable fluorosis. At 2 ppm, waterborne fluoride begins to produce fluorosis in susceptible individuals. Antifluoridationists who point out that fluoride can produce adverse effects deliberately fail to mention that the concentrations that produce adverse effects is higher than the concentration produced by properly maintained fluoridation systems.
Why does the dental profession strive for fluoridation?
The vast majority of dentists and dental organizations advocate water fluoridation. If dentistry operated according to business ethics, it would favor a system that required consumers to obtain fluoride's benefits through dental offices. This would not only put more money in the pockets of dentists, it would eliminate one of the profession's biggest headaches, the jibes it must endure in the hassle over fluoridating public water systems. The dental profession continues the struggle for fluoridation because of the ethical traditions observed by health professionals. Because no equally effective, economical, and efficient method for preventing tooth decay is available, the dental profession has a moral duty to support fluoridation. Professional associations differ from business trade associations in important ways. Businesses work to perpetuate market demand for their products and services, while professions conduct research to find ways of eliminating the very diseases from which their members earn their livelihood. Businesses have trade secrets, while professionals share information through scientific publications. The public expects professionals to put public health ahead of its own financial interests. This fact is recognized by the Sherman Antitrust Act, which excludes scientific enterprises from the rules governing competition.
Antifluoridationists nearly always raise the issue of freedom of choice when arguing against fluoridation. Although this argument has appeal, it must be weighed against the right of the public to benefit from scientific discoveries in preventive medicine. In the case of fluoridation, the democratic principle of equality comes into play. Fluoridation provides its benefits to the children of all social classes, and reaches children whose health needs are neglected by inattentive parents.
Effectiveness of fluoridation.
Over the years. hundreds of studies have attested to fluoridation's effectiveness against tooth decay. The most elaborate study ever done, the National Preventive Dentistry Demonstration Program (NPDDP), provided evidence that fluoridation is the most effective, and economical method for preventing tooth decay. The NPDDP was conceived by the American Fund for Dental Health, a non-profit, independent organization in Chicago which raises funds to support dental research, education and the delivery of dental services. The study involved nearly 30,000 children ages 5-14 in 10 US communities -- 5 fluoridated and 5 nonfluoridated -- over a four-year period (1977-81) at a cost of over $10 million. The project was funded by the Robert Wood Johnson Foundation. The Rand Corporation was separately funded to conduct an independent evaluation of the effectiveness and costs associated with the various procedures. In each community, 5 preventive regimens were tested with a sixth set of schools as controls. The control subjects received annual dental examinations but no preventive care from the program. The project's purpose was to assess the effects and costs of various types of school-based preventive dental procedures under realistic field conditions. Dividing the study between fluoridated and nonfluoridated cities enabled the researchers to measure the effects of fluoridation. The results clearly established that drinking fluoridated water from birth onward is the most effective, and economical way to prevent tooth decay. The difference in cost per cavity prevented was stunning:
|Fluoride mouth rinse and tablets||
|Prophylaxis and fluoride gel||
Safety is the primary issue that must be addressed, and any procedure that involves the public water supply must be safe beyond doubt.(Public water may undergo as many as 25 different treatments to make it potable.) Fluoridation is the most thoroughly studied public health intervention of all. Not only was it well studied before 1945 when Grand Rapids, Michigan became America's first fluoridated city, but studies have continued since that time as fluoridated cities are continually monitored by public health scientists. Some wonder whether fifty years is long enough to discover any unanticipated adverse long-term effects of fluoride ingestion. The reality is that scientists are not limited by the 50 years that fluoridation has been in effect. Evidence is also available from studies of people who have lived for generations in regions where the natrual water supply contains effective levels of fluoride. Further, since seawater contains from 0.8 to 1.4 ppm fluoride, sea creatures have thrived in water with levels comparable to fluoridation for aeons.
To influence public opinion, antifluoridationists do not have to prove that fluoridation is unsafe, ineffective, or undesirable in some other way. They merely have to create doubts. Many who express their concerns over fluoridation have been duped by antifluoridationist's propaganda. Antifluoridationists work to create doubt through confusion. Their favorite tactic is to create the illusion that a scientific controversy exists of the safety of fluoridation.
Because fluoridation involves community water supplies, public health authorities feel compelled to investigate even when the charges are made by people with a history of raising questions of doubtful validity. Investigations take time to complete. In the meantime, the very fact that an investigation is underway helps the antifluoridation propagandists achieve their goal of creating doubt about fluoridation's safety. The amount of effort required to answer antifluoridationist charges is attested to by the fact that it took a 184-page book to disclose the misinformation presented in a single flyer entitled the Lifesaver's Guide to Fluoridation published by the Safe Water Foundation of Delaware, Ohio . Nothing in the antifluoridation armamentarium ever becomes outdated. Charges that have been answered in the past are resurrected years later and presented as if they were valid. Because of this, articles written years ago are still relevant today to debunk antifluoridation misinformation.
Distortion of facts and sensationalism peaked in 1978 when Congressional hearings were held on the charge that fluoridation was causing cancer . As a result of those hearings the National Toxicology Program (NTP) was asked to determine the toxicity and carcinogenicity of fluoride. The NTP was in the process of analyzing certain crude data when someone leaked the data, which led to an antifluoridation cover story in Newsweek magazine (2/2/90). It was impossible for responsible scientists to respond because the data had not been fully analyzed. The result was a propaganda victory for the antis for a time. However, when the NTP completed its analysis, the results were classified as "equivocal," and of insufficient meaning to be published in the agency's annual report .
What motivates antifluoridationism?
NCAHF believes that antifluoridationism is motivated by two factors: profit and paranoia. The nidus of the movement in the health food industry [4,5]. A psychology of distrust underlies the entire health food concept because if supermarket foods are safe and healthful there is little justification for an alternative food industry to exist. For the perspective of profit, health food stores sell bone meal supplements, special tooth pastes, and other products alleged to be effective for preventing cavities. Antifluoridationism has become a business enterprise for some individuals. Some of these also sell paraphernalia (water filters and distillation units) for people who wish to avoid ingesting fluoridated water. Some are public speakers who have received fees of as much as $1,000 per day for coming to locations where fluoridation is at issue to spread misinformation, fear and confusion. NCAHF has monitored the publications of some of these activists and has seen their ability to raise large sums of money from donors who apparently believe that they are contributing to a patriotic cause to "save" America from communism, or some other sinister enemy -- the paranoid aspect of antifluoridationism. This faction is made up of people who either hold, or capitalize upon paranoid views of reality described by Hofstadter . Antifluoridationists thrive on a paranoid view that shares the notion that there is also a conspiracy to withhold medical advances from the public, especially a cure for cancer . Curiously, the idea that a conspiracy among the medical profession holds back truly effective cures is held by 30% of Americans . This misconception is refuted by the medical and dental professions' 50+ year record of backing fluoridation efforts in order to effectively reduce tooth decay despite the fact that less tooth decay means less money spent for restorative dentistry. The reality is that the healing professions are dedicated to finding ways of preventing disease, prolonging life, and improving the human condition.
In their intemperate crusade to scuttle fluoridation, antifluoridationists have accused the U.S. Public Health Service of everything from incompetence to high treason. Antifluoridationists have a long history of using deception to call attention to their cause. In the 1950s they raised the paranoid ultra-rightwing spectre of Communist and Jewish plots to enslave Americans. Today's manifestations of such paranoid hate-mongering can be seen in the anti-government militia movement. Antis justify their use of deception and terrorism by the reasoning that government authorities are evil and that "all is fair in love and war."
Extremists within the health food industry have traditionally opposed not only fluoridation but immunization, pasteurization of milk, food processing, modern agriculture, food irradiation, and the products of recombinant DNA research. The National Nutritional Foods Association, a health food trade group, is organizing opposition to state mandated fluoridation in California .
Some people oppose fluoridation because they are simply against any form of government intervention based upon a personal ideology. NCAHF's comments refer to the organized antifluoridation movement, not necessarily to citizens outside of the movement who oppose fluoridation. Some have undoubtedly been deceived by antifluoridation propaganda, but would be willing to change their minds when they get the facts. NCAHF believes that the factions that keep alive the antifluoridation movement are a major detriment to the health and well-being of the public. Whether or not they sincerely believe their own propaganda is irrelevant. Their history of deception and deviance has unveiled them as unworthy of trust. NCAHF urges the public to reject their cynicism, paranoia, and extremist views.
Other Resource Documents
Health Effects of Ingested Fluoride (Executive Summary). (Committee on Toxicology, Nat'l Research Council) Nat'l Acad Press 1993.
Covers intake, metabolism, and disposition of fluoride; dental fluorosis; bone strength and the risk of bone fracture; effects on the renal, gastrointestinal, and immune systems; reproductive effects in animals; genotoxicity; and carcinogenicity in animals and humans; conclusions; and, recommendations for further research.
Drinking water fluoridation concerns unwarranted (Nat'l Acad Sciences press release) 8/16/93
The press release that announced the item above. Contains a summary of the summary.
Water Fluoridation for the North West (North Western Regional Health Authority) November, 1989
Antifluoridation disinformation claims made by the "North West Councils Against Fluoridation" are answered by the North Western Regional Health Authority (United Kingdom). A convenient two column presentation that juxtaposes the false claims of an antifluoridation group with responses by a public health agency.
4. Fluoridation: strategies for success. (Iman) Amer J Publ Health 1981;71:717-21 5
Analyzes why 17 of 19 referenda on fluoridation held in the first six months of 1980 were defeated. Useful for planning campaigns to bring the benefits of fluoridation to a community.
5. Fluoridation: the cancer scare (part one); (and) The attack on fluoridation: six ways to mislead the public (part 2) Consumer Reports 8/78 8
Part 1: covers the history of fluoridation; the history of the National Health Federation, the most important single antifluoridation organization at that time; and, exposes the scheme to create a cancer scare by John Yiamouyannis, PhD, who was hired by NHF to discredit fluoridation. Part 2 covers false claims used by antis: Fluoride is a poison, causes birth defects, is mutagenic, causes allergic reactions, causes cancer in animals, and contributes to heart disease. Describes the experience of Antigo, WI which learned the hard way not to listen to anti's propaganda -- it suspended and then reinstated fluoridation after child dental health declined.
America's longest war: the fight over fluoridation, 1950-- (McNeil) The Wilson Quarterly Summer, 1985
A well-written review of the history of fluoridation and opposition to it. Includes information on prominent antifluoridationists including super-anti John Yiamouyannis, PhD. The basic theme is that the struggle over fluoridation is reflective of the workings of American democracy.
Thirty years of fluoridation: a review (Richmond) Am J Clin Nutr 1985;41:129-38
Contains basic information on fluoride, history of discovery of fluoride's effects on teeth and bones, misinformation disseminated by antifluoridationists, safety issues, and current status at the time.
The alleged association between artificial fluoridation of water supplies & cancer: a review (Clemmesen) Bull World Hlth Org 1983;61:871-83
Refutes antifluoridationist's claims that fluoridation is followed by an increase in cancer.
Nutritional quackery, the health food industry and the antifluoridation movement (Easley) Ohio Dent J 1983;57:19-26
The new antifluoridationists: who are they and how do they operate? (Easley) J Publ Hlth Dentistry 1985;45(3):133-141
Describes the contemporary antifluoridation movement, facts on litigation the movement has sponsored, and anti's tactics.
Evaluatory Surveys of Long-tern Fluoridation Show Improved Dental Health. U.S. Dept of Health, Education & Welfare. March, 1979.
Provides basic information on variables that must be considered when evaluating the effectiveness of fluoridation. Also provides data on surveys taken up to that time.
Effectiveness of water fluoridation (Newbrun) J Public Health Dentistry 1989;49:279-89
Review of surveys in the USA, Australia, Britain, Canada, Ireland, and New Zealand. Efficacy is greatest for deciduous dentition (30-60%), 20-40% in 8-12 yr-olds; 15-35% in 14-17 yr-olds. Limited data for adults shows 15-35% less caries. Viewed in toto, data show consistently and substantially lower caries for all groups. Benefits have decreased due to other forms of fluoride that have spread to nonfluoridated communities.
Public support for water fluoridation in California 1991-94 California Morbidity Sept, 1995
Summary of workshop on drinking water fluoride influence on hip fracture on bone health [NIH] (Corbin) Osteoporosis Int 1992;2:109-17
Addresses questions on the effects of drinking water with 0-4 mg/liter fluoride on various bone (hip, vertebrae, wrist, and other fracture rates; and, the effects on bone density.
Statement by James O. Mason, MD, Assistant Secretary for Health, HHS News released 4/26/90
Affirms the National Toxicology Program's interpretation of the findings of its 2-year animal study of the toxicity and carcinogenicity of fluoride. The findings were classified as "equivocal"--a category for uncertain findings; and, the conclusion that there was no information that would alter the U.S. Public Health Service policy on fluoridation.
The case for eliminating the use of dietary fluoride supplements among young children (Burt) original paper presented at the Dietary Fluoride
Supplement Conference, American Dental Association, Chicago. Jan 31-Feb 1, 1994.
A response by Dr. Brian Burt to inferences drawn by John R. Lee, MD, from a paper presented at the Dietary Fluoride Supplement Conference,
American Dental Association, Jan.31-Feb 1, 1994
What does the public think of amalgam? (also fluoridation, AIDS risk) (McCann) ADA News, 4/8/91, p.3
Hofstadter R. The Paranoid Style in American Politics and Other Essays. New York: Alfred A Knopf, 1966.
Traces paranoid world views throughout the American experience; not clinical paranoia, but a public version.
Notes from the cancer underground: participation in the Laetrile movement (Markle) Soc Sci & Med 1978;12:31-7
Sociologists attend an antiregulatory rally in Kalamazoo, Michigan aimed at legalizing the quack cancer remedy Laetrile. Questionnaires returned by a majority of participants revealed that "disapproval of fluoridation" was the strongest predictor of organizational participation and the second strongest of use of Laetrile.
Important Resources From Other Sources
© 1996, National Council Against Health
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