The Water Fluoridation Controversy

The water fluoridation controversy arises from moral, ethical, and safety concerns regarding the fluoridation of public water supplies.

Fluoride is naturally present in most water sources that are used for drinking water supplies. Fluoride protects teeth from decay by joining with minerals in the outer layer of the tooth. Fluoridated teeth are more resistant to acids that decay teeth and produce bacteria.

Fluoridation merely adjusts the amount of fluoride to an optimal level to provide for protection of teeth. The American Dental Association notes that “Fluoridation is a form of nutritional supplementation that is not unlike the addition of vitamins to milk or iodine to table salt.

The United States Public Health Service states that “Fluoride has substantial benefits in the prevention of tooth decay.” Numerous studies clearly establish a causal relationship between water fluoridation and the prevention of dental caries. While dental decay is reduced by fluoridated toothpaste, mouth rinses, and professional fluoride treatment, fluoridation of water is the most cost-effective method. It provides the greatest benefit to those who have the least access and who can least afford preventative and restorative dentistry.

Extensive studies over the last 50 years have established that individuals whose drinking water is fluoridated show a reduction in dental caries, although the comparative degree of measurable benefits has been reduced as other fluoride sources have become available in non-fluoridated areas.

Although fluoridation may still be a relevant public health measure among the poor and disadvantaged, it may be unnecessary for preventing tooth decay, particularly in industrialized countries where tooth decay is rare.

Fluoride’s benefits come from topical contact with the teeth. Its risk to health (which involves many more tissues than just the teeth) results from being swallowed. Fluoridated toothpastes and mouthwashes which are universally available seems a more rational approach to delivering fluoride to the teeth, while minimizing exposure to the rest of the body.

Adverse effects from fluoride ingestion have been linked to a risk to the brain, thyroid gland, and bones. However, the Center for Disease Control (CDC) has found no clear association between fluoridation and other adverse effects, and lacks sufficient evidence to reach a confident conclusion. Further research into these potential associations is necessary to help support or refute these observations. At the dosage recommended for water fluoridation, the only clear adverse effect is dental fluorosis. This effect is cosmetic and is unlikely to represent any real effect on public health.

On January 7, 2011, the U.S. Dept. of Health and Human Services (HHS), and the U.S. Environmental Protection Agency (EPA) announced new recommendations pertaining to the amount of fluoride currently being used in nearly two-thirds of this country’s water supply. Too much fluoride causes white spotting on the teeth – this overexposure is know as fluorosis. Dr. Paul Connett, a chemist specializing in environmental chemistry, noted that approximately 32% of American children have been overexposed to fluoride, as these children display signs of fluorosis.

Patients at low risk of dental decay may not benefit from professional fluoride application – the fluoride in toothpaste and mouth rinses may be enough. Factors such as poor oral hygiene, prolonged nursing (bottle or breast), poor family dental health, enamel defects, xerostomia (dry mouth), eating disorders, drug or alcohol abuse, irregular dental care, a high-acid or sugar diet, braces, or gum loss may increase the risk of decay.

Children with any history of decay and older patients with at least a few cavities and multiple risk factors are at high risk for decay, and will benefit from professional fluoride applications at least twice each year. However, it is important to note that, regardless of the delivery method, fluoride can’t overcome poor diets and dental hygiene.


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