Sixty years after Grand Rapids Michigan became the first city to fluoridate its drinking water supply, the arguments for and against fluoridation continue as each community in this nation has been forced to investigate the possible benefits and dangers of fluoridation. The arguments between medical professionals in the small northern California town of McKinleyville is a prime example of why the controversy over fluoridation continues over a half century after its introduction.
âItâs not a conspiracy, weâre in it for the health of the patient,â said McKinleyville dentist Dr. Allen Ehlers. Ehlers claims the American Dental Associationâs support for fluoridation canât be the conspiracy some claim it to be because it actually costs dentists money as it improves the oral heath of patients and results in reduced profits for dentists. According to the ADA, the cost to fluoridate a community ranges from $0.50 to $3.00 per person a year. And approximately every $1.00 spent on fluoridation saves $38.00 in dental treatment costs. So if the drive for good oral health is the more likely reason the ADA supports fluoridation of drinking water, and locally 100% of the McKâ DDSâs support fluoridation of local drinking water, then why all the controversy?
History of fluoridated drinking water
After model dental health (lack of tooth decay) was discovered in key populations of the southwest, it took scientists several years to figure out why, and according to the American Dental Association, as a result, over a period of time the scientists came to three conclusions: 1) Areas containing high concentrations of residents with model oral health and a good cosmetic appearance of teeth had an optimal level of fluoride in their drinking water supply. 2) Areas with higher rates of cavities had lower than optimal fluoride levels. And 3) areas where the fluoride level was too high had low cavity rates, yet also had a strong prevalence of fluorosis or enamel mottling (white spots on their teeth). The studies led to the idea of adjusting the levels of fluoride (up or down) to a beneficial level; so, in 1945, Grand Rapids Michigan became the first city to adjust the level of fluoride in its water supply to about 1 part per million with the intention of benefiting public health.
What is fluoride anyway?
âSodium Fluoride (one of the most common compounds used in water fluoridation) occurs naturally; itâs extracted from nature.â Said Humboldt County Health Officer Dr. Ann Lindsay.
Sodium Fluoride is a compound of fluorine that is a member of the Periodic Table of the Elements or Atomic Number 9. Fluoride is a naturally occurring element found in rocks, soil, fresh water and salt water. However the variety of types and sources of fluoride from pharmaceutical to industrial grade (or the spectrum of production from toothpaste to uranium) and how these substances are used, could be creating a whirlpool of confusion about the issue of fluoridated water.
For example, Los Alamos National Laboratory's Chemistry Division website indicates a soluble fluoride in drinking water (provided in quantities less than two parts per million) helps prevent dental cavities. The site also lists other uses for the substance and its compounds including but not limited to the production of uranium and more than 100 commercial fluorochemicals including plastics and Fluorochlorohydrocarbons used in air conditioning and refrigeration. Also, the possibility of using elemental fluorine as a rocket propellant has not been ruled out. However the grade of fluoride that may be someday be used by ground-control to propel a budding Major Tom to Mars is not at the same saturation level as that approved to fluoridate drinking water.
âItâs purified to the point of the standards set by the California Department of Health Services and the EPA that set standards of safety,â stated Health Officer Dr. Lindsay.
According to the Centers for disease Control studies reveal waters in and around the United States have natural fluoride levels that range from 0.1 parts per million to over 12 parts per million. So because fluoride already exists naturally in water supplies, on their website, the American Dental Association indicates the fluoridation of water is, âsimply the precise adjustment of the existing naturally occurring fluoride levels in drinking water to an optimal fluoride level recommended by the US Public Health Service (.7-1.2 parts per million) for the prevention of tooth decay.â
As for Humboldt Countyâ¦ a representative from the Humboldt Bay Water District reported the HBWDâs last study of Humboldt County water indicated a ânon-detectâ of fluoride in drinking water throughout the region. In other words, if fluoride occurs in the water supply locally, the level is beyond current measure of detection.
At the ebb of the last millennium, the Centers for Disease Control and Prevention listed the fluoridation of drinking water one of the Ten Great Public Health Achievements in the United States of the 20th century. The CDC April 1999 report declared, âFluoridation of drinking water began in 1945 and in 1999 reaches an estimated 144 million persons in the United States. Fluoridation safely and inexpensively benefits both children and adults by effectively preventing tooth decay, regardless of socioeconomic status or access to care. Fluoridation has played an important role in the reductions in tooth decay (40%-70% in children) and of tooth loss in adults (40%-60%).â
âIf we didnât end up approving fluoride in the water, we would be negligent; I would feel bad,â said Dr. Ehlers. He explained several years ago while involved with a project that provided the fluoridation of drinking water to wells in the Weitchpec area he saw first hand a distinct difference in the improvement of the oral health of the children in the rural area after their drinking water was fluoridated. âNo doubt itâs a benefit and not a risk,â said Dr. Ehlers.
The American Medical Association also has a positive attitude in regard to the fluoridation of water. As AMA policy Fluoride Content of Municipal Water Supplies states, âLocal and state medical societies and individual physicians have the opportunity to become involved in correcting the problem of fluoride underfeeding by (1) ascertaining whether municipal water supplies are optimally fluoridated and (2) working with public health agencies to take corrective action if sub optimal fluoridation is found.â
âItâs the nature of our civil society to benefit the population,â said Dr. Lindsay.
âI think science supports the safety and effectiveness of fluoridation, but there are dangers of fluoride in higher concentrations,â said Health Officer Dr. Lindsay. She explained that fluoride taken in does of 10-20 parts per million may cause bone weakness, but that bone weakness cannot occur at one part per million (an amount within the legal perimeters of fluoridated water).
Dr. Lindsay pointed out that fluorosis (the staining of teeth with white spots) could happen if certain infant formulas are mixed with fluoridated water, yet, âIt doesnât impair the integrity of their teeth and the benefits are greater.â She continued, âThe ADA did come out with a warning, if you use fluoridated water for babies less than six months of age it could result on spots on their teeth, but dental decay is a bigger problem than fluorosis.â
âA lot of the misunderstandings come from different concentrations having different effects; you cannot drink enough water to get fluoride toxicity. There is no evidence that it accumulates in the body to a toxic level,â claimed Dr. Lindsay who believes the risk of not fluoridating the drinking is far greater. She explained between 2003 and 2006 Humboldt County Health screened 3,000 children and 30% had untreated dental cavities and 9% needed an immediate dental referral.
The National Research Council (a branch of the National Academy of Sciences) released a report in 1997 prepared for the Environmental Protection Agency that claimed the allowed fluoride levels in drinking water does not pose a risk for heath problems such as cancer, kidney failure or bone disease. The EPA declared that naturally occurring amounts up to 4 parts per million was an âadequate margin of safety.â
Ill-effects and Deaths linked to excessive fluoride ingestion
Even though âallowed fluoride levelsâ in drinking water are deemed safe by the Environmental Protection Agency, media reports linking illnesses and deaths to an overdose of fluoridated drinking water occasionally turn up in the headlines, and most overdoses appear to be blamed on human error, equipment malfunction or both.
According to a November 1979 article in the EVENING CAPITAL in Annapolis, Maryland the effects of a fluoridated water overdose was unprecedented up to 1979, as spills had never occurred in a city where a dialysis center is located. An autopsy proved fluoride poisoning was linked to the death of a 65-year-old kidney dialysis patient who suffered a toxic reaction leading to cardiac arrest after a blood cleaning process; seven other kidney patients also became ill. The state authorities had not been notified a worker at the city's water filtration plant accidentally left a valve open for 11 hours, releasing 10 times the recommended amount of fluoride into the water supply. The report indicated the accidental spill of 1,000 gallons of fluoride into Annapolisâ drinking water supply probably would have gone undetected if the kidney patients had not become ill.
Similarity, in 1993, the CHICAGO SUN-TIMES reported fluoride was the cause of 3 deaths after a series of devices used to purify the water used for dialysis somehow failed to do so and traces were found in blood of dialysis patients. The finding was confirmed by the Centers for Disease Control in Atlanta.
In 1992 the NEWS TRIBUNE in Tacoma, Washington reported that an Alaska state study found a faulty pump and poor government structure was to blame for fluoride poisoning resulting in one manâs death and the illnesses of more than 260 villagers in Hooper Bay, Alaska. A report by the state found malfunctioning pumps and a barely functioning local government allowed fluoridation at nearly 40 times the level considered safe by the federal government.
And in California, according to a June 2002 article in the Contra Costa Times, city officials suspected an overdose of fluoride in the drinking water was to blame for the illnesses of 23 people at a Dublin business. Bert Michalczyk, the Dublin-San Ramon Services District general manager indicated that half of those made ill complained of acute symptoms, including stomach pains and vomiting and three people were taken to a hospital. Dublin-San Ramon Services District tries to maintain a fluoride level of about one milligram per liter in the drinking supply; however, tests at the Dublin business showed concentrations of up to 200 milligrams per liter at the time of the incident. A water pump with a history of problems was suspect to be faulty and the cause of the incident.
Exposure to multiple safe levels of fluoride under scrutiny
Contrary to McKinleyvilleâs dentists, Eureka DDS, Dr. Brian Smith has concerns about the fluoridation of drinking water. Dr. Smith cited from the ADA Guide, âFluoride is thought to work topically, the mechanisms are still incompletely understood,â and then commented, âIf the primary effect of fluoride is topically, then why drink it?â
âItâs hard to know our total exposure to fluoride,â said Dr. Smith, who has concern about the amount of fluoride people may be ingesting in addition to fluoridated water that could possibly result in a fluoride overdose. For example, âProcessed foods contain fluoride exposure if made in a fluoridated area,â he said, and explained that foods such as some colas, bottled water, baby formula, mechanically de-boned chicken (such as nuggets) and juices may contain higher than the recommended safe levels of fluoride. And some countries such as Mexico fluoridate table salt supplies; so, any processed foods from countries that fluoridate salt should be taken into account as well when drinking fluoridated water.
Although there does not appear to be a warning from the American Dental Association in regards to the consumption of fluoridated water, the ADA recommends precaution when dietary fluoride supplements (tablets, drops or lozenges) are used. As listed on the ADA website, âIt is important to note that fluoridated water may be consumed from sources other than the home water supply, such as the workplace, school and/or day care, bottled water, filtered water and from processed beverages and foods prepared with fluoridated water.â
Prescription fluoride vs. fluoridated water
Dr. Smith read a passage from the ADA Physicians Desk Reference Guide to Dental Therapeutics pertaining to prescription fluoride, âThe actual maximum dose for each patient must individualize by weight, age, physical status and other dietary sources of fluoride intake,â he continued, âItâs one of the few supplements that you need a prescription to get.â He claims fluoridated water should be treated in the same respect to prescription fluoride supplements.
Local specialist in Periodontics, Dr. Schonfeld stated his professional opinion on the difference in risks between fluoridated water and other exposure to fluoride. âFluoride in the water is safer than fluoride pills. The negative effects of fluoridated pills or exposure to fluoride in industrial settings have never been demonstrated at the dosage level in fluoridated water,â said Dr. Schonfeld who also claims, unlike fluoride supplements, fluoridated water is not just for children. âIt helps older adults because of recession of the gums it helps the roots,â he said.
However, Dr. Smith claims the FDA classifies all fluoride for ingestion as an, âexperimental new drug,â he said, âThere is not a fluoride that has been FDA approved for ingestion.â He explained even toothpaste has a warning on the label not to swallow.
Yet, the Food and Drug Administration (FDA) does not have power to regulate what goes into community water supplies. According to the FDA website www.fda.gov, âEnvironmental Protection Agency has the responsibility for developing national standards for drinking water from municipal water supplies. FDA regulates the labeling and safety of bottled water.â
Consumerâs right to choose
âYou can buy fluoridated water if you want it,â said Dr. Brian Smith.
According to current McKinleyville Community Service District rates, 3,740 gallons of (currently non-fluoridated) water on average costs $4.70. One MCSD employee explained that whether or not the fluoridation of the water is approved, individuals are not mandated to buy water from their service districts. In other words, they have the right to shop around and buy from a different water supplier. âIf somebody wants to do that they can probably get a permit from the county,â he said.
MCSD Operations Director Greg Orsini said, âFluoridated water would be a public health service we provide to the public just like the chlorination of water to kill bacteria.â And because the possibility of fluoridation locally is undecided Orsini explained, âThe type of fluoride that may be used has not been determined.â
However Orsini also stressed concern for the lack of factual information floating around the community. âTo this point itâs been more emotion than anything else,â he said.
Nanette Kelley is a free-lance writer who resides in the northern California redwoods. She is also co-owner of http://www.ItsSimplyNatural.com a chemical-free bath & body web store.