Several proponents of adding fluoridation chemicals to Davis water have argued for it on the basis of social justice for minority and poor residents.
But such civil rights activists as the League of United Latin American Citizens and Andrew Young — former Atlanta mayor, former U.S. ambassador to the United Nations and friend and supporter of Dr. Martin Luther King Jr. — oppose fluoridation partly as a civil rights issue because some minorities and others are disproportionately at risk of harm from fluorides.
Early in his letter against mandatory fluoridation, Young writes: “My father was a dentist. I formerly was a strong believer in the benefits of water fluoridation for preventing cavities. But many things that we began to do 50 or more years ago we now no longer do, because we have learned further information that changes our practices and policies. So it is with fluoridation.”
He also says, “So now we know that fluoride’s impacts are primarily topical and are very limited where needed most in the teeth (pits and fissures). And on top of this we are learning that fluorides do not simply affect teeth, but can also harm other tissues and systems in the body. So we must weigh the risks to kidney patients, to diabetics and to babies against the small amount of cavities prevented by swallowed fluorides.
“The National Research Council (NRC) has acknowledged that kidney patients, diabetics, seniors and infants are susceptible groups that are especially vulnerable to harm from fluorides. There are millions of these persons who have these health conditions or who meet the criteria for concern.”
The 2006 NRC report, “Fluoride in Drinking Water,” examines diabetics’ and physically active people’s fluid intakes in Section 2, “High Intake Population Subgroups.” It reports that physically active people’s daily fluid intake “can range from 6-11 L (liters),” and that diabetics’ daily urine output can range from 3 to 30 liters, with most central diabetes insipidus patients having daily urine volumes of 6-12 liters.
Diabetics’ (and others’) high fluid intake is significant because the concentration of fluoride in water is not the only thing that determines the fluoride dose a person ingests. Dose equals concentration (mg/L) times intake (liters of water consumed). So a person drinking 8 liters of water containing 1 ppm of fluoride gets the same dose as a person drinking 1 liter of water containing 8 ppm. Fluoridation proponents assume an intake of 1 to 2 liters of water a day (containing 0.7 ppm fluoride), so diabetics can ingest up to 30 times the intended dose.
The NRC’s 2006 report says an estimated 18.2 million people in the United States have diabetes, up to 50 percent of them undiagnosed. This is a lot of people to risk overexposing to ingested fluoride. And, according to the Office of Minority Health, non-Hispanic black adults and Hispanic/Latino adults have diabetes at 1.7 times the rate of non-Hispanic white adults.
And the increased risk does not stop there. Diabetes further magnifies the effects of ingested fluoride when the diabetes damages the kidneys, resulting in less efficient clearance of fluoride from the body. Kidney disease, like diabetes, occurs at higher rates in some minorities, leaving them — again — more vulnerable than the population at large to the ill effects of ingested fluoride.
Some minorities also experience more enamel fluorosis — caused by ingesting too much fluoride — than white non-Hispanics, especially moderate and severe fluorosis.
The U.S. National Health and Nutrition Examination Survey, 1999-2002, Table 23 — “Enamel fluorosis among persons aged 6-39 years, by selected characteristics” — clearly shows higher rates of moderate and severe enamel fluorosis in black non-Hispanics and Mexican-Americans than in white non-Hispanics.
And the NRC’s 2006 “Fluoride in Drinking Water” reports that only two of the 12 committee members did not agree that severe enamel fluorosis is an adverse medical effect. This is very significant because, for decades, fluoridation proponents dismissed all enamel fluorosis as merely cosmetic, including moderate fluorosis (in which “all enamel surfaces of the teeth are affected, and surfaces subject to attrition show marked wear. Brown stain is frequently a disfiguring feature.”) and severe fluorosis (in which “all enamel surfaces are affected and hypoplasia is so marked that the general form of the tooth may be altered. The major diagnostic sign of this classification is the discrete or confluent pitting. Brown stains are widespread and teeth often present a corroded appearance.”).
At the end of his letter, Young writes, “I am most deeply concerned for poor families who have babies: If they cannot afford unfluoridated water for their babies’ milk formula (as the ADA and CDC recommend to prevent fluorosis), do their babies not count? Of course they do. This is an issue of fairness, civil rights and compassion. We must find better ways to prevent cavities, such as helping those most at risk for cavities obtain access to the services of a dentist.”
The same government that advocates water fluoridation acknowledges that fluoride’s predominant effect on teeth is topical, not systemic. So it makes no sense to expose everyone — including the most vulnerable — to the risks of ingesting fluoride (dental fluorosis and skeletal problems, among others). Instead, the money for fluoridation should be used to provide topical fluorides (toothpaste, rinses and lacquers), toothbrushes, floss, dental sealants and dental care to those in need.
We should not — in a well-intended effort to do something good for minority and poor Davis residents — inadvertently do something risky and ineffective to all Davis residents.
— Barbara King is a Davis resident and a member of Davis Citizens Against Fluoridation. Reach her at firstname.lastname@example.org