Most dentists aren’t about to discourage people from drinking fluoridated water. After all, fluoride is credited with preventing an untold number of cavities and related tooth decay-at an estimated $1 billion to $2 billion savings in annual dental bills-since it was first added to public drinking water supplies more than 50 years ago. The American Dental Association endorses fluoridated water without hesitation.
Dr. Ieva K. Wright is not your typical dentist. She is one of Chicago’s leading practitioners of what can be described as holistic dentistry, which she provides at a North Michigan Avenue office.
“I recommend fluoride be used topically,” says Wright, “not that we drink it in our water. I know the caries rate (cavities and tooth decay) goes way down with fluoridated water supplies, but I am less sure fluoride is good for the bones, kidneys and liver.”
Instead, Wright recommends an in-office fluoride gel treatment every six months to help fight tooth decay. The procedure takes about a minute and a half. She also suggests that brushing with a fluoride toothpaste is a positive step for children and adults “as long as you don’t swallow.”
The debate about whether fluoride belongs in our drinking water-even at the level of one-part-per-million deemed safe by the federal government-comes in the wake of the compound’s tremendous success in saving teeth during the last half-century. There is little argument that it can fight harmful bacteria in the mouth. It is nearly forgotten that tooth loss was common before 1950; young men were turned down for military enlistment during World War II because they didn’t have enough teeth.
“In some respects the controversy is not scientific,” says Dr. John W. Stamm, dean at the University of North Carolina’s School of Dentistry in Chapel Hill and spokesman for the American Dental Association. “It’s more a sociological phenomenon that has woven itself into our culture. We have to do a better job of educating the public about the safety of fluoridated water.”
“There are some people who contend fluoride doesn’t prevent tooth decay,” says Dr. Bill Maas, a dentist and director of the oral health division for the federal Centers for Disease Control and Prevention in Atlanta. “You have to totally dismiss those claims.”
After that, the plot thickens. A cover story in the July issue of the Journal of the American Dental Association concludes “fluoride, the key agent in battling caries, works primarily via topical mechanisms: inhibition of de-mineralization (of teeth enamel), enhancement of remineralization and inhibition of bacterial enzymes.”
This position is different from the one embraced by many scientists 35 years ago, Stamm says.
Back then, “researchers believed fluoride’s primary effect was systemic,” says Stamm, meaning we would have to consume it for full benefits. Fluoride tablets, for instance, were widely recommended for children on the hypothesis that the chemical would help a child grow strong teeth.
By the 1980s, scientists realized fluoride simply passing over the teeth has an “important effect on the surface” of teeth, Stamm says.
Even so, Stamm says the ADA recommends fluoridated drinking water as a safe, effective and highly convenient way to introduce fluoride into tooth enamel.
“It’s also highly cost-effective,” Stamm says. “The safety is unquestionable.”
J. William Hirzy would be raising his hand about now. He is a government scientist and vice president of the National Treasury Employees Union Chapter 280, which includes toxicologists, biologists, chemists, engineers, lawyers and other professionals who work for the Environmental Protection Agency. Hirzy testified before a U.S. Senate Environment and Public Works subcommittee on wildlife, fisheries and water in late June about a 1997 study published in the Journal of Public Health Dentistry. That study estimated 66 percent of children in communities with fluoridated water have at least one tooth with visible signs of “overexposure and fluoride toxicity” known as fluorosis (opaque white spots, brown stains, mottling of enamel or a sort of white-streaked effect). Sixty-two percent of the nation’s public water supplies are fluoridated, including 43 of the 50 largest U.S. cities.
Hirzy presented several animal studies linking fluoride to brain and kidney damage in rats, though everyone agrees more human research is needed before any sweeping conclusions can be drawn. He also provided a written statement >from a Toronto dentist, Dr. Hardy Limeback, a former leading advocate of fluoridated water supplies throughout Canada who reversed his position in 1999.
“I believe this issue will come to a head in our country,” says Jeff Green, a dental industry consultant and director of Citizens for Safe Drinking Water in San Diego, a city that happens to not have fluoridated water. “I see the day when we won’t have fluoridation.”
Green says citizens and government officials alike will realize teeth can be protected by topical use of fluoride, eliminating the need for adding it to public water. For now, of course, most mainstream health organizations–from the CDC to the American Medical Association–don’t see the same vision in the crystal ball.
Nonetheless, some communities, including San Francisco, are reconsidering whether fluoride in the water is necessary. Green points out one hot button is that the fluoride used to treat public water supplies is a byproduct of fertilizer, pesticides and aluminum factories–not exactly the ideal image of what we want to ingest in a cold glass of water on a hot day. There’s also a significant amount of fluoride in soft drinks and juices made with fluoridated water, plus milk from cowsthat eat plant food treated with pesticides and fertilizers.
The CDC’s Maas says people need to get fluoride one way or another for preventing cavities and tooth decay.
Maas says if people insist on drinking bottled water, either for taste or to avoid ingesting the chlorine that’s in public water, they should do at least one of the following: They should be sure to use fluoride toothpastes regularly, and they should see whether their local bottled water company sells fluoridated water.
Stamm is less convinced that bottled water should be fluoridated.
“You get fluoride from a variety of sources in the diet, especially processed foods and beverages,” he says.
Another source is water from the faucet used for cooking. While chlorine will boil out, Maas says, fluoride remains in, say, the pasta on your plate.
Parents take note: Fluoride toothpastes can lead to fluorosis in younger children. The government requires all fluoride toothpaste labels to carry a warning that kids under 6 years old should not be allowed access to fluoride toothpaste without supervision and a poison center should be contacted if a child swallows more than the recommended amount for brushing. The American Academy of Pediatrics, for example, recommends using only a “pea-sized amount.”
In any case, fluoride does and should play a key role in protecting your teeth, says Ieva Wright. Make your own decision about fluoridated water, yes, but don’t throw out the fluoride with the tap water.
Wright says a few too many parents these days identify fluoride as “all bad.”
“Parents are refusing the fluoride gel treatments (and not using fluoride toothpastes at home) for their children,” she says. “It makes me almost ill. We end up treating kids for cavities and abscessed teeth. There is a middle ground with fluoride.”