Few people will dispute that fluoride strengthens tooth enamel, but how that fluoride gets to those teeth is a hot-button issue.
Citizens for fluoride gathered enough signatures this fall to put Issue 8 on the Nov. 8 ballot. The issue will ask voters if they want Springfield to fluoridate the city’s water. Springfield is the largest of 30 Ohio cities that, 30 years ago, passed referendums excluding them from mandatory fluoridation. Since then, six cities have reversed that decision.
Those for fluoride say the issue is a no-brainer: national and world health authorities, including the American Dental Association and the World Health Organization, have endorsed water fluoridation. The Centers for Disease Control and Prevention calls fluoridated water one of the top 10 health initiatives of the 20th century.
Those against fluoride are not convinced. They say independent studies have shown that ingested fluoride provides minimal protection to teeth while accumulating in bones and other tissues, causing harm. They approve of topically-applied fluoride only.
James Duffy, director of the Rocking Horse Center, said he understands residents’ concerns about fluoride but warned about relying on studies that have not be scrutinized by reputable health authorities.
“There is no scientific association between any (cited health issues) — the cancers, the bone problems, mental deficiencies. There is no evidence that fluoride has anything to do with those conditions.” Duffy said.
Fluoridated water would benefit all residents, but low-income children have the most to gain, Duffy said. Tooth decay is the second cause of bacterial infections in the nation’s children, second only to the common cold.
“I see children every day that suffer because of the chronic untreated infections in their mouth and no resources to provide that treatment — no apparent relief,” Duffy said. The Rocking Horse Center is a pediatric clinic that caters to low income and uninsured children.
“(Fluoridation) removes health disparities without harming those people in the community that have greater resources than others,” he said.
Springfield has only one part-time pediatric dentist. Many family dentists who will see young children will not accept Medicaid because of its low reimbursement rate.
Poverty is a bigger factor in tooth decay than fluoride-free water, said Paul Connett, professor of chemistry at St. Lawrence University. Local opponents of fluoride have asked Connett, a national leader in the fight against water fluoridation, to come to Springfield to speak about the issue.
“Poverty goes hand in hand with poor nutrition,” Connett said. “Some of the worst tooth decay in the U.S. is in cities that have been fluoridated for years; Cincinnati, Pittsburgh, Boston (and) New York City. And where do you find it? In the poor communities.”
Connett recommends cities address the issue of accessibility to dental care instead of fluoridating water.
Cincinnati has fluoridated its water since 1979, yet in 2000, the Cincinnati Enquirer reported the city has an epidemic of tooth decay among its lower-income children. Dentists likened the children’s oral health to that of a third world country.
Fluoride will not erase all dental problems, but it can give disadvantaged children a leg up on tooth decay, Duffy said. “Fluoride brings them up a little bit, but it doesn’t provide the whole solution.”
Duffy likens fluoridated water to iodized salt, vitamin D enriched milk and folate added to cereal. Those additives were designed to improve the health of a large group of people, not just individuals who could independently supplement their food. Folate in cereals can help women prevent birth defects before they even know they are expecting, Duffy said.
Connett said fluoride can’t be lumped together with naturally occurring minerals in the body. Fluoridated water contains 100 times the amount of fluoride found in breast milk, he said.
Duffy said fluoride is found in natural water sources and adding fluoride to Springfield’s water would only elevate it to the recommended level. Fluorisis — spots on the teeth from too much fluoride — occurs only in children in areas where the water supply exceeds recommended fluoride levels, he said.
Duffy said fluorisis is only cosmetic; Connett said the spots are cosmetic signs of internal poisoning.
Pediatricians begin prescribing fluoride vitamins at 6 months, Duffy said. Fluoride supplements are not recommended for children under 6 months. Duffy did not have a recommendation for mothers who would use city water in their infant’s powdered formula.
The city can control the amount of fluoride it puts in the water system but it cannot regulate how much people drink, said Deb Catrow, local spokewoman for Concerned Citizens Against Fluoride.
“What about an athlete who drinks large amounts of water? They would be taking in more than someone who doesn’t drink water,” Catrow said.
It would be hard to ingest a toxic amount of fluoride at 1 part per million, said Rich Foster, fluoride advocate and Clark County Board of Health member. “One part per million means one part fluoride diluted in a million parts of water. That’s like one inch in 16 miles, or one cent in $10,000.”
“Duffy said people can purchase bottled water or filtration systems if they have concerns about fluoride.
Catrow said she can buy bottled water but a low-income family cannot.
“What about the single mother working two jobs? Are you going to force her to buy bottled water? I don’t think we should mass medicate,” she said.
Duffy said it is not mass medication, but believes fluoride fits the concept of public health — providing for the common good.
He said he would like opponents to consider the disadvantaged children who have little control over their oral health.
“This is a social justice issue,” he said.