Locally and lately, assertions have been made that anyone who questions fluoridating our water supply is a kook who doesn’t care about poor children, and that these kooks are just a vocal minority that the rest of us should disregard. The 600 dentists, doctors, and PhDs (including world-renowned scientists, a former Chief of Water Toxicology at EPA, and a Nobel Prize winner in medicine) who this year signed a petition calling for an end to water fluoridation might take exception to that characterization. And the scientific evidence of the last decade or so indicates reason to be vocal about thinking carefully before jumping onboard the water fluoridation bandwagon.

The information presented by the local pro-fluoride “side” has mostly excluded current data and studies, which generally do not support their whole-scale advocacy of fluoridating community water supplies. Nor, as far as we know, have they mentioned that in light of recent legislation, the California Environmental Protection Agency (Cal-EPA) is advising agencies and water districts that standards for fluoride in water may be lowered. This means that the level of fluoride in water supplies that is considered safe–under new regulations–may be below the concentration needed to provide dental benefits. We have been disappointed that our Public Health officials have not informed the public about these recent developments. Although not expert in these matters, we will try to provide a small portion of the missing information here. If you (like we) were thoroughly indoctrinated in the benefits of fluoridated water when you were young, the following information will be startling, but new information should not be dismissed simply because it contradicts what you thought you knew. You should, however, look critically at it, and that is why we hope you will be stimulated to check it out further for yourselves.

To get into specifics, the recent studies we mentioned above are not “fringe element” sources. They went through “peer review” scrutiny of other scientists working in their field prior to publication, and are presented in well-respected scientific journals. Some sources include: Caries Research, The Journal of Clinical Pediatric Dentistry, Journal of the American Dental Association, Community Dentistry and Oral Epidemiology, British Medical Journal, and Oral Health and Preventative Dentistry. One especially pertinent example is from the scientific journal Clinical Oral Investigations, which this year published an article providing a summary of the most current research (research published in the English language from 2001-2006) on the role of fluoridating water supplies in preventing tooth decay as well as in comparison with topical fluoride treatments and with discussion of some health risks. This review article, entitled “Community Water Fluoridation and Caries Prevention: a Critical Review”, states that the findings are quite clear that fluoride is very effective at preventing dental caries (i.e. tooth decay) and otherwise promoting dental health when it is applied topically to the teeth themselves and then spends some time in contact with the saliva/surface of the teeth (via fluoride toothpastes, fluoride gels, foams, mouthwashes, etc.). HOWEVER, the data also shows that systemic ingestion of fluoride (i.e. drinking fluoridated water at the standard levels currently used) is both much less effective than topical treatments, and also much less effective than previously believed.

Don’t believe it? Here are a few direct quotes from this article summarizing the findings from numerous recent studies:

“It is now accepted that systemic fluoride plays a limited role in caries prevention.” [“systemic fluoride” here means fluoride that is ingested via the water supply].

“the anticaries effects of systemic fluoride are recognized to be minimal.”

“…the level of fluoride incorporated into enamel by systemic ingestion was proved to have no significant effect in preventing or reversing caries”

“the cariostatic effect of fluoride is almost exclusively post-eruptive and the mechanism of action is topical”. [meaning fluoride has no anti-cavity benefit for children before they have teeth because fluoride’s action is from physical contact with the teeth themselves].

“The main reason for the decline in the caries prevalence in industrialized countries is recognized to be the introduction of fluoridated toothpaste in the early 1970s.”

Also of interest, “Recent differences in caries prevalence between fluoridated and nonfluoridated communities have been confirmed to be much smaller than in the past”. Moreover, in places where fluoridation of water supply has been discontinued, the rate of cavities did not rise, and in fact remained the same or even declined further! The reason for this seeming anomaly is the prevalence and availability of fluoridated toothpaste since the 1970s.

The review article also makes clear that many other industrialized countries, especially in Europe, that once did artificially fluoridate their drinking water, have since stopped. The reasons are that fluoridation of the water supply is viewed as a violation of medical ethics (“silicofluorides used in water fluoridation are unlicensed medicinal substances”) and of human rights (“silicofluorides are administered to large populations without informed consent or medical supervision”). Instead of fluoridating their water supply, many of these countries use different ways of providing fluoride: in table salt, in bottled water (thus, those who want fluoridated water can get it), and of course, fluoridated toothpaste and other topical applications which are the most effective anyway.

Thus, to reiterate some of the main points of the research summarized by the article:
1. For dental benefits, fluoride is very effective when applied to the surface of teeth, but not when swallowed as a component of drinking water.
2. Fluoridating water supply has some limited dental benefits for some target groups of people, but is nowhere near as useful as previously believed.
3. Fluoride (in water or topical application) is not useful prior to tooth eruption (i.e. for babies or in the womb), and actually has some health risks associated with its ingestion.

Now on to some very interesting developments in California’s regulatory environment. Cal-EPA is—right now– in the process of establishing a new safety standard for fluoride in drinking water (Cal-EPA public notice published June 16, 2006), and they are advising that the current safety standard may well be lowered. Two factors are driving this change. The first is new scientific data that suggests fluoride may cause health problems at levels previously considered safe, including levels used for fluoridation programs. The second factor is a new law that places more stringent requirements on how Cal-EPA sets its safety standards, directing them to give greater consideration to sensitive populations (infants, children, pregnant women, etc). Back in 1997, when Cal-EPA established the current standard, their toxicologists were concerned that it offered “little to no margin of safety for sensitive populations”. Now they have a new legal mandate to address that concern. In this regard, the problem for fluoridation programs is that the currently recommended dosage for fluoride (in water) to provide dental benefits is already near the upper limit of the existing safety standards. So, new regulatory standards identifying a lower maximum safe level for fluoride in water (as seems likely) would require reductions in fluoridation levels (dosages), and thus diminish the already limited anti-cavity effects of fluoridated water.

Another regulatory problem for fluoridation is that Cal-EPA recently reduced the safety standard for arsenic in drinking water. This is pertinent to this discussion because most fluoridation chemicals are contaminated with arsenic. According to regulatory authorities, fluoridation produces, on average, 120 ppt of arsenic, but the new safety standard for arsenic is 4 ppt. This means that in order to meet the new standard, much purer (and more expensive) fluoridation chemicals will need to be used in the process of water fluoridation. The bottom line here is that Cal-EPA has already made regulatory changes that will likely increase the cost of fluoridating water, and is in the process of making other changes that very well may lower the maximum allowable levels of fluoride added to water to a point that any existing dental benefits from fluoridation will be drastically reduced or eliminated entirely.

But please don’t just take our word for it. We encourage everyone to look up the review article we have been discussing (in the scientific journal Clinical Oral Investigations, or it can also be found online at: http://www.springerlink.com/content/t048360372371167/); this article has a large references section including many recent scientific articles that point us in a direction different from that which has been accepted for many years now. The Professional’s Statement we mentioned is available at www.fluoridealert.org . And do check out the status of Cal/EPA’s regulatory recommendations.

We would like to leave you with these questions:
Why are we moving towards committing ourselves to an outdated and flawed system (i.e. water fluoridation) of delivering dental care when there are, according to the most current scientific information, much better alternatives–including fluoride toothpaste? For that matter, how many toothbrushes and fluoride toothpaste could we buy for the cost of the infrastructure and yearly supplies to fluoridate our water? (Some teachers in public schools already buy toothpaste/toothbrushes for their students and make sure the kids brush their teeth at least once a day–at school). We don’t know exactly, but MCSD estimated that to fluoridate McKinleyville’s water supply would cost $30,000 upfront for infrastructure and then at least an additional $22,000 each year–and remember, that’s without taking into account the reduction in allowable arsenic levels which will be affecting (increasing) fluoridation costs soon.

Why would we even consider investing in a water fluoridation system during a transition period like this? The state has already made regulatory changes that will raise the cost of fluoridating water and indications are that it will soon make other changes that will require communities that have been fluoridating their water to lower their fluoride levels to a point where dental benefits that did exist may be eliminated. Wouldn’t it be prudent to see what happens to allowable standards and costs for fluoridating water before continuing this discussion?

Let’s base our decisions about whether to add fluoride to our drinking water on the best current science. And let’s find and deliver preventative dental care in the most effective way instead of simply taking what has, til now, been the easy way out.

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Sabra Steinberg holds a Master of Science degree, and has worked on environmental regulatory issues for the National Park Service.
Mike Rademaker holds a Master of Science degree in Molecular Biology from the University of Michigan – Ann Arbor, and has worked as a Research Scientist in the Department’s of Biochemistry and Nutritional Science at the University of Missouri – Columbia, where he researched the role of trace minerals in nutrition.

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