Many hot-button medical issues get a lot of media attention. Most people could have an informed conversation about topics like stem-cell research, alternative cancer treatments or vaccinations. But there is another battle waging behind the scenes in many municipalities across the country: the battle over fluoridation.

Angie Roberts, a mom from Indiana, says she knows just enough about fluoridation to make her wary. “I’m not sure where I stand on [fluoridation],” she says. “We have fluoridated water in our community, but we have a well at our house, so we don’t get city water. A few years ago, our then-dentist told us we needed to give the kids fluoride supplements because the well water didn’t have enough fluoride in it.”

Roberts complied, but then she discovered the water they were buying at the store for their children already had fluoride in it. She says after that, she learned more about fluoride and became concerned about some of the information she read.

“I stopped giving the kids the fluoridated water from the store,” Roberts says. And while she understands it’s a complex issue, she says that her kids now get fluoridated water from the fountains at their school, and she doesn’t worry about it.

Roberts’ experience with fluoride research is similar to that of many parents who seek out information on this topic. While medical groups, such as the American Dental Association, support public water fluoridation, other groups vehemently oppose it.

Neil Gussman, a scientist at the Chemical Heritage Foundation in Philadelphia, Pa., has researched fluoride and water fluoridation, and he says that perception is a major factor in how people view water fluoridation. “In general terms, the history of medical technology shows that people are slow to accept medical innovation, and suspicions of some technologies linger long after the treatment has been shown to be very effective,” he says.

Gussman says that a visit to the dentist now, however, if very different than it was even 50 years ago. “In the case of fluoridation, people who grew up before air-powered drills rightly remember a dental visit as very painful,” he says. “People facing dentistry of 50 or 100 years ago would accept a small risk of fluorosis to avoid many dental visits and have a better chance of keeping their teeth through adulthood.”

Risks of Fluoride Treatment

But today, that small risk of fluorosis that Gussman mentions is enough to convince many people to eliminate fluoride as a water or toothpaste supplement. Fluorosis is a condition that, in its mild form, causes white mottling of the tooth enamel. More severe cases of fluorosis will result in dark brown spots all over the teeth and some degeneration of the enamel integrity.

And while the connection between fluoride ingestion and fluorosis is clear, some groups have begun to examine connections between fluoride and other health issues.

Dr. Kathleen Thiessen, senior scientist at SENES Oak Ridge, Inc., Center for Risk Analysis, has been involved in some of these studies. Dr. Thiessen maintains that because people have different levels of water intake, the distribution of fluoride is not controlled enough for it to be considered generally safe.

“For fluoridated water to be ‘safe’ would mean that all individual exposures to fluoride from fluoridated water are below a level at which adverse health effects might be expected to occur in at least some individuals,” Dr. Thiessen says.

The risk-to-benefit ration, for Dr. Thiessen, isn’t compelling enough to support the practice. “My review of the literature to date indicates little if any benefit from public water fluoridation, particularly for those most at need of improved dental health, and a variety of risks of adverse health effects, especially for those with high water intakes, impaired fluoride excretion or dietary deficiencies,” she says.

Dr. Thiessen says many benefits of fluoride are topical, and that she thinks the money spent on public water fluoridation could be better used in other ways. “The money currently spent on promoting and implementing water fluoridation would probably produce a much bigger impact on improved dental health if it were to be used in some other way, such as improving access to dental care for those most in need of it,” she says.

Benefits of Fluoride Treatment

While those who oppose public water fluoridation cite studies showing adverse affects of the treatment, the American Dental Association and other proponents of the practice cite studies showing the safety and benefit of the practice.

Dr. Howard Pollick is the spokesperson for the ADA on fluoride issues. Pollick says that despite what some research reports to show, fluoride has been shown by repeated studies to be safe.

“People are naturally concerned about any changes in their environment,” Dr. Pollick says. “But the safety has been reviewed, the science has been reviewed and repeated studies have shown conclusively that this is safe.”

Dr. Pollick says that some of the studies cited by those opposed to fluoridation don’t accurately represent the facts. “You really need to think about the credibility of the sources you’re looking at for facts,” he says. “The Centers for Disease Control, the National Research Council, the American Dental Association – I would say those are credible sources.”

Dr. Pollick also points out that most any substance can be harmful when ingested in large enough doses, citing the recent case in California where a woman was poisoned by drinking excessive amounts of water. He says that when it’s judiciously administrated, fluoride is effective in preventing tooth decay and cavities.

“When we were launching the legislation for California back in 1995, a reporter asked me why anti-fluoridationists continue to fight against public water fluoridation,” Dr. Pollick says. “I said we’ve known the earth is round since the days of Galileo, but to this day, the flat earth society exists. There will always be those suspicious of change.”

He says the documents available online at www.ada.org are an excellent resource for those concerned about fluoridation. According to the ADA, “the overwhelming weight of credible scientific evidence has consistently indicated that fluoridation of community water supplies is safe. The possibility of any adverse health effects from continuous low-level consumption of fluoride has been and continues to be extensively studied. Of the hundreds of credible scientific studies on fluoridation, none has shown health problems associated with the consumption of optimally fluoridated water.”

Gussman agrees, noting that in one of the first studies of the effects of public water fluoridation, residents of Grand Rapids, Mich., had 60 percent fewer cavities over a 15-year-period after fluoridation was introduced to the system.

It is worth noting, however, that all parties on both sides of the issue point out that infants who drink concentrated powdered formula should not be given water from general fluoridated systems. Bottled water that has not been fluoridated is recommended for bottle-fed infants who are given powdered formula.

A Personal Decision

Thanks to the Internet, however, all the information is available for families to make their own decisions about the safety of fluoridation. The science is out there, and for those families concerned about water fluoridation, all public water systems must provide data about what is in the water. Many are available online, but if yours is not, you can call or stop by to pick up a water report.

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Note: Article online September 26, 2009

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