In 1999, the Hinesburg Selectboard unanimously approved the installation of a sodium fluoride saturator to the town’s water system. Fluoride, when added to drinking water, has the beneficial effect of preventing tooth decay.
Despite broad scientific support of the safety and effectiveness of properly fluoridated drinking water, anti-fluoridation activists have some Hinesburg residents afraid to drink from their tap. An investigation into this lingering controversy reveals issues of individual rights, socioeconomic inequality and scientific misrepresentation.
Standing in opposition to Hinesburg’s community water fluoridation is the Fluoride Action Network (FAN). FAN asserts that fluoridation is an outdated form of mass medication that is unnecessary and ineffective.
FAN claims that because fluoride is added to the water for the prevention of tooth decay, it is a form of mass medication rejected in 97 percent of Western Europe. While most European countries reject community fluoridation, they do so on larger individual rights concerns, not safety. In fact, the European Food Information Council and European Academy of Pediatric Dentistry both support the use of community fluoridated water. Moreover, many European nations offer subsidies for preventative dental care and school-based fluoride rinses instead of fluoridated water.
In the US, however, socioeconomic inequalities in the availability of dental care make community water fluoridation the most effective and cost-efficient measure in preventing tooth decay, therefore pitting individual rights against the common good. In Vermont, over one-third of uninsured adults do not receive needed dental care because they can’t afford it. That means, in the absence of fluoridated water, people living in low-income families in Vermont bear a disproportionate burden of chronic oral disease.
FAN claims that a recent Harvard review published in The Lancet Neurology of 27 studies, mostly from China, demonstrates a link between fluoridated water and reduced IQ scores in children. However, the review only suggests the possibility of a link, does not control for confounding variables, and concludes that “our review cannot be used to derive an exposure limit, because the actual exposures of the individual children are not known,” and that “the estimated decrease in average IQ … may be within the measurement error of IQ testing.”
Tooth decay affects one-third of Vermont children, according to a 2013–2014 Vermont Department of Health (VDH) survey of 24 public elementary schools. Of the surveyed schools, Shelburne Community School had the lowest prevalence of tooth decay at 10 percent, while Bennington Elementary, Molly Stark Elementary (Bennington), Killington Elementary and Shaftsbury Elementary all had tooth decay prevalent in over 50 percent of surveyed students. Shelburne has community fluoridated water, while Bennington, Killington and Shaftsbury do not.
Water fluoridation in Vermont began in Burlington in 1952. Today, 68 community water systems provide fluoridated water to approximately 57 percent of Vermonters. Vermont does not mandate water fluoridation, but VDH recommends that all public water systems maintain a fluoride concentration of 0.70 parts per million (ppm)—the same concentration recommended by the US Public Health Service for optimal prevention of tooth decay.
Fluoride also occurs naturally, so even if a resident has his own well or lives in a town without supplemental fluoridation, he will still have varying levels of fluoride in his water. For example, Charlotte does not fluoridate its community water systems, yet fluoride occurs at concentrations ranging from 0.10ppm to 1.40ppm. Hinesburg supplements its 0.20ppm of naturally occurring fluoride with enough sodium fluoride to meet the recommended 0.70ppm standard.
Swallowing too much fluoride during a child’s tooth development, however, can cause a condition known as dental fluorosis. Fluorosis can appear in its most mild form as barely recognizable white specks on teeth, up to its most severe form as brown staining and pits on the teeth. Children with at least one tooth showing signs of moderate to severe dental fluorosis has increased from 0.50 percent of children in 2002–2003 to 3.5 percent of children in 2009–2010.
To minimize the occurrence of fluorosis, VDH recommends exclusive breastfeeding for infants through the age of six-months, and suggests using fluoride-free water when mixing infant formula. Moreover, children under six should not use fluoridated mouthwash, and should be monitored when using fluoridated tooth paste. For families with children under four, VDH will also test fluoride levels in private wells for free. Fluoride, at concentrations found in Vermont, pose no other known health or environmental risks. Still, some Hinesburg residents remain unhappy that they have no personal choice in the matter.
According to VDH, community water fluoridation in Vermont has led to an over 30 percent reduction in tooth decay over the past twenty years. Whether one agrees or disagrees, the Hinesburg Selectboard made a decision thoroughly supported by science and in the best interest of the overall well-being of their greater constituency.
The Vermont Department of Health, Vermont State Dental Society, U.S. Environmental Protection Agency, U.S. Public Health Service, American Dental Association, National Academy of Sciences, American Academy of Pediatrics and World Health Organization all support the proper use of water fluoridation. The Centers for Disease Control and Prevention even lists community water fluoridation as one of the “ten great public health achievements” of the twentieth century.