WASHINGTON – When she was diagnosed with hypothyroidism in 2004, Phoenix resident Jody Clute had no idea it would lead her, and her city, to revisit one of the biggest public health debates of the 20th century – water fluoridation.
After her diagnosis, Clute read “every book she could get her hands on” about the thyroid and they all said to stay away from fluoride. But that’s nearly impossible with fluoride in the drinking water, even in some bottled waters. So Clute started asking questions, and started asking the city to do the same.
The city council has agreed to take a look, making Phoenix the largest city to reconsider the practice of fluoridation. On Sept. 11, a city council subcommittee will hear testimony on the fluoridation of the city’s water supply and vote whether to send the issue to the full council for review.
“No one had even thought about it or even thought to think about it,” Clute said of the council. “Fluoride in water was like air.”
And just about as harmful, supporters of fluoridation say.
“It’s like saying you treat some people with oxygen because they have lung disease – but having oxygen in the air is wrong,” said Steven Schonfeld, a dentist and spokesman for the American Dental Association. “Their argument is just bogus.”
Arizona Dental Association Director Kevin Earle said challenges to fluoridation are based on “junk science” and arguments that “have been effectively debunked.”
“It’s like adding vitamin C to your milk, a supplement to your bread. They are not harmful supplements,” Earle said.
Clute understands the stereotype of the anti-fluoride activist, the person who sees a threat in what the Centers for Disease Control and Prevention identified as one of the top 10 public health achievements of the 20th century.
“I’m not a conspiracy theorist and I’m not a hippie,” Clute said. But she is against water fluoridation.
She has an uphill fight.
Decades of fluoride history
Forty-two of the 50 largest U.S. cities are fully fluoridated, a process that was popularized in the 1950s as cheap, effective way to prevent tooth decay. Phoenix began fluoridating its water 22 years ago, and nearly 57 percent of Arizona residents got fluoridated water in 2010, according to the CDC.
Cities that fluoridate their drinking water reduce cavities by 20 to 40 percent and reduce unnecessary dental costs by $38 for every taxpayer dollar spent, according to the American Dental Association.
Phoenix spends $582,000 a year on water fluoridation, according to a spokesman for Phoenix’s Water Service Department, which averages out to just under 40 cents per resident per year.
More than $400,000 of the cost goes to buying hydrofluorosilicic acid, a chemical variant of fluoride. It’s a contaminant regulated by the Environmental Protection Agency, which limits the presence of fluoride in drinking-water systems to 4 parts per million.
Too much fluoride can cause fluorosis, a discoloration and breakdown of the teeth that occurs only as adult teeth are developing, typically before age 8, according to the CDC.
Fluorosis has grown more prominent as fluoride has become prevalent in toothpaste, food, water and other drinks. About 23 percent of people between ages 6 and 49 had dental fluorosis between 1999 and 2004, the CDC said.
The U.S. Department of Health and Human Services, which recommends safe levels of fluoride in drinking water, is considering lowering its recommended fluoride levels from the current range of 0.7 to 1.2 parts per million down to a maximum of 0.7 ppm to minimize the “chance of dental fluorosis.”
The new recommendation wouldn’t affect Phoenix, which has maintained a level of 0.7 ppm since it started fluoridation in 1990.
Caution or junk science?
But opponents argue that while officials can control the amount of fluoride in the water, they cannot control the amount of water that people consume.
“You’re giving every human the same medicine and you have no control how much they consume,” Clute said. “It’s in everything, everything with water.”
Other opponents say that any amount of fluoride is still too high.
Chemist Paul Connet, a staunch fluoridation opponent, said that while fluoridation is aimed at helping teeth, it is “unlikely” that it is not affecting other parts of the body as well.
“If you use topical toothpaste, then you are not forcing it on people,” said Connett, who has worked with the anti-fluoridation Fluoride Action Network. “Fluoride works on the outside of the tooth. Why expose every tissue to a known toxic substance?”
He said it would “be a miracle if it’s not damaging any other tissues in the body,” citing a list of potential health effects that include lower IQ, bone damage and harm to organs like the kidney and pineal gland.
Those are the claims that Earle labels “junk science.”
The CDC says an adult would have to drink 660 fluoridated gallons in a two- to four-hour period, and a young child would have to drink 85 gallons in the same time period, to consume a fatal dose of fluoride.
Fluoride often occurs in water naturally and a person would get sick from water intoxication before reaching a level of fluoride toxicity, said Will Humble, director of the Arizona Department of Health Services.
“It’s not like it’s not in water anyways,” Schonfeld said of fluoride. “It’s just an adjustment to an optimal level.”
Supporters point to the tremendous benefits of fluoridation.
“Water fluoridation helps everybody, helps young people, helps older people. It’s safe, it’s inexpensive and it’s fair,” said Schonfeld, noting that it reaches people who do not have access to dental care.
Paying through the teeth
If Phoenix stopped water fluoridation, Schonfeld is confident that the rate of cavities would go up. Quitting fluoridation would be “penny-wise and pound foolish,” he said. Earle agreed that stopping fluoridation in Phoenix would increase dental costs.
“Fluoride does have a severe impact on dental costs. Ultimately we all pay for that,” Earle said. “As a city government … clearly we want to make sure that it doesn’t happen.”
If fluoridation stops, “sources of fluoride are eliminated,” for an already vulnerable population, he said.
“Unfortunately there is a large population that doesn’t ever see the dentist and don’t engage in activities that are good on the prevention side, such as routinely brushing and flossing their teeth,” Earle said.
Earle said he is confident the council will make the right decision “based on science not on emotional or irrational” arguments.
Clute knows what she’s up against. Fluoridation is as “American as apple pie,” she said, but not as “safe and effective” as supporters claim.
“I have hypothyroidism and my endocrinologist is telling me one thing but you’re telling me … that I need to listen to my dentist?” Clute said. “Why are we listening to dentists about something the affects the whole body, not just the mouth?”
Humble said it would be hard to quantify how much Phoenix tap water is “actually getting into people’s stomachs and teeth.”
“The vast majority goes into plants and swimming pools and dishwashers,” he said. “It’s just a practical matter and a cost you have to accept.”
Cost is exactly what Phoenix Council Member Thelda Williams said she will focus on when the fluoridation issue comes before the Transportation and Infrastructure subcommittee that she chairs.
Reopening an old argument
Williams has been down this road before: She voted for water fluoridation as council member in 1989 and has “made it clear” that she is still supportive 22 years later.
While Williams is “open to new information,” she said she has yet to see any new or compelling evidence on the issue.
“I’ve had a lot of information sent to me by both sides,” she said. “Unless they can show me new data, I haven’t seen anything to change my mind.”
Clute disagrees with the focus on finances, and worries the council will argue about cost when “the real problem of it is the health effects.”
“How can one set of people vote to get another set of people to ingest something?” Clute asked. “They are politicians and not medical doctors.”
And they “aren’t giving the other side a fair chance,” Clute said of the subcommittee hearing, which does not include a speaker opposed to water fluoridation.
“The deck is stacked. I just want a fair debate, where both sides are represented and the public can ask questions and get the facts,” Clute said.
Williams said opponents will “have an opportunity to speak. They can fill out a card and speak for two minutes.”
One of the two scheduled speakers is Humble, who said he’s not going in to the hearing “trying to convince them to continue fluoridating but to help them make the best decision possible.”
“My attitude is my job … is to provide the kind of information that I would want if I was on a city council making a public-policy decision like this,” Humble said.
“If they decide that it’s not worth the 38 cents a year for the citizen, that’s their decision not mine,” he said. “I just want the council to have full perspective before they make their decision.”
Humble said that fluoridation, like most public health measures, has its opponents despite its “overall public health benefit.”
“You’ll find a sliver of the population that is against everything we do in public health from vaccines, to fluoride. You name it- it’s there,” Humble said.
Fluoridation and fluorosis
• The Centers for Disease Control and Prevention attributes the decline in tooth decay in the U.S. to the discovery of the “simple, safe, and inexpensive” process of water fluoridation.
• Benefits of fluoride were discovered in the 1930s, and the first city to fluoridate its drinking water was Grand Rapids, Mich., in 1945. The CDC said the National Academy of Sciences’ National Research Council saw a decline in tooth decay in Grand Rapids when compared to other cities.
• The U.S. Public Health Service and every U.S. surgeon general has endorsed water fluoridation since 1951.
• As of 2010, the CDC reported, 26 states and the District of Columbia were providing water fluoridation to more than 75 percent of their residents on community water systems, according to the CDC.
• The rate of decayed, missing or filled teeth declined among persons aged 12 years in the United States declined 68 percent, from 4.0 in 1966-1970 to 1.3 in 1988-1994, according to 1999 data by the CDC.
• As of 2010, 73.9 percent of people were receiving fluoridated water.
• According to CDC data on years 1999-2004, less than one-quarter of persons aged 6-49 in the United States had some form of dental fluorosis.
• The prevalence of dental fluorosis was higher in adolescents than in adults and highest among those aged 12-15.
• Adolescents aged 12-15 in 1999-2004 had a higher prevalence of dental fluorosis than adolescents aged 12-15 in 1986-1987.
• From 1999 to 2004, the prevalence of dental fluorosis was higher among younger persons and ranged from 41 percent among adolescents aged 12-15 to 9 percent among adults aged 40-49, according to the CDC.