So what about fluoride?
Both sides were presented Wednesday evening as a battle of words, coupled with conflicting research, characterized The Herald Journal’s forum on water fluoridation.
An occasional heckler from the anti-fluoridation gallery taunted proponents Ariel Thomson and John Hubbard, but the setting was generally educational.
But again, the question of to fluoridate or not to fluoridate was posed. Ph.D. clashed with Ph.D., with fluoride being described as a “toxin, a pesticide and a residue” on the one side and “safe, cost-efficient and beneficial” on the other.
Freedom of choice advocate and panelist Walt Appel rallied the crowd by claiming that “big tobacco is going to be small potatoes in comparison” to the effects of fluoride.
“In a truly free society, a majority cannot dictate the moral decision of an individual,” he said. “Right now, everyone has the right to chose whether they want fluoride. Those who want it aren’t denied it, and those who don’t aren’t forced to have it.”
Appel urged the public to keep water from becoming a vehicle for drugs.
Is fluoride safe? It depends on who you ask.
Dr. Thomson, former principal investigator for the epidemiology branch of the National Institute of Dental Research and epidemic intelligence service officer for the Centers for Disease Control and Prevention, said fluoride presents no adverse health effects when applied at optimal levels.
It does not pose a detectable risk for cancer, he said, nor is there conclusive evidence that it is connected with brittle bones or hip fractures.
“Since 1950, opponents of water fluoridation have claimed it increased the risk for cancer, Down’s syndrome, low intelligence, Alzheimer’s disease, allergic reactions and other health conditions,” states a report from the Journal of the American Medical Association. The article, dated March 8, 2000, was distributed to the audience following Thomson’s presentation. “The safety and effectiveness of water fluoridation have been re-evaluated frequently, and no credible evidence supports an association between fluoridation and any of these conditions.”
Thomson quoted endorsements from the American Dental Association, the U.S. Environmental Protection Agency and the Department of Health and Human Services.
“In the interest of the public health, the American Dental Association unreservedly endorses the fluoridation of community water supplies as safe, effective and necessary in preventing tooth decay,” Thomson said, quoting from the ADA.
Dr. David Kennedy, founder and president of the Preventive Dental Health Association and founder of Citizens for Safe Drinking Water, disagreed adamantly, questioning Thomson’s authority and expertise.
“Fluoridation is cancer-causing, cancer-promoting and is linked to increased cancer rates in rats, mice and humans,” Kennedy said, referring to studies conducted by the Battelle Memorial Institute in 1989 and to reports issued by the U.S. Public Health Service and New Jersey Department of Health in 1991-92.
He quoted similar studies from JAMA and the Journal of American Medical Association tying water fluoridation to an increase in hip fractures.
“It is a hazardous waste product,” Kennedy said. “All scientists in the last decade have concluded that the only benefit of fluoride is topical (or effective on the surface of the teeth).”
He said dental fluorosis, a discoloring and weakening of the teeth, has climbed significantly over the past 40 years. It is documented by the Journal of the American Dental Association and Journal of Public Health Dentistry, he said.
Fluorosis is a side-effect, said Thomson, but only if applied in excess. His statement was backed by the ADA.
“Based on extensive research, the United States Public Health Service established the optimum concentration for fluoride in the water in the United States in the range of 0.7 to 1.2 parts per million, or one milligram per liter of water,” according to an explanation of health risks and benefits provided by the ADA. “This range effectively reduces tooth decay while minimizing the occurrence of dental fluorosis.”
A study from the subcommittee on Health Effects of Ingested Fluoride offered a similar conclusion on behalf of the National Research Council. “The optimal concentration of fluoride in drinking water for U.S. communities has been set at 0.7 to 1.2 ppm depending on the average local temperature, based on the assumption that in warmer climates people drink more water,” it stated. “That range provides a balance between effective cavity prevention and the incidence of dental fluorosis.”
Proponents of fluoridation, said Thomson, do not intend to fluoridate above the optimal level recommended by the U.S. Public Health Service.
The suggested concentration is comparable to 1 inch in 16 miles, or 1 cent in $10,000. Cache Valley already contains one-fifth of the recommended concentration. Cornish has an optimal level of fluoride naturally, Thomson said.
Dr. John Hubbard, who has a doctorate in inorganic chemistry, explained that it is easy to point fingers at any element and argue strongly that it is a hazard to public health. Fluoridated drinking water, he said, is consumed by more than 150 million Americans. Just nine million of those individuals are receiving that fluoride naturally.
Fluoride can be toxic, he said, but “toxicity is based on dose.”
Appel argued that dosage cannot be regulated with a one-size-fits-all approach. Children, he said, are at the greatest risk for overdosing on the substance.
Kennedy said the American Academy of Pediatrics recommends that infants should not receive fluoridated water. More than 60 percent of children drinking formula with fluoridated water have developed some degree of dental fluorosis. Similar effects have been seen from other forms of fluoride, he said.
“Fluoride drops and tablets are not approved by the U.S. Food and Drug Administration as safe or effective,” he said. “Ingested fluoride has no detectable effect on decay rates. Fluoride tablets and drops have been shown to be ineffective in reducing tooth decay, and to cause skin eruptions, gastric distress, headaches and weakness – which disappear when fluoride use is discontinued – as well as dental fluorosis, a permanent disfigurement.”
Dental fluorosis is the fist outward visible sign of fluoride overdose, he said. It causes the surface of the tooth to be chalky or brown in color.
Pediatric Nursing reported in 1997 that dental fluorosis increased between 35 percent and 60 percent in fluoridated water and between 15 percent and 45 percent in communities with unfluoridated water.
Since April 1997, the FDA has required fluoridated toothpaste to attach the following warning : “Keep out of reach of children under 6 years of age. In case of accidental overdose, seek professional assistance or contact a poison control center immediately.”
But fluoridation of community water supplies has been accepted by several prominent agencies, said Thomson.
“Extensive research has examined the effects of fluorides given as dental treatments, or added to toothpaste, public water supplies or foods,” reported the American Cancer Society last year. “Fluorides do not increase cancer risk.”
The American Heart Association included this endorsement: “There is no evidence that adjusting the fluoride content of public water supplies to a level of about 1 ppm has any harmful effect on the cardiovascular system.”
The Congressional Subcommittee on Health Effects of Ingested Fluoride concluded in 1993 that cancer, kidney disease, stomach and intestinal problems, infertility and birth defects, and genetic mutations were all unsubstantiated arguments against fluoride.
Hip fractures, however, remain a topic of debate.
The studies, Thomson said, are inconclusive.
Joseph Lyon, a professor from the University of Utah Department of Family and Preventive Medicine disagrees.
Along with three other colleagues, Lyon published a paper titled, “Hip fractures and fluoridation in Utah’s elderly population,” in the Journal of the American Medical Association in 1991. He concluded that there was a 27 percent increase in hip fractures among women and a 41 percent increase among men, ages 65 and older, in Brigham City, one of Utah’s only fluoridated communities. This percent increase was higher than what was seen in Logan and Cedar City.
The actual study reports, “We found a small, but significant increase in the risk of hip fracture in both men and women exposed to artificial fluoridation at 1 ppm, suggesting that low levels of fluoride may increase the risk of hip fracture in the elderly,” read Lyon’s report.
Kennedy cited three other studies printed in JAMA which concluded that hip fracture rates were substantially higher in people residing in fluoridated communities. The elderly population, he said, is particularly susceptible.
From an economic standpoint, Thomson echoed a statement by the ADA, explaining that water fluoridation is beneficial for communities with a significant number of low-income families.
“These communities have a disproportionate burden of dental caries and have less access than higher-income communities to dental-care services and other sources of fluoride,” reads a 1999 report from the ADA. “Water fluoridation may help to reduce such dental health disparities.”
Thomson said the cost would amount to 50 cents per person per year for fluoridation, or approximately $3.35 per family. In addition to reducing dental decay between 30 and 60 percent, he explained that the lifetime cost of implementing fluoride for a child is less than the cost of one filling.
Appel countered that fluoride is available in the schools for $1 per year. A family of five, he said, could also purchase a year’s supply of fluoride tablets for $20.
Filtration equipment is available for removing fluoride, but the equipment costs approximately $100 in addition to the $50 filter which must be replaced annually.
“We’ll have to pay to put it in and pay to take it out,” Appel said.
Thomson remains committed to fluoride as a beneficial supplement to community water. It is the least expensive and most effective method for reducing tooth decay, he said.
“Fluoridation is the single most important commitment a community can make to the oral health of its children and to future generations,” said former U.S. Surgeon General Dr. C. Everett Koop in a pamphlet distributed by fluoride proponents.
In sum, proponents are pushing for fluoridation to benefit low-income families who are either financially incapable of providing fluoride themselves or who have developmental difficulties which impair their judgment. They describe it as safe and effective for reducing tooth decay. Proponents are in favor of placing it on the ballot, stating that fluoride will be maintained at optimal levels, reducing tooth decay 30 to 60 percent. They acknowledge fluorosis as a legitimate side effect of fluoride overdose, but feel it will not be a problem for the population at large.
Opponents of fluoridation see fluoride as a toxin and pesticide. They believe it is cancer-causing. They argue that fluoridation is linked to hip fractures, brittle bones, infertility, genetic mutations and a national increase in fluorosis. Fluoride does not reduce tooth decay, they claim, nor are fluoride drops and tablets effective, as reflected in the FDA’s failure to approve them. They also perceive fluoridation as a freedom of choice issue. The government should not be permitted to interfere so intimately in the lives of its citizens. They see fluoridation as an infringement upon the rights of the minority.
Brigham City and Helper are the only communities to fluoridate community drinking water supplies in Utah. A recent movement has sought to fluoridate the water in communities across the Wasatch Front and in Northern Utah, and reports have indicated that Utah has the least number of fluoridated water supplies in the nation. Logan and Nibley have decided to put the issue to a vote, while Smithfield has voted the item down.