Dr. Cynthia Morrow, commissioner of health for Onondaga County, answered questions about community water fluoridation and the safety of fluoride during a live Q&A session on syracuse.com today. Read the full transcript of the Q&A below.

Morrow has been the health commissioner since 2005. She has an undergraduate degree in psychobiology from Swarthmore College, master’s degree in public health and medical degree from Tufts University School of Medicine in Boston, Mass.

Paul Connett, the director of the Fluoride Action Network, will be taking questions in a separate live Q&A on Tuesday, Dec. 18, from 12:30 to 1:30.

The village of Pulaski in Oswego County recently decided to stop fluoridating its water.

Dozens of other public water authorities in the five counties surrounding Syracuse also do not add fluoride to their water, according to a database created by the Centers for Disease Control. Central New York communities without fluoridated water include the cities of Auburn, Cortland and Oneida, according to the CDC.

Cynthia Morrow, MD, MPH:
Good afternoon everyone,  I am happy to be here today to try to address questions that you may have about community water fluoridation. I look forward to working with you to get information out about this important topic. Thank you.

Carol Kopf:
Is it your job to promote fluoridation or study it? If you have studied it, what research papers have you read to convince you fluoridation is safe for everyone?

Hi Carol,
It is my job to try to improve the public’s health by promoting evidenced-based population level interventions that improve health and to work with partners to accomplish this. I have attached some links to studies that have convinced me that fluoridation is safe.
http://www.thecommunityguide.org/oral/supportingmaterials/is-waterfluoridation.html
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm

Matthew:  
Doctor, because the dental benefits associated with fluoride (the calcification) are derived solely from topical application to the teeth, what are the associated benefits of increasing fluoride consumption through ingestion and skin absorption by means of fluoridating municipal water supplies?

Cynthia Morrow, MD, MPH:
There are advantages to both topical and systemic fluoride. The below link from the American Dental Association should help answer some of the questions you may have about systemic fluoride but if it doesn’t, please feel free to contact my office and we can provide you with other resources to address this.
http://www.ada.org/sections/newsAndEvents/pdfs/fluoridation_facts.pdf

Alan: 
Regardless of how I feel about fluoridating water, can you address why it is the government’s role to provide ‘blanket’ medical supplementation to every single person, leaving them with virtually no choice, versus the much more logical process of allowing doctors to recommend and/or prescribe fluoride supplementation only to those who need it.

Cynthia Morrow, MD, MPH:
One of the important roles of public health is to reduce disparities in health outcomes. The impact that community water fluoridation has had on dental caries is not in dispute- it has dramatically improved oral health over the past 50-60 years. If we did not have this important public health tool, we would see tremendous disparities in oral health with impoverished, disadvantaged individuals being disporportionately impacted by poor oral health.

Mary Rose: 
Fluoride lowers thyroid function. It was once used as a drug to lower thyroid function in hyperthyroid patients, starting at 2mg. Why is it OK to add fluoride to the water if it lowers thyroid function?

Cynthia Morrow, MD, MPH:
Hi,  This is an important question about the issue of dose. The dosing that you are referring to was therapeutic dosing for a specific medical situation. The amount of fluoride added to the community water supplies is at a much lower range.

Kathy: 
There was a recent book opposing fluoride in water supplies. Have you had the opportunity to read it, and the studies it includes?

Kathy: 
I am afraid this is another issue like the one surrounding vaccinations, where people act on poorly designed studies and put their children at risk. I have seen the benefits of fluoridation in my own family.

Matthew: 
How can a community feel more secure about their water supplies knowing that every so often someone is chemically altering their water? Isn’t water supposed to be as pure as possible to flush out all the toxins ingested?

Guest: 
Singapore has been 100% fluoridated since 1956 yet 40% of preschoolers there are currently suffering with severe tooth decay. Can you explain this epidemic of tooth decay despite water fluoridation?

Cynthia Morrow, MD, MPH:
Unfortunately, I really cannot speak to Singapore but for virtually every condition, there are multiple factors at play. Poor nutrition, poor oral health care (no flossing/brushing), family history and numerous other factors contribute to the risk of dental caries. While fluoride is a protective factor, it is not a panacea.

Jim:
Dr. along the same line as Mathews question about keeping water pure, it appears he may be against adding chlorine to the water. Knowing chlorine can kill instantly if inhaled at large doseage, we still chlorinate because the benefits outway the downside, is that not correct?

Cynthia Morrow, MD, MPH:
Thanks Jim. I think that this is an excellent point. In developing countries, children still die of preventable diarrheal disease because they do not have access to safe, chlorinated water. We are extremely fortunate that we can turn on a tap, take a drink, and not even question whether or not we will have to worry about getting a gastrointestinal illness.

Alan: 
Thanks again for your insight. I really appreciate the open forum and that this debate is happening. I guess my final question is that, given studies and examination of many hunter-gather groups who do not consume processed foods, refined sugars, or fluoridated water, but who also have exceptional oral (and overall) health and virtually no dental caries, shouldn’t the focus be placed more on the CAUSE of our poor oral health (mainly poor diet, not lack of fluoride)? It seems like fluoride is acting more as a Band-Aid.

Cynthia Morrow, MD, MPH:
I think you make an excellent point. In my opinion, fluoridation is just one of prong on a multipronged approach to improve oral health. We absolutely need to look at diet, access to nutritious foods, access to dental care, and so many other factors if we want to continue to improve health outcomes in our community. Identifying root causes of illness and trying to develop interventions to address disease at all levels is imperative.

Guest: 
On PubMed.gov http://www.ncbi.nlm.nih.gov/pubmed/11512573 “Regression analysis of cancer incidence rates and water fluoride in the U.S.A. based on WHO data…” “…cancers of the oral cavity and pharynx, colon and rectum, hepato-biliary and urinary organs were positively associated with Fluoridated Drinking water (FD). This was also the case for bone cancers in male, in line with results of rat experiments. Brain tumors and T-cell system Hodgkin’s disease, Non-Hodgkin lymphoma, multiple myeloma, melanoma of the skin and monocytic leukaemia were also correlated with Fluoridated Drinking water.” PMID: 11512573 Does fluoride cause cancer?

Cynthia Morrow, MD, MPH:
I think that many professionals, including myself, have concerns about excess levels of fluoride. Fortunately, that is not what we are talking about at a population level with community water fluoridation. We have strong evidence that the current fluoridation standards are protective against dental caries but we also have evidence of harms of exposure to fluoride at high levels (again, not the current situation). There is an impressive review by the Institute of Medicine about the current standards that comprehensively looks at health risks. I think that the issue of association with cancer is addressed carefully in this review.
http://www.nap.edu/openbook.php?record_id=11571&page=1

Cynthia Morrow, MD, MPH:
Thanks very much. I appreciate the questions and the opportunity to address them. I hope that the resources that I have provided will allow you the opportunity to look at the evidence yourself. Be well and happy holidays!

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