Fluoride Action Network

Environmental Justice

Low-income communities need dental care, not cheap industrial fluoride chemicals in their water.

The Oral Health Crisis

Water fluoridation is routinely proposed by public health officials as an effective way of preventing the high rates of tooth decay found in low-income populations throughout the United States. Fluoridation is presented as an equitable means of providing “dental care” to people in need of dental services. In reality, however, fluoridation does nothing to remedy the real problems. Indeed, most urban areas that are suffering “oral health crises” today have been fluoridated for decades. The idea, therefore, that the oral health crisis in low-income communities can be fixed by adding cheap industrial fluoride chemicals to water is as illusory as it is insulting.

The real oral health crisis in the United States is not from lack of fluoridation. It is, instead, the result of (1) a broken health care system that makes it extremely difficult for low-income individuals to find a dentist they can afford, and (2) a broken food system in which large swaths of low-income areas have become “food deserts” with little access to fresh food.

Broken Health Care System

In terms of the health care system, up to 80% of dentists now refuse to accept Medicaid patients. For many low-income individuals, the only dental care they can receive is in the emergency room. This problem could be partially solved by allowing dental therapists to perform routine dental services (e.g., drilling and filling), which research shows they are perfectly competent to do. However, the nation’s leading dental trade organization, the American Dental Association, adamantly opposes the right of low-income patients to receive care from anyone but licensed dentists–a position that neatly aligns with the ADA’s financial self-interest.

Broken Food System

Recent research has brought attention to the problem of “food deserts” in low-income areas. A food desert refers to a situation where a lack of grocery stores makes it difficult for residents to purchase fresh, nutritious food. This, in turn, fosters reliance on fast food chains and convenient stores for food, which results in a high consumption of processed beverages and foods that are high in sugar, but low in nutrients. While most of the research on food deserts has focused on the connection with rising obesity rates, there is likely a connection to tooth decay — which is now on the rise in low-income areas (despite increases in fluoride exposure).

In a study of an adult population in fluoridated Detroit, for example, the high rate of tooth decay among city residents was found to be significantly related to soft drink consumption. The authors also noted that the daily consumption of fresh fruits and fresh vegetables among the residents was significantly below the recommended intakes. As the authors noted:

“It seemed to us that at least part of the reason [for the low consumption of fresh fruits and vegetables] is the poor availability of good-quality fruits and vegetables in sections of the city, with cultural and economic issues compounding this complex relationship.” (Burt 2007)

The Failure of Fluoridation

Despite the fact that the cause of the “oral health crisis” is primarily socioeconomic in nature, the response by state and federal governments is often to simply push for more fluoridation programs. Fluoridation is promoted despite its repeated failure to prevent the very oral health crises it is claimed to prevent. In Cincinnati (a city that has been fluoridated since 1978):

“City and regional medical officials say tooth decay is the city’s No. 1 unmet health-care need. ‘We cannot meet the demand,’ says Dr. Larry Hill, Cincinnati Health Department dental director. ‘It’s absolutely heartbreaking and a travesty. We have kids in this community with severe untreated dental infections. We have kids with self-esteem problems, and we have kids in severe pain and we have no place to send them in Cincinnati. People would be shocked to learn how bad the problem has become.’” (see article)

This raises the obvious question: If fluoridation in America’s major urban areas has not succeeded in preventing the current oral health crisis, why should anyone believe it will begin preventing it now? People in San Antonio, Texas, may be asking themselves this same question because:

“After 9 years and $3 million of adding fluoride, research shows tooth decay hasn’t dropped among the poorest of Bexar County’s children it has only increased—up 13 percent this year. One out of two children in the Head Start program who were checked for cavities had some last year.” (see article)

The Distraction of Fluoridation

Not only is fluoridation an ineffective solution, but all of the time and money that is tirelessly spent forcing it on more communities is time and money that could have been spent on constructive solutions, like improving access to dentists or dental therapists, improving Medicaid, increasing access to healthy food, and/or tackling the larger issue of poverty.

The Danger of Fluoridation

Adding cheap industrial fluoride chemicals to the water supplies of low-income communities is not just ineffective, it is dangerous. The toxicity of fluoride ingestion is magnified in people with nutrient deficiencies and kidney disease, conditions that are significantly more prevalent in low-income communities and communities of color.

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