In the early-1900s, a dentist arrived in Colorado Springs and made an observation that was something like: Holy cow, the people in this town have strong but ugly teeth.
Residents’ teeth looked gawdawful — stained dark brown with what the dentist, Dr. Frederick S. McKay, called “mottled enamel.” But there was a shockingly low incidence of tooth decay in those chocolate-colored chompers.
McKay’s decades-long quest to understand what was going on led to a revolution in dental medicine and drinking water treatment that continues to stir debate today and now may take center stage as one prominent piece of a massive shift in the U.S. public health system.
The issue has to do with fluoride, a chemical naturally abundant in drinking water in Colorado Springs a century ago. The realization that fluoride could make teeth resistant to decay led to widespread fluoridation of drinking water by utilities across the country — a movement considered by many to be among the greatest public health achievements of the 20th century. (The discoloration, dubbed the “Colorado brown stain,” was due to fluoride levels quite a bit higher than what is in drinking water today.)
But fluoridation has also long been controversial, with opponents citing research that suggests that fluoride at too-high levels can cause brittle bones and is associated with lower IQ in children. These concerns have a champion in Robert F. Kennedy Jr., President-elect Donald Trump’s choice to lead the powerful U.S. Department of Health and Human Services, or HHS.
As the debate over fluoride hits the national spotlight, here are a few things to know:
HHS doesn’t regulate fluoride.
That’s the Environmental Protection Agency’s job. The EPA has set a maximum allowable limit of fluoride in drinking water of 4 milligrams per liter. There’s also a secondary, nonenforceable limit of 2 mg/l designed to protect against discoloration and pitting.
So, if the federal government were to ban fluoride in drinking water, that wouldn’t be done through the department Kennedy has been tapped to lead — at least not with the laws currently in place.
HHS has issued a public health recommendation supporting water fluoridation.
This is where Kennedy’s authority would lie.
In 2015, the U.S. Public Health Service, which is a division of HHS, issued a recommendation supporting an optimal concentration of 0.7 mg/l of fluoride in drinking water. This recommendation is not enforceable, and it is ultimately up to water providers whether they will add fluoride or not.
The federal Community Preventive Services Task Force, whose members are appointed by the head of the Centers for Disease Control and Prevention, another HHS agency, has also recommended fluoridation of drinking water.
Kennedy has suggested he would target these recommendations, saying that upon taking power “the Trump White House will advise all U.S?. water systems to remove fluoride from public water.”
Local public health agencies may not go along.
The Colorado Department of Public Health and Environment supports the current federal fluoride recommendation, noting in a statement that cavities are the leading chronic disease among children and adults in the United States.
“Since 1945, community water fluoridation has been studied hundreds of times by many reputable scientific organizations for its safety and efficacy in preventing tooth decay,” the agency wrote in an October statement following a controversial legal ruling. (More on that in a bit.)
“The overwhelming findings of these studies indicate that fluoride, at the … recommended level in drinking water, reduces tooth decay by more than 25%, irrespective of other oral health-protective factors such as brushing, flossing, or visits to the dentist, without posing risks to health or safety.”
Asked whether CDPHE’s recommendation would change if the federal government’s does, an agency spokeswoman wrote in an email: “CDPHE’s recommendations will continue to be guided by the weight of evidence and the scientific consensus, including on optimal community water fluoridation.”
Local water providers may not go along either.
The Sun also asked Denver Water, the state’s largest water utility, what it would do if HHS pulled the fluoride recommendation.
“Denver Water is monitoring developments with the upcoming administration change,” the agency said in a statement. “We do not currently plan to make changes to our fluoride policy.”
When pressed further with a question about any federal funding that Denver Water receives and whether that could be used as leverage when it comes to fluoride.
“We want to make it clear,” the agency responded, “that there is no connection between the federal funding we receive and our decisions about fluoride. Denver Water’s decisions about fluoride are based on the best available science and the guidance of state and federal public health agencies.”
A federal judge ruled against fluoride earlier this year.
The case was in California and was brought by anti-fluoride advocates seeking to require the EPA to strengthen fluoride standards. The judge, who was appointed by former President Barack Obama, agreed that there is too much of a risk that fluoride could harm the IQ of children.
The judge based this ruling in part on an analysis released this year by the National Institutes of Health’s National Toxicology Program, which reviewed a number of studies in what is called a meta-analysis. (The NIH is a government agency that is under HHS.)
The analysis concluded “with moderate confidence, that higher levels of fluoride exposure, such as drinking water containing more than 1.5 milligrams of fluoride per liter, are associated with lower IQ in children.” But it also noted, “There were insufficient data to determine if the low fluoride level of 0.7 mg/L currently recommended for U.S. community water supplies has a negative effect on children’s IQ.”
Critics of the report, including CDPHE, pointed out that many of the studies analyzed came from countries outside the U.S. and that some of the studies looked at fluoride levels that were several times larger than what is recommended for drinking water in the U.S.
Tooth decay used to be a big problem in the United States.
During World War II, 20% of U.S. recruits were disqualified from service because of severe tooth decay. The revelation that poor oral health could be a national security risk led President Harry S. Truman to create the National Institute of Dental Research, which conducted some of the early research that supported the idea of adding fluoride to water.
“One of the things that’s important to recognize, before we began using fluoride in a therapeutic way, the population of the United States really experienced extreme tooth decay problems,” said Dr. Bruce Dye, a professor at the University of Colorado School of Dental Medicine and an expert in population health. (Dye holds an endowed position known as the Delta Dental of Colorado Foundation Chair in Oral Health Equity.)
In the early 1960s, at the dawn of community water fluoridation, the percentage of people between the ages of 45 and 54 who had lost all their permanent teeth was 20%, according to the CDC. By the late-1980s and early-1990s, that percentage had shrunk to 9.1%.
Opponents of fluoridation say these declines in tooth decay have not been conclusively linked to fluoride and that generally improving standards of oral hygiene should receive more credit. They say other developed countries that do not fluoridate their water have seen similar declines.
Cavities are not a mere annoyance, Dye said, but can be extremely painful if large enough. Research has suggested a link between poor oral health and poor school performance in kids, as well as higher rates of absenteeism.
The impacts of poor oral health are most likely to be felt by people who are socially or economically disadvantaged, which is why Dye said relying solely on fluoride in toothpaste or mouthwash isn’t enough.
“How are you going to distribute that equally to the population?” he asked. “Toothpaste is not exactly cheap.”
Some cities fluoridated and then stopped.
There are at least two prominent examples of cities in North America that removed fluoride from the water, providing researchers an opportunity to understand what came next.
The first was in Juneau, Alaska, which stopped fluoridating its water in 2007. Subsequent research showed an uptick in the likelihood of dental carries — another term for cavities or tooth decay — in kids. The anti-fluoridation Fluoride Action Network called the study, “more hype than evidence.”
The other was in Windsor, Canada, which removed fluoride from its water in 2013. Afterward, according to the local health department, the percentage of kids with tooth decay or requiring urgent care increased 51%. City leaders voted to restore fluoride in 2018.
Not all water providers add fluoride in Colorado.
About 63% of people in the United States receive fluoridated water in their taps, according to the Centers for Disease Control and Prevention. In Colorado, that percentage is higher — roughly 75% of people living here do, according to the CDC.
The CDC lists 947 water providers in Colorado. Of those, 455 do not add fluoride to drinking water. Many of those are small — raise your hand, for instance, if your water comes from the Aldasoro Ranch Homeowners Company in San Miguel County. But some are bigger. Montrose, for instance, does not have fluoride added to its water.
Some tap water has fluoride even if it’s not added.
Let’s end where we began, in Colorado Springs. The city’s utilities agency doesn’t add fluoride to the water — it doesn’t have to. That naturally abundant fluoride that caused the Colorado brown stain is still there.
“We blend these local supplies with the water we import from the Continental Divide to reduce concentrations to recommended levels,” Colorado Springs Utilities writes on its website.
Even still, that blending varies across the city. The agency maintains an interactive map showing the estimated 12-month average fluoride concentration at any address in town. While most parts of the city are below the 0.7 mg/l level, some areas report concentrations of up to 1.3 mg/l.
Original article online at: https://coloradosun.com/2024/12/09/colorado-springs-fluoride-rfk-jr/