Frank Graham believes fluoridation is one of the great public health achievements of the past century. Adding fluoride to community water supplies has improved children’s oral health and led to steep declines in tooth decay, says Graham, who is president of the New Jersey Dental Association. He calls the additive safe and effective.
Nancy Browne Coleman believes fluoridation is akin to adding toxic waste to her tap. She is president of a group that has worked for five decades to keep fluoride out of New Jersey’s public water supply. The efforts have resulted in just 15 percent of the state’s residents having the additive, making New Jersey one of the nation’s least fluoridated states.
Now a long-running argument that has been simmering beyond the public’s eye is about to burst like a downtown water main as New Jersey considers an unprecedented plan: the mandatory fluoridation of its water systems.
The New Jersey Public Health Council, an eight member volunteer group, plans to vote this summer on a petition by the state’s dental society to require the fluoridated water supply. A public hearing is scheduled for June 6, and the vote is expected July 11. Most dentists say the decision is a no-brainer.
They are flabbergasted so little New Jersey water is fluoridated in light of studies that they say show the additive can help those without access to good dental care. Many New Jersey residents mistakenly assume their water is fluoridated, the dentists say, noting a recent survey by the U.S. Centers for Disease Control and Prevention found just 1.1 million of 7.2 million New Jerseyans with a public water supply are drinking fluoridated water.
“For every dollar spent on fluoridation, the community saves $38 per year on dental care,” said Graham, a Teaneck orthodontist. He said statewide savings in dental costs would be $2 million each week. (The dental association says it extrapolated those figures from CDC data.)
Anti-fluoride activists point to research that questions the effectiveness and safety of ingested fluoride. They say most people get enough fluoride — if not too much — from toothpaste, mouthwashes, dental treatments, soft drinks and even beer, manufactured in areas with fluoridated water.
“This is a politically appointed council. How can they make the decision to mass-medicate all of New Jersey? They want to put a byproduct of fertilizer manufacturing in our water supply,” said Browne Coleman, who lives in Parsippany and is president of NJ Citizens Opposing Forced Fluoridation.
The public health council already has heard from scientists, and it has the power to draft regulations . Its president, Robert Pallay, a family-practice physician in Hillsborough, said he personally believes data back up the benefits and safety of fluoridated water, ‘‘but I am trying to keep an open mind.’’
“This is a decision affecting millions of people,” Pallay said. “I may think fluoride is good, but what gives me pause is that some people do not want fluoride in their water. Is it right to force them? Their feelings must be weighed against the public health consequences of not fluoridating the water.
“This is not a slam dunk.”
In 1909, a young dentist named Frederick McKay left the East Coast to practice in Colorado Springs, Colo., where he was astounded to see people with brown splotches — termed “Colorado brown stain” — covering many of their teeth. Later, McKay traveled to Bauxite, Ark., an Alcoa company town. People there also had the brown stains. An Alcoa chemist eventually discovered fluoride in the water caused this problem, subsequently termed fluorosis.
But dentists also noted people with fluorosis had few cavities at a time people routinely lost teeth to decay. Public health scientists in 1936 concluded that a fluoride level of one part per million in drinking water would protect teeth from cavities without causing fluorosis.
Today more than half of all Americans drink fluoridated water.
Even the CDC counts fluoridation among the 10 greatest health achievements of the past century, ranking it with vaccinations and antibiotics.
“We have over 60 years of research that supports our position,” said Scott Presson, a public health dentist with the CDC. “Our endorsement is based on research of experts who have not reviewed just individual studies but the whole body of evidence.”
Early studies reported 50 percent to 70 percent reduction in dental caries, as dental disease is called, according to the CDC. By the 1980s, as the oral health of Americans improved through diet and dental care, the gap narrowed to an 18 percent improvement with fluoridated water.
Regardless, the CDC wants to increase water fluoridation to 75 percent by 2010, and many expect the New Jersey vote to reverberate nationally, where fluoridation rates vary.
In California, for example, the rate is similar to New Jersey, with 15.7 percent of people drinking public [water] getting fluoride, according to the CDC.
In Hawaii, it’s 9 percent.
In Kentucky, where poor rural communities remain a public health concern, it’s more than 96 percent and making a difference, according to James C. Cecil of the state’s Department of Public Health.
“We’ve seen decay rates go down, especially in poor rural areas,” he said. “Fluoride is cheap and effective and it reaches everybody.”
Not so fast, say the critics.
They argue that tooth decay has gone down everywhere, regardless of whether communities fluoridate their water. They also say proponents of fluoridation are minimizing the risks.
“We have research that shows fluoridation of water does not work to reduce cavities and poses great risk. Why we continue to do it is a travesty, and why New Jersey is considering it is an abomination,” said J. William Hirzy, an Environmental Protection Agency senior scientist who addressed the New Jersey Public Health Council in March.
Hirzy was not speaking for the EPA, which now allows up to 4 parts per million of fluoride in water, but was speaking as vice president of the union that represents 1,500 scientists, chemists, toxicologists and other professional employees at EPA headquarters.
The union came out against fluoridation after an employee in 1984 complained of political pressure to support fluoride as the EPA created drinking water standards.
Hirzy cited a 1990 study by the National Toxicology Program, part of the U.S. Department of Health and Human Services. It found a link between fluoride and bone cancer in male rats. He also cited a 1995 study that showed hyperactivity in laboratory animals that were born to mothers fed fluoridated water.
Critics also complain about fluorosis and argue tooth damage can extend to bones. Hirzy also said research links fluoride to hypothyroidism, a disorder of the thyroid, and he told the council that tooth decay continued to decline in Canada, Cuba, Germany and Finland after fluoridation was stopped.
Most fluoridated systems in the United States do not use sodium fluoride, the compound found in some toothpaste, but silicofluorides, which are a byproduct of fertilizer production.
Roger D. Masters, a researcher at Dartmouth College, said silicofluorides never have been properly studied. A letter to him dated Nov. 16, 2000, by EPA official Robert C. Thurnau said the EPA and the National Health and Environmental Effects Research Laboratory were “unable to find any information on the effects of silicofluorides on health and behavior.”
An EPA spokeswoman said Thurnau has retired and she could not authenticate or comment on the letter.
Masters makes a distinction between sodium fluoride, which he called safe, and the silicofluorides most often used in water systems. In 2000, studying data from the New York State Department of Children’s Health, he examined the level of lead in the blood of more than 150,000 children and concluded silicofluorides increased it. He found the highest lead levels were in children exposed to both fluoridated water and the common risk factors for high blood levels, such as old housing.
“At every meeting, it is dentists who speak in favor of fluoride. They don’t study toxicology, and they refuse to discuss our research,” Masters said.
Critics note the CDC now says fluoride mainly works topically, or on the surface of teeth. Furthermore, they claim fluoride does not need to be ingested to protect teeth. And they claim silicofluorides are not purified and can contain other compounds, including arsenic, which is a carcinogen.
John Bucher is a senior scientist at the National Institute of Environmental Health Sciences.
He doesn’t have a stake in the New Jersey argument but has looked closely at several studies. He said many scientists consider the bone cancer study to be inconclusive, meaning the cancer could be from fluoride or simply random chance. Subsequent tests in humans were equally inconclusive, he said.
He also said some scientists criticized the lead studies for not having proper control groups.
But Bucher does not push fluoride, either.
“From the very beginning, looking at fluoride has been detrimental to one’s career for the reasons you can imagine,” he said. (Activists complain that researchers whose work does not support fluoride have been labeled “kooks,” and that some have lost their jobs.)
If, by now, this sounds like an argument with no middle ground, that may be true.
Even the cost is contested.
Arthur Meisel, executive director of the New Jersey Dental Association, says fluoride can help poor children in urban areas who do not have access to good dental care. He said the cost, which would be passed along in water bills, is minimal: Large water systems would have to boost bills by about 50 cents per person each year, while smaller systems would have to charge about $3.50 per person.
Browne Coleman, however, said she has spoken to water directors who told her that adding fluoride and monitoring the correct levels is more costly and complex.
So, for now, the anti-fluoride people will ask the New Jersey Public Health Council to put a moratorium on fluoridation while the Board on Environmental Studies and Toxicology, part of the National Academy of Science, prepares a report on fluoride and drinking water.
The report has been delayed because the committee needs to meet and review more data, a spokeswoman said. It is expected out by the end of the year — about six months after the council holds its public hearing.
That public hearing is scheduled for June 6 at the Suburban Square Shopping Center in Ewing Township. It begins at 10 a.m.