Fluoride Action Network

Hard to Swallow

Source: The Salt Lake Tribune | March 5th, 2002 | Editorial
Location: United States, Utah

Public health officials are fighting two anti-fluoridation bills in the Utah Legislature with a familiar two-pronged argument: Weird Utahns have been bucking a trend with their dogged opposition to water fluoridation, and scientists are unanimously behind it. It is the same misinformation that helped proponents win referendums in Davis and Salt Lake counties in November 2000.

The truth is voters around the country have been rejecting fluoridation regularly for the past decade. Ten U.S. towns — including Flagstaff, Ariz., and Modesto, Calif. — defeated fluoridation measures handily last year while only Yuma, Ariz., and Utah’s Centerville passed them. Even the City Council of progressive Colorado Springs, Colo., recently spurned fluoridation, while the national Sierra Club is urging communities to seek “safer alternatives.” Utahns didn’t start bucking a trend until they voted for fluoridation.

An even greater falsehood is that scientists are united behind fluoridation. That notion has always been proponents’ most intimidating weapon, and a federal health official predictably unsheathed it again last week while speaking with the Utah media. William Maas, the government’s director of oral health, said he couldn’t understand “why people don’t trust the recommendations from esteemed scientific [sources].” What he and other fluoridation proponents know well but never acknowledge is that the many scientists who question fluoridation are every bit as “esteemed” as the ones who don’t.

Dr. Maas, meet Dr. Arvid Carlsson of Sweden. Carlsson won the Nobel Prize in medicine in 2000, then joined a list of a dozen other past Nobel-winning scientists by advising the world not to fluoridate. In an interview last year with the Kamloops (British Columbia) Daily News — verified by The Tribune via e-mail — he said fluoridation isn’t worth the risks. “Side-effects cannot be excluded and, thus, some people might only have negative effects without any benefit,” Carlsson explained. “In Sweden, water fluoridation, to my knowledge, is no longer advocated by anybody.”

It has few advocates in the rest of Europe, either. Dutch officials responded to a Tribune inquiry last year by forwarding a Ministry of Health study, which noted that “a number of questions concerning human health and the environment in connection with fluoride have not and can hardly be clarified.” The Netherlands today doesn’t even recommend fluoride tablets for consumption, and about 98 percent of Europe has rejected fluoridation.

How can this be when the U.S. Public Health Service is such a relentless proponent? It’s possible that America knows something that Europe doesn’t — a premise not supported by comparisons of cavity rates — or it could just be simple politics. European health organizations didn’t stick their necks out by aggressively promoting fluoridation early on, so they risked no loss of credibility by backing away when questions arose about its safety and effectiveness.

In any event, the “esteemed” scientific community that pushes fluoridation is far smaller than it would have Utahns believe. From a global standpoint, it appears as odd as it has always accused Utahns of looking.


Past Salt Lake Tribune editorials on fluoridation:


Salt Lake Tribune

September 30, 2001

Editorial: Fluoridation Proponents Misled Utahns Before Last Year’s Vote


If anyone doubts that health officials had Utah’s best interests at heart when they campaigned for water fluoridation last year, the officials have only themselves to blame. Their misinformation and attempts to discredit scientists holding opposing views demonstrated an unhealthy disrespect for voters’ intelligence.

By now you know that health officials misled voters about the complexity of fluoridating the Salt Lake County water supply, and you might have heard that they exaggerated the impact of fluoridation on cavity rates. These rates have been falling for years in non-fluoridated areas such as Utah, and 12-year-olds in many countries that don’t fluoridate water have fewer cavities than their American counterparts. The decay rates in many non-fluoridated countries have also dropped faster than the rates in the heavily fluoridated United States (World Health Organization statistics).

Now a report from the Centers for Disease Control has made it clearer than ever that fluoridation proponents were also misleading about how the substance works. The CDC report reflects the view of most scientists today that while there is an excellent argument for putting fluoride in one’s mouth, the same can’t be said for swallowing it.

Just to be absolutely clear, the CDC report and every scientist on its fluoride review panel support water fluoridation, because they say even small amounts of fluoride splashed regularly on the teeth can prevent cavities. But the report — as well as several of the scientists who e-mailed The Tribune last month — confirmed what this paper pointed out in an editorial last fall: Fluoride’s predominant effect is topical — that is, “the overwhelming majority of its benefit” comes from direct contact with teeth, explained William H. Bowen, a University of Rochester researcher on the CDC panel.

The CDC report, while political enough not to explicitly rule out any benefit from swallowing fluoride, nevertheless confirmed that the amount recycled into the saliva ducts is too small to affect the three agreed-upon ways that fluoride fights cavities: impeding bacterial action, enhancing remineralization of the tooth enamel, and inhibiting demineralization of the enamel. The only thing all the CDC scientists now agree upon is that fluoridated water is effective when it is in your mouth and for a relatively short time afterward. That’s why “swishing and spitting [fluoridated water] is probably just as effective as swishing and swallowing,” according to University of Iowa researcher Keith Heller, another of the CDC’s reviewers.

Arguing about whether fluoridated water is just million-dollar mouthwash or whether there is a benefit to consuming it might seem a pedantic exercise to some. After all, however it works, the CDC is adamant that it does. But if there is no benefit to swallowing fluoride, that leaves only risks, and even the CDC acknowledges that ingesting too much fluorididated water is not a good idea.

The CDC recommends that babies under 6 months of age ingest no more than 0.7 milligrams of fluoride per day. But since babies that age drink up to 1 1/2 liters of water-based formula every 24 hours — according to nurses in the University Hospital maternity ward — they could ingest twice the CDC’s recommended dose in a fluoridated area. The CDC report also advises that in areas where the water has twice the fluoride that Utah health officials have considered adding, “children should use alternative sources of drinking water.” So an active Utah child who drinks twice the water of the “average” sedentary kid for which the fluoridation formula was devised could conceivably ingest more fluoride than the CDC recommends.

This is an issue today only because of how proponents sold fluoridation to voters last fall. Had they been forthright with the information and still won the fluoridation election, The Tribune would not be wasting ink on the topic. But fluoridation lobbyists weren’t honest. They pitched fluoride as a crucial building block in the formation of children’s teeth, then seeded Northern Utah with billboards featuring smiling kids.

“Fluoride is to teeth what cement is to concrete,” asserted a Deseret News editorial last fall, echoing fluoridation proponents. “Fluoride in the water is incorporated into the enamel of developing teeth in children under 16, rendering teeth more resistant to decay for a lifetime.” On this point, proponents could not have been more misleading. The CDC report states that “fluoride works primarily after teeth have [formed and emerged], especially when small amounts are maintained constantly in the mouth.”

Several other proponents built on the myth that fluoride is some kind of children’s vitamin by framing the argument solely in terms of fluoridation vs. fluoride pills. The irony of this campaign is that it undoubtedly convinced many Utahns that merely swallowing fluoride pills is effective when, unless the pills are chewed and swished around the teeth first, they are of little (if any) benefit. Many also downplayed the benefits of brushing with fluoridated toothpaste, which one of the world’s most respected pro-fluoride researchers last year told The Tribune “is as good or better than fluoride in the water.”

You might wonder why, if swallowing fluoride yields no significant benefits, public health officials continue to push the idea. A few undoubtedly are still believers in the old research. But another member of the CDC review panel has a theory on the rest. “Given the turbulence that all too often accompanies local decisions on fluoridation, keeping up with changing paradigms can lag behind the political necessities,” says Brian A. Burt, a University of Michigan researcher and a co-author of The Dentist, Dental Practice and the Community.

In other words, if public support for fluoridation is achieved with inaccurate information, some health officials (not Burt) believe the end justifies the means.

It doesn’t. No matter how beneficial fluoridated water — or any public health measure — might be, people are entitled to the truth before deciding whether to implement it. Utahns weren’t trusted with the whole story before they voted last fall.


Kirk Millson is a Tribune editorial writer. He welcomes e-mail at kmillson@sltrib.com

Salt Lake Tribune

October 29, 2000

Editorial: Fluoride: The Hard Truth

You probably heard it first from your pediatrician or dentist: Give your kids fluoride while their teeth are forming and they will be more cavity-resistant for life. That explains why fluoridating water makes so much sense on the surface.

The cover story in July’s issue of the Journal of the American Dental Association, however, unequivocally states that fluoride ingested during the formation of teeth — before they break through the gums — does not create teeth that are more resistant to decay. Fluoride is an effective means of preventing cavities, but only when splashed directly and regularly on the surface of existing teeth (topically). It does not help children more than adults.

The benefits of fluoridated water have been overstated by many proponents, according to the article’s author, John D.B. Featherstone, head of the Department of Preventive and Restorative Dentistry at the University of California, San Francisco. “The extreme pro-fluoridation proponents and the [extreme opponents] should be grabbed by their heads and bashed together,” he told The Tribune on Wednesday. Both sides have been guilty of gross hyperbole. The truth is that when it comes to preventing cavities, “brushing with fluoridated toothpaste twice a day is as good or better than fluoride in the drinking water,” he said.

Your dentist probably told you something different, but Featherstone is a respected researcher and an authority on the subject. The American Dental Association chose his article for its “Continuing Education” series because it is basic information that it wants all dentists to have.

This might read like heresy, because conventional wisdom says only nutty folks oppose fluoridation, but in light of Featherstone’s information a key question should be asked: Are the benefits of fluoridation worth the costs? There is no easy answer, which explains the record length of this article. But fluoridating the water in Salt Lake and Davis counties will be expensive. One estimate in Davis has suggested as much as $1 per week per water bill.

Featherstone is solidly pro-fluoride. In fact, he supports fluoridation on the grounds that every little bit helps, which is why most dentists support it. But to much of the health care profession, price is appropriately not an object, and that’s why everyone else needs to consider the issue carefully.

Yet Featherstone is also adamant that fluoride delivered topically — with toothpaste, mouth rinses and pills that are chewed slowly and swished around the mouth — is far more effective than when it is swallowed. “Fluoridation is not the panacea [proponents] say it is,” he said. “It is just one of the tools” for fighting cavities.

Utah proponents are selling fluoridation as the primary tool, contending that the substance re-emerges in the saliva to bathe teeth “all day long.” But Featherstone explained that fluoride’s effectiveness peaks a mere 15 minutes after it is swallowed; 45 minutes later, the benefit is gone. Toothpaste is more effective during the hour after it is used because of the vastly higher concentrations of fluoride left behind in the mouth. You don’t have to be a scientist to understand why: Fluoridated water has 1 part fluoride per million compared with the 1,000 parts per million in most fluoridated toothpastes.

It is important to note that regardless of the delivery method, fluoride can’t overcome poor diets and poor dental hygiene. Featherstone pointed out that while 75 percent of U.S. children ages 5-11 were cavity-free in the late 1980s, 70 percent of children ages 12-17 had decayed teeth. He said the cavity rates soar because older kids frequently drink sugary sodas and snack on junk food, which boosts the bacteria that cause tooth decay and inhibits the remineralization process that protects teeth. He described the bacteria as “caries challenge” and stated that “no amount of fluoride can overcome big caries challenge.”

That fact alone might explain why sugar-loving Utahns have an average of nine-tenths of one cavity more than the rest of the nation.

The most effective means of reducing cavities in children, then, might be to remove the soda and candy machines from Utah’s schools and to educate children on brushing their teeth. If government must get involved, maybe schools could serve a cup of fluoride mouthwash with lunches or breakfasts. Those three simple steps would cost millions less and be far more effective than merely fluoridating the water.

The pro-fluoridation folks aren’t going to like reading this, and they will be ready tomorrow with soothing responses to every issue raised above. But after they respond, ask them why they didn’t volunteer any of this information before.

It’s going to be hard to jump off the bandwagon, particularly when it looks so logical and so many smart folks are supporting it. Pride alone might keep you riding for a while longer. But on Nov. 7, when you are alone with your thoughts in the voting booth, ask yourself if it is really worth spending millions of dollars for something that is at best no more effective than a tube of toothpaste.

Then vote no.