Two recent Lincoln Journal commentaries discuss fluoridation. In my opinion, we must keep open minds while considering the most recent data. Also note that this vote at town meeting cannot end water fluoridation; an affirmative vote only starts a process whereby we consider whether fluoridation’s benefits outweigh its risks. I highlight three factors.
#1) Fluoridating water appears neither necessary nor effective. The Oral Health Division of the Center of Disease Control (CDC) acknowledges that fluoride’s benefit comes from topical contact. Brushing your teeth with a toothpaste containing fluoride is the most common topical application. Swallowing fluoride provides no known benefits. An article in the Journal of the American Dental Association (ADA) indicates no known benefit before the teeth emerge, when topical contact with fluoride becomes possible. So why do some think that fluoridation is effective? The answer appears straightforward – cavity rates decreased and dental health improved after fluoridation began. But better dental care has improved dental health and reduced the number of cavities everywhere, even in communities without fluoride. In fact, research shows no significant difference in the number of cavities for US communities with and without fluoride in the drinking water. As another example, the vast majority of West European countries do not fluoridate; yet the dental health of Western Europe is no worse than for US communities that fluoridate.
#2) Fluoridating water does not appear to be safe. It is accepted that fluoridation causes severe problems for some individuals. Kidney patients are told to avoid fluoride, and the CDC recommends that bottled water with less fluoride be used when mixing infant formula. Furthermore, fluoride is known to cause dental fluorosis (a developmental disruption of dental enamel that yields tooth discoloration) in millions of children, including children in Lincoln. Finally, while not yet conclusive, there is a growing body of peer-reviewed research, including a very recent publication by colleagues at the Harvard School of Public Health, that links higher levels of fluoride in children’s drinking water with reduced IQ.
#3: Fluoridating water provides uncontrolled drug delivery. If you want to ingest fluoride, you can get fluoride tablets from your pharmacy, but you will need a prescription. Fluoride is not an essential nutrient. It is a medication that the Food & Drug Administration (FDA) regulates as a drug. If you read the fluoride tablet page in the online Physicians’ Desktop Reference for Consumers, it notes, “This drug has not been found by FDA to be safe and effective”. Yet fluoride is mass distributed via water. When water is fluoridated, the dose is uncontrolled as the amount ingested varies with water intake. Can you imagine your health care professional telling you to just put your prescription drugs in your water, ingest the drugged water when you are thirsty, and go ahead and share your drugged water with others? Of course not! In fact, most European countries do not fluoridate their water, because such mass medication is considered ineffective and unethical.
After considering a great deal of evidence, the benefits of fluoridation do not seem to justify the risks. This is my personal decision. If you decide fluoride is right for your family, I suggest that you consider a topical application by using toothpaste with fluoride. You can even choose to swallow toothpaste, but due to the fluoride content that is not recommended. Given this, does it make sense to swallow water with fluoride? Nonetheless, if you decide that ingesting fluoride is right for you, I respect your decision. Each of us regularly makes personal health decisions, often in consultation with health-care providers, without impacting others. This provides an ethical approach for fluoride as well. Why force fluoride on anyone, especially those who are sensitive to its side effects?
Lincoln was the only town in Massachusetts that fought three fluoridation orders before finally approving fluoridation in 1971. Across the US and world, opposition to fluoridation is growing. About 70 communities have rejected fluoridation since 2010. Civil rights leaders oppose fluoridation because its negative side effects disproportionately impact poor communities. The US Environmental Protection Agency (EPA) Headquarters Professionals’ Union, which represents knowledgeable scientists, lawyers, and other environmental professionals, opposes fluoridation. Many scientists, including Nobel Prize winners, oppose fluoridation. Finally, the US National Resource Council of the National Academies published a comprehensive review in 2006 that concluded that the current EPA standard was not adequately protecting health and, based on the available evidence at that time, recommended that the maximum contaminant level for fluoride be lowered. This recommendation placed the maximum contaminant level near the level provided via fluoridation.
While I will keep an open mind regarding the latest research, at least three facts are indisputable. 1) Fluoridation provides an uncontrolled fluoride dose. 2) Fluoridation began before research showed that fluoride’s benefits were due to topical application not ingestion. 3) Fluoridation began before all its side effects were known. Even if our perspectives differ, I hope that we can agree to vote for article 40 at town meeting. This would allow every Lincoln resident to weigh the benefits and risks over the coming year. By discussing our perspectives, each of us will likely learn something.
Dan Merfeld is a Lincoln resident and a Harvard Medical School professor. A version of this text with endnotes will be available at town meeting and online at www.wickedlocal.com/lincoln