Health officer: Fluoridation is ‘safe, beneficial, has great value’
Bari Wrubel, the supervisor of the Marysville water and wastewater treatment plant, wants the city to discontinue fluoridating its public water supply.
Fluoride is added in small amounts to the water treatment process in Marysville — and in plants producing the water that 73% of Americans drink — to reduce cavities.
“Tooth decay has been the bane of mankind probably since the beginning of our existence,” said Dr. Annette Mercatante, St. Clair County’s medical health official. “It causes lost economic activity and considerable pain and suffering.”
Wrubel made a nearly 50 minute argument at a special meeting on Sept. 21 to eliminate the mineral from the treatment process at the plant.
Then Mercatante, a local periodontist, a dentist who serves patients with Medicaid and a dental hygienist disputed his argument at every turn.
Wrubel argued that fluoride and the equipment used to fluoridate the water in Marysville is too expensive. He said it was economically inefficient. He noted that some residents don’t want it in their water and don’t want to pay for it. He said that the naturally occurring mineral in large quantities is toxic and presents a danger to employees in the water plant. There have been three leaks of fluoride at the plant, the latest in April, he said, adding that at least $42,000 in equipment upgrades must be made at the water plant to continue using fluoride. He presented the results of a study that suggested adding fluoride to the water supply was not effective. Removing it from the public water system would still leave fluoride in the water at a level of .15 parts per liter, he said, about a quarter of the recommended minimum.
“I believe it’s the right thing to do,” said Wrubel, as heard on the recording of the meeting posted on the city’s website.
The case for fluoride
Mercatante said that removing fluoride from the water system was the wrong thing to do.
“Fluoridated water is safe, economical, beneficial and has been in Michigan water for 75 years,” Mercatante said.
According to Wrubel’s research, the Marysville City Council approved adding the mineral to the water at its regular meeting on June 28, 1951.
Whereas COVID-19 is an emerging disease that has often seen changing, sometimes contradictory recommendations by health officials, there is no such uncertainty with fluoride, she said.
Fluoridation has reduced tooth decay in children by 40% to 70% and in adults by 40% to 60%, according to the Centers for Disease Control and Prevention.
Tooth decay affects about 60% of children, making it the most common childhood disease, said Mercatante.
“Talking about removing this from the water frightens me,” said Dr. Jason Souyias, a Port Huron periodontist. “In 75 years, we went from people who expected to lose their teeth by the time they were in the twenties or thirties to people who never expect to lose their teeth their entire life because of disease.”
Wrubel said that fluoride, if it is used at all, should be individually tailored to a person’s weight, physical fitness, preexisting conditions and how much water they drink, like prescription medicine, implying that putting it in the water and exposing people to uncontrolled amounts was somehow dangerous.
“I don’t know anywhere else this happens,” said Wrubel.
But Mercatante knew of some.
Adding iodine to salt eliminated goiters in the Midwest and began with Marysville’s own Morton Salt, which began selling iodized table salt nationally in 1924. Iodine also functions to prevent intellectual and developmental disabilities.
Fortifying milk with vitamin D eliminated severe bone disease in children, Mercatante said.
Fortifying food with nutrients and vitamins has been common since the 1940s in an effort to provide necessary nutrition to children and others who don’t have access to enough fresh fruits and vegetable.
Wrubel said information about fluoride and its efficacy were hard to find. Not so, said Mercatante.
“Thousands of studies and 60 years of research consistently prove there is no epidemiological evidence that points to any harm from fluoridation,” she said. Further, the paper cited by Wrubel has been faulted for ignoring cross-sectional studies.
The CDC named fluoridation one of the top 10 public health achievements of the 20th century, joining vaccinations against diseases like measles, and rubella, the reduction of heart disease and stroke, the decline of smoking, safer cars, workplaces and food, family planning, and maternal and infant health.
Economy of dental health
Wrubel said the main group targeted by fluoridation is young people ages six-16, encompassing about 2,000 of Marysville’s population of 10,000. It costs about $12,000 a year for fluoride at the plant. Based on an assumed consumption of a half-gallon of water per person per day, young people are drinking $7.05 worth of fluoride per year. But it’s costing the city $12,000 to achieve that much consumption, said Wrubel.
Dr. Souyias argued that Wrubel’s reasoning was too narrow on two counts.
“Fluoride benefits not just infants but people throughout adulthood,” Souyias said.
For $1.24 per person per year, Marysville residents automatically benefit from a dental safety net provided by the mineral.
Souyias said that every dollar spent on fluoridation returns $38 in dental treatment savings.
Looking at only Wrubel’s youth population, that’s an annual savings of $76,000 per year in dental work.
Relying on the natural amount of fluoride in the city’s water, .15 parts per liter, is an insufficient to prevent tooth decay. Mercatante said.7 is the minimum level necessary to prevent tooth decay.
Requirements versus recommendations
Wrubel argued that regulatory agencies recommended adding fluoride to the water system, but did not require it like they do for chlorine.
“In medical and public health, the word ‘required’ is regulatory,” said Mercatante. “In medicine, we use the word ‘recommend’ when there is enough rigorous science and consensus to compel that something should be done.”
A medical recommendation — such as do not eat raw meat; exercise at least a half-hour per day; wear a bike helmet, or don’t smoke — is not a lesser thing than a regulatory requirement.
Mercatante also noted that fluoride technology is advancing and grants are available from the Michigan Department of Health and Human Services upgrading fluoridation equipment.
Eight years ago and now
The last time the issue came before the city council was in 2012, when the council seemed ready to cut fluoride from the water plant’s budget.
“It’s very clear that removing fluoride from the water will have very significant impacts on the health of our community, especially on the young and those who do not have access to dental care,” Mercatante said then.
In 2012, Mercatante offered the expertise of her office to help council members weigh the evidence and, invoking the Hippocratic Oath, urged them to do no harm. She again urged them to do no harm.
“I think I was on the council when we did this,” said council member Joe Johns in 2012. Johns was then 89 and was speaking of the decision to embark on fluoridation in the 1950s. Johns died in 2018. His daughter Kathy Hayman now sits on council.
“It’s doing what it’s supposed to do and we have been getting our money’s worth,” Johns said.
Jim Bloch is a freelance writer.