It’s been more than 50 years since community water fluoridation was denounced by fearful citizens as a Communist plot to undermine America. But in recent years, a new wave of distrust has surrounded fluoridation, ranked by the Centers for Disease Control among the top ten great public health achievements of the 20th century.
In March, David Stahl, the mayor of East Brunswick, condemned the town’s fluoridation program, in place for nearly 60 years, as “mass medication” and vowed to end it. A growing number of communities across the United States have opted against community fluoridation. New Jersey has had a long history of resisting fluoridation programs. Nationwide, 75 percent of towns are part of community fluoridation programs, but in the Garden State, the figure is only 14 percent. When the CDC in May lowered its recommended levels, citing concerns over fluorosis – which causes white streaking on tooth enamel – it was interpreted by many as a statement about the dangers of fluoride.
Nothing could be further from the truth. Sound scientific research has repeatedly shown that fluoridated water, at the right level, prevents tooth decay and its consequences: needless suffering, tooth extractions and costly restorative work. The CDC has not changed its position on that.
In the U.S., tooth decay is one of the most common infectious diseases among children, five times more common than asthma. Severe tooth pain causes children to lose sleep, miss school and when they are in class, interferes with learning.
The benefits of fluoride as a preventive measure far outweigh the risk of fluorosis, which is mostly a minor cosmetic issue. According to studies, fluoride in community water supplies prevents dental decay in both children and adults by at least 25 percent. A recent study in Israel found an association between water fluoridation and lower rates of hospitalization due to dental problems among children and adolescents.
In many respects, the anxiety surrounding community fluoridation is understandable. Fluoride is an additive, and most additives are a matter of choice. You can buy salt without iodine and bread without folic acid. But if the municipal water supply is fluoridated, your only means of avoiding it is buying bottled water.
There is also a distrust of government-run health programs and research, particularly among minority communities. The most notorious example is the Tuskegee experiment of the 1940s, in which black men with syphilis were told they getting free health care while researchers instead documented the fatal progression of an easily treated disease. The claims of anti-fluoride activists, however, who believe that water fluoridation causes cancer and lowers IQ, have no scientific validity.
In New Jersey, a major obstacle to community water fluoridation is the fact that there are many municipalities and several water companies. One municipality can get its water from multiple companies and each water company works with multiple communities. This makes passage of water fluoridation measures extremely cumbersome and difficult.
Pushing past these complications, however, would greatly benefit New Jerseyans, particularly the state’s underprivileged children. Cheap and convenient alternatives to water fluoridation, notably fluoridated vitamins, do not exist. While fluoride water streams out of the tap, vitamins are expensive, requiring doctor visits, pharmacy visits and vigilant parents who make sure they are taken each day.
As a result, New Jersey’s lack of fluoridated water has led to significant health disparities. Every day at the Rutgers School of Dental Medicine, we see evidence of this in our clinics in Newark and South Jersey: a disproportionate number of children visit with painful infections caused by decay; adults who have lost teeth and can’t afford dentures or implants have waning health because they can’t eat solid food.
For more than a decade, the New Jersey Dental Association and the Rutgers School of Dental Medicine have advocated for a state mandate to fluoridate community water, including the latest effort in 2013. The measures have not been adopted, even though the most recent initiative was approved by the New Jersey Public Health Council. Nonetheless, we won’t give up. Rather than abandoning our efforts now, in the face of the new CDC guidelines, we are renewing our commitment to educating the public about the benefits of water fluoridation and safeguarding the oral health of all New Jerseyans.
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