Two Oregon cities, Hillsboro and Lebanon, are holding votes on whether to fluoridate their tap water amid increasing national debate questioning the practice’s safety versus its benefits to oral health.
In Hillsboro, the City Council put on the ballot an advisory measure asking voters if the city should start adding fluoride to its drinking water system for about 100,000 people. In Lebanon, a town of about 20,000 people in Linn County, the council asked voters whether to continue fluoridating water.
In August, a federal agency issued a report intended to assess the latest scientific research on whether fluoride exposure to the developing brain is harmful. Based on the government agency’s findings, a federal judge in San Francisco ruled last month that fluoridation at current levels represents an “unreasonable risk” of harm to public health and ordered the Environmental Protection Agency to take action to address that risk.
Anti-fluoridation activists are using the report and ruling to challenge the decades-old orthodoxy calling for fluoridation to fight cavities, especially among low-income populations.
But fluoridation supporter Dr. Eddie Ramirez, president of the Washington County Dental Society, said that the federal report found insufficient data to determine if the concentration of 0.7 milligrams of fluoride per liter that the CDC currently recommends for U.S. drinking water supplies is causing negative effects on children’s IQ. Ramirez said that the federal agency’s underlying science failed to include studies looking at fluoride’s effects on communities in the U.S.
“It’s beyond my pay grade to determine the appropriate concentration in water to achieve appropriate dosage across the community, but I’m glad that American scientists will be looking into it again,” he said.
Staci Whitman, a longtime fluoride skeptic who worked as a dentist in Hillsboro and still sees her old patients in her newer Portland location, alludes to the recent studies in taking a stance that’s contrary to that of most others in her profession.
“I can repair a tooth, but we have only one chance to develop a child’s brain,” Whitman said. “We need to choose children’s brain health over the minuscule, small effect that fluoride may or may not have on their oral health.”
Swirling Science
The National Toxicology Program is a federal interagency effort to assess potential health hazards that’s formed by the National Institutes of Health, the Food and Drug Administration and the Centers for Disease Control and Prevention.
In August, based on more than 70 studies that concerned fluoride’s effect on the developing brain while in the womb, the program finalized a long-delayed “state of the science” report. It concluded “with moderate confidence” that drinking water containing more than 1.5 milligrams of fluoride per liter is associated with significantly lower IQ in children.
The review did not say that fluoridation harms kids, noting the uncertainty involved. It also did not draw conclusions concerning the levels at which fluoride is added to drinking water in the United States, which is 0.7 milligrams per liter.
Supporters of fluoridation, such as the American Dental Association questioned the review, calling its reasoning and some of the underlying studies flawed.
In the wake of the review, the Centers for Disease Control continues to espouse fluoridation, though it has since added a notice saying that it does not mandate the practice.
However, a coauthor of the federal review has told the online scientific magazine Undark that pregnant women likely should be warned about the risk of ingesting fluoride. Similarly, the former head of the federal toxicology program, Linda Birnbaum, has raised alarms about drinking water fluoridation and its risks for developing brains in utero, as well as for infants.
Federal judge weighs in
In September, based on a lengthy trial that included testimony from scientists as well as government and private-sector experts, a federal judge in San Francisco, Edward Chen, issued a ruling that cited federal policies calling for a safety margin between allowable exposure and known harms.
He didn’t conclude with certainty that fluoridated water causes lower IQ, but found that the research in the federal report shows “a preponderance of evidence” that current water fluoridation levels represent an “unreasonable risk” of harm. He ruled that federal law requires that the Environmental Protection Agency take action to address the risk, whether it be warning labels or new, more protective regulations.
But Ramirez, the Washington County dentist, said he interprets the judge’s ruling as merely requiring a second look at fluoridation, a move he said he welcomes to ensure public confidence.
“This ruling is an opportunity to get some balance between the public health benefits of fluoride and the concerns of the community,” he said.
Polarizing issue for Oregon
In Oregon, the recent judge’s ruling and new science have stirred up disagreements over what was already a polarizing topic.
Portland voters have said no to fluoride four times: in 1956, 1962, 1980 and 2013.
Oregon has the third lowest fluoridation rate in the nation, above only Hawaii and New Jersey. Fluoride is added to drinking water serving 26.4% of Oregon residents, about a third of the national rate.
And now opponents are citing the new federal report and judge’s ruling to support their arguments in Hillsboro and Lebanon.
Whitman, the Hillsboro dentist who opposes fluoridation and sells a fluoride-free toothpaste, said she’s seen that “everyone has cavities, whether they live in fluoridated communities or in non-fluoridated communities, whether they used fluoride or not,” she said. “Fluoride is no match for ultra processed food, so there’s a much larger conversation about public health that needs to happen.”
Rick North, a former executive vice president of the Oregon Chapter of the American Cancer Society, now serves as a spokesperson for the Fluoride Action Network, the anti-fluoridation group that spearheaded the litigation leading to Chen’s ruling and which is calling on communities like Hillsboro to stop fluoridating in light of Chen’s ruling and the federal report.
“Pro-fluoride folks are nitpicking the court decision, and instead of reconsidering their opinion in the face of new scientific evidence, they circle the wagons,” he said.
But fluoridation advocate state Rep. Hai Pham, D-Hillsboro, said he speaks for most of his fellow Oregon dentists in standing by “respectable sources” showing that fluoride is effective.
Pham echoed Ramirez and cited the American Dental Association’s arguments that the federal government report concerning fluoride’s effects on developing brains had fatal flaws, including its reliance on studies of populations outside the U.S. The studies cited by the review were conducted in Canada, Mexico, China, India and Iran, and some of those countries have high levels of naturally occurring fluoride.
“I look at credible sources of information, such as the ADA, which is looking at clinical evidence to get the best patient outcomes possible,” Pham said. “Just like with anything, you can find almost anything on the internet to support your cause.”
Equity arguments raised
Supporters of drinking water fluoridation say the practice is the best and most inexpensive way to reach marginalized populations whose kids may not be brushing their teeth or who lack access to dental care.
The Oregon Nurses Association is supporting fluoridation in Hillsboro, and the group’s government relations director, Paige Spence said that equity is a big reason. “When these fluoridation opponents are saying ‘our body, our choice,’ they are not taking into account the fact that there are people who have no choice to access fluoride treatments,” Spence said.
Similarly, Pham said he frequently has to put children under general anesthesia in order to treat their advanced gum disease and debilitating tooth decay. He said it’s challenging to get the Medicaid-eligible segment of the population in for fluoride treatment, even though he feels they would have the most to gain from fluoride sealants or varnishes applied to children’s teeth in a clinical setting. He said that there’s a disproportionate number of children in the low-income program who suffer from some of the worst possible pediatric dental diseases, leading to a waiting list for them to receive treatment.
“There is so much devastation in the kids’ mouths, and they have to wait months for treating dental abscesses and rot down to the gumline,” he said.
Whitman, for her part, said fluoridation proponents fail to acknowledge that people who drink a lot of water would ingest a much larger dose of fluoride. She says whether to apply fluoride topically through toothpaste or a mouthwash is a matter of personal choice.
“We cannot properly dose the population,” Whitman said. “If families want to use fluoride, they can use it topically.”
Fluoridation critics cite a prominent scientific collaborative’s new review of research suggesting that the benefits of fluoridation are now smaller than they were previously thought to be. The review also found insufficient evidence to determine whether water fluoridation results in a change in disparities according to socioeconomic status.
Fluoridation proponents, however, say that review leaves out researchindicating cavities increase when fluoride is turned off.
Original article online at: https://www.thelundreport.org/content/oregon-cities-consider-water-fluoridation-amid-evolving-science