Ten years ago the Centers for Disease Control and Prevention listed the fluoridation of community water systems as one of the 10 great public health achievements of the 20th Century for reducing the incidence of tooth decay.
Is water fluoridation still right for the 21st Century, though?
The St. Croix Falls City Council wrestled with that issue last week in light of the American Dental Association’s 2006 recommendation that powdered or liquid concentrate infant formula should not be mixed with fluoridated tap water to help ensure that infants do not get more fluoride than they need.
“Many U.S. researchers think it is time to reexamine (the affinity) to fluoridate tap water because we have so much (more) fluoride in the environment now than we did in the ‘50s” when the practice became widespread, council member Deb Kravig said.
Kravig is the daughter of a dentist and a trained, registered dietician, though she is not presently active in the field.
She began researching water fluoridation when a constituent called her attention to the recommendation about mixing infant formula with fluoridated water.
Kravig pointed out there is fluoride in a lot of brands of toothpaste, mouth rinse and even foods such as processed chicken products, fruit juice, soda pop, and–via pesticides–raisins and grapes.
She also noted that while about 60 percent of the drinking water in the United States is fluoridated, compared to only 2 percent in western Europe, there now essentially is no difference between the number of dental cavities in children under age 12 in the United States and western Europe.
“You have to be a little careful in drawing conclusions,” local dentist Steve McCormick commented about that comparison, cautioning that many factors could be involved.
“When it comes to fluoride you have to be a little careful too about whether you’re talking topical or systemic application,” McCormick added. A systemic application “actually gets into your body,” he explained.
McCormick said the dental fluorosis condition that is a concern for infants who get too much fluoride “is primarily a cosmetic thing” affecting baby teeth. “It is not compromising the structure of a tooth,” he said. “It’s not compromising the integrity of anything within the gums or the bone or the jaw.”
In McCormick’s estimation, the benefit of topical fluoride “is marginal. . . compared to the systemic benefit of fluoride that’s ingested via prescription medications or fluoridated water.”
McCormick said he personally has seen the direct benefit of water fluoridation in St. Croix Falls during his nearly 20 years of practice here.
Scores of national and international dental, medical and public health organizations and agencies continue to support the fluoridation of public water, he noted.
“There are tens of millions of people that have truly benefited from fluoride across this county,” McCormick said. “. . . I just really, really have a problem with eliminating this from our water supply because I’ve seen the benefits of it. . . . I honestly feel it’s just cruel to take away this one time-tested, proven health benefit that so many agencies support, that gives children just a little extra chance of preventing decay. It’s all about prevention.”
Kravig countered that her research led her to conclude that excessive exposure to fluoride may have other harmful effects and that scientific consensus is leaning toward regarding the topical affect of fluoride as a much bigger player than the systemic affect.
“There’s no doubt that there are benefits from topical applications,” McCormick said. “Is it enough? Is it substituting for a systemically provided one? I don’t think so. I would argue that the scientific community is greatly leaning towards proving that there is a scientific benefit for systemically received fluoride.”
Dr. Cheryl Cermin, an orthodontist in St. Croix Falls, agreed with McCormick’s comments and observations.
She said Dr. McCormick “could see a lot more patients and do a lot more dentistry” if the local water supply was not fluoridated. “But he cares about the public health of the community,” she said. “And the American Dental Association does too. They strongly believe that this is important.”
Dr. Cermin’s husband, Jon, grew up in west Texas, where groundwater naturally contains a higher concentration of fluoride than fluoridated city water contains.
“I didn’t have a single cavity until I went to college in south Texas where they didn’t fluoridate water,” he said.
“I don’t think anybody’s disputing whether fluoride has a positive affect,” councilman Brian Blesi said. “I think that’s very well established. It’s just as we look at the question now: is the fluoridation of water equally effective now and in the future as what it was in the past? Or is it redundant with other mechanisms to provide that fluoride to those that are most vulnerable or actually need it?”
“It seems to me. . . that the amount of fluoride that we’re using in our city wells is pretty well regulated, and the need for it is pretty well documented,” councilman Arnie Carlson said. “We don’t have any clear data. . . on how much fluoride is in all those other sources. And we don’t know how much any given individual or group is likely to be ingesting.”
Given that, Carlson favored a status quo approach to water fluoridation.
He suggested including a notice about the American Dental Association’s recommendations about limiting fluoride for infants and children in the next city water bills.
“I personally feel that in five years (or) 10 years from now we will be at the point where we estimate that we have too much fluoride,” Kravig said.
For “fear of backlash,” though, she said she didn’t want to propose eliminating fluoride from the city water system at this time.
“I think that what we need to do is keep educating ourselves,” she said. “. . . I really think that down the road we are going to find that we have more than enough fluoride. But I don’t necessarily want to go out on a limb and say we have to take it out now.”
Blesi agreed that more studies will bear out the contention being made by some scientists that water fluoridation has become redundant.
The council passed a motion to send out the ADA warning recommendations with the next water bills, as Carlson suggested.
Local business owner Woody McBride, who sent an e-mail to the council members expressing his opposition to water fluoridation, calling it “compulsory medication,” has indicated he intends to start a petition drive to have fluoride eliminated from the St. Croix Falls public water system.
McBride also hopes to have an expert about the harmful affects of fluoride speak in St. Croix Falls.