Nearly 100 years ago, it was a Pittsburgh chemist who first identified fluoride as the mystery ingredient in the water supply affecting teeth — trying to understand why children in some communities had teeth with mottled brown spots.
Further research found that while the children’s teeth looked unpleasant, they were surprisingly resistant to decay.
And in 1939, that discovery led the director of dental research at Pitt’s dental school to be the first to publicly call for fluoride to be added to public water systems.
Fluoride was first added to drinking water in 1945 and has since been lauded as one of the greatest public health achievements of the 20th century.
But it’s also been demonized for decades — by the John Birch Society, Ralph Nader, and frequently in recent years by Robert F. Kennedy Jr., President-elect Donald Trump’s nominee for U.S. health secretary.
“On January 20, the Trump White House will advise all U.S. water systems to remove fluoride from public water,” Kennedy tweeted on Nov. 2. “Fluoride is an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders and thyroid disease.”
While the majority of the country drinks fluoridated water, Pennsylvania and the Pittsburgh region are a true patchwork of fluorinated and non-fluoridated public water. In the state as a whole, 55% of Pennsylvanians connected to community water systems drank fluoridated water as of 2022. In Pittsburgh, most of Allegheny County has fluoridated water, while most of Westmoreland County does not. Even in Allegheny, it can vary by municipality, or even by neighborhood.
For example, the Pittsburgh Water plant at its waterworks near Aspinwall pumps fluoridated water. A couple miles down Route 28, the Shaler plant does not. O’Hara Township is divided by a vertical line on a map — the eastern half of the township receives fluoridated water, the western half does not.
Over the years, Pitt professor Aaron Barchowsky has been contacted repeatedly by local water systems wondering whether it’s worth the money to add fluoride, and whether it’s safe.
“There are 20-some water companies in Allegheny County,” he said. “I’ve had a number of different municipal managers contact me.”
Residents of Western Pennsylvania can search by address on a map developed by the Pittsburgh Water Collaboratory, PA Coalition for Oral Health and the University of Pittsburgh School of Dental Medicine to check whether their water is fluoridated.
In high doses, fluoride is most certainly harmful. Its effect on dental health was first discovered because it naturally occurred in the water in scattered communities at levels high enough to mark teeth with brown spots, in a condition known as fluorosis. High doses can also affect bone health and possibly lower IQ in children.
A report released in August by the National Toxicology Program found with moderate confidence that high levels of fluoride are associated with lower IQ in children — though the high levels assessed were more than double the level recommended in U.S. drinking water and none of the IQ studies included were conducted in the U.S.
In September, a federal judge ordered the U.S. Environmental Protection Agency to regulate fluoride or do further analysis, citing concerns about IQ in children.
Because of concerns about excessive fluoride exposure, parents are advised to use caution with fluoride toothpaste until children are about 6 years old and able to reliably spit the toothpaste out after brushing instead of swallowing.
“The most important thing that we always teach in toxicology is that the dose makes the poison,” said Barchowsky. “With an essential element in the environment like fluoride, there’s a safe dose and there’s toxic doses. Far too often in communicating the risk, the amounts that would cause a problem are lost.”
The optimal level of fluoride in drinking water is 0.7 milligrams per liter of water, equal to about 3 drops in a 55-gallon barrel according to the U.S. Centers for Disease Control. The CDC lowered that limit in 2011 after determining that children were also getting fluoride from other sources besides drinking water, such as toothpaste and mouthwash.
Fluoride hardens the enamel around a tooth, protecting it from decay. The CDC estimates that drinking fluoridated water reduces cavities in children and adults by about 25%. Adults with certain medical conditions, such as those undergoing radiation, are sometimes prescribed fluoride at higher levels to help prevent tooth decay.
“This has been working out for many many years at safe levels — it works,” said Paulina Zunino, a practicing dentist and chief of the dental medicine division at Allegheny Health Network. “The research and the data are pretty heavy in that regard — we need to do our homework and not just get our information from TikTok.”
Original article online at: https://www.post-gazette.com/news/health/2024/12/07/fluoride-drinking-water-rfk/stories/202412080026