Pipe Dreams: America's Fluoride Controversy

Grand Rapids schoolchildren giving saliva samples as part of the city's water fluoridation project.

Grand Rapids schoolchildren giving saliva samples as part of the city's water fluoridation project. National Library of Medicine.

The fluoridation era dawned sleepily enough in America. On the afternoon of January 25, 1945, municipal workers at the Grand Rapids, Michigan, waterworks began feeding powdered sodium fluoride into a system of basins, hoppers, filters, and tanks. The powder dissolved into the water supply and flowed out to the citizens of Grand Rapids. A great experiment had begun.

For nearly a year Grand Rapids had prepared for this moment. Children had lined school halls to “open wide” for preliminary examinations by the white-smocked workers from the U.S. Public Health Service. The city’s blue-collar residents had just helped deliver Michigan for Franklin D. Roosevelt by the slimmest of margins, and still remembered how FDR had pushed through the New Deal. Faith in the benevolence and efficacy of the federal government ran high. The Grand Rapids Herald boasted about the fluoride trial’s unique importance; the trial, nearly everyone believed, would prove fluoride’s cavity-fighting power. And the citizens of Grand Rapids would be a proud dental vanguard.

Still, not everyone shared this rosy view. Weeks before the start of fluoridation, city officials began receiving complaints about sore gums and peeling tooth enamel, after press accounts wrongly informed readers that the trial would begin in early January.

Such pockets of dissent—along with claims of provable harm—prefigured an impending battle, one now raging toward its seventh decade. The Grand Rapids trial continued as planned, with Public Health Service scientists observing a significant decrease in tooth decay among children sooner than they’d expected. The results were deemed so successful that the control city 40 miles away, Muskegon, Michigan, demanded fluoridation of its public water. Doing so brought the comparative study, intended to last fifteen years, to an end after only six. But by then communities across the country had begun fluoridating their water, with support from the Public Health Service, surgeon general, and American Dental Association. In 1951 five million Americans drank from fluoridated supplies; by 1960 that number grew to 41 million. As of 2008, the Centers for Disease Control and Prevention reported that 72% of the U.S. population had access to fluoridated water.

Despite this seemingly inexorable progression, a vocal opposition has persisted—perhaps most famously embodied in the grizzled and gruff cigar-chomping and gun-toting General Jack Ripper of Dr. Strangelove. In that 1964 film Ripper explains his rationale for inciting nuclear war: “Have you ever heard of a thing called fluoridation? Fluoridation of water? Do you realize that fluoridation is the most monstrously conceived and dangerous Communist plot we have ever had to face?”

Though General Ripper’s speech caricatured anti-Red paranoia, right-wing groups like the John Birch Society have long implied dark motives behind fluoridation. But more common are groups raising safety questions. Anti-fluoridation literature goes back over half a century, with titles like Robotry and Water: A Critique of Fluoridation (1959). Members of the Fluoride Action Network and Citizens for Safe Drinking Water have linked the chemical to several varieties of cancer, diminished intelligence, birth defects and declining birth rates, and heart disease—among other maladies. The Sierra Club worries about the “potential adverse impact of fluoridation on the environment, wildlife, and human health.”

Such sentiments are exceptions. The scientific and medical consensus, represented by the American Medical Association, National Academy of Sciences, and World Health Organization declares fluoridation a perfectly safe method of cavity prevention. The Centers for Disease Control and Prevention even named it one of the 10 great public-health achievements of the 20th century.

How did a seemingly benign chemical and a near-miraculous public-health initiative spark such heated debate? One more anti-fluoridation title offers a possible answer: The Case against Fluoride: How Hazardous Waste Ended Up in Our Drinking Water and the Bad Science and Powerful Politics That Keep It There. Many opponents see fluoridation as a consequence of collusion among industry, government, and a scientific establishment in thrall to both. The scientific evidence—more complicated than revealed during the original Grand Rapids trials—collides with skeptical public opinion. Seven decades of controversy remind us that the two realms are never truly separate.