Pipe Dreams: America's Fluoride Controversy

H. Trendley Dean consulting with colleagues about fluoridation.

H. Trendley Dean (center) consulting with colleagues about fluoridation. National Library of Medicine.

By 1964 such Communist-plot stories were so well known that everyone recognized the character of General Ripper. The Red Menace of Fluoridation was a warped expression of deep-seated concerns about the role of government in private life. Was fluoridation like chlorination—a public-health measure protecting citizens from disease? Or was it intended to provoke a change in the populace—something like mass medication? That it would primarily affect children was a double-edged sword: proponents and opponents alike encouraged voters to “think of the children,” while opponents asked why, if only children benefited from fluoride, should everyone have to drink it? The fluoridation issue, much like the recent vaccination controversy, involves fundamental concerns about the sovereignty of one’s own person. Or, as protestors have put it, “Only You Know What’s Best for Your Body.”

This contrarian attitude continues to flummox scientists who believe they’ve proven their case. Later trials further enhanced claims for fluoridation’s efficacy. Even many anti-fluoridationists don’t contest its effectiveness: instead, they argue that it should be delivered topically via toothpaste or rinse. (In fact, current research suggests fluoride’s benefit is purely topical; nothing is gained by ingestion.) That the debate has continued for over 60 years suggests to many that the issue has passed out of the realm of reasoned discourse and into ideology: one arrives at a camp and remains there—pro- or anti-fluoridation—despite any contradictory empirical evidence.

Or perhaps the controversy continues because the simple question—to fluoridate or not to fluoridate—provokes complicated sub-questions. It requires citizens of varying opinions and experience to wade through hard science, popular science, and junk science in an attempt to find the truth. That search is bound to become contentious and, given the collective stakes, politicized.

In 1952 New York Congressman James J. Delaney held a series of hearings regarding chemical additives in food and cosmetics, at which Dean and his team, as well as scientists urging caution in fluoridation, testified. The congressmen grilled the Public Health Service scientists, particularly about mottled teeth. The committee’s chief counsel, Vincent Kleinfeld, had a sharp exchange with Dean. “Isn’t it a fact, doctor, that any degree of fluorosis of the teeth caused by fluorine or fluoride is an abnormality?” Dean tried to defuse the word abnormality by emphasizing the fewer cavities in those “abnormal” teeth. Kleinfeld responded, “Are you in a position to tell this committee now that if the fluoridation program for the District of Columbia is put into effect, no children will suffer from mottling of the teeth which is objectionable?” “Yes,” replied Dean, “they will not have objectionable mottled enamel at 1 part per million.” Kleinfeld, handed a rhetorical gift, responded, “Who decides what is objectionable, doctor?” Though they did little to stem the fluoridation tide, the Delaney hearings symbolically mirrored the Stevens Point referendum: scientific expertise would be brought to heel by the will of the people.

Since that time the landscape of the fluoridation debate has remained in a state of churning stasis. Scientists consider closed the question of fluoridation’s safety, but the opposition continues to point out its earlier use as a rat poison and cites foreign cases of skeletal fluorosis, a crippling bone disease caused by acute fluoride poisoning. Scientists respond by distinguishing between the high-level, long-term doses that produce skeletal fluorosis (a condition virtually nonexistent in the United States) and the 1.0 ppm recommended for drinking water. The opposition also points to osteosarcoma, an extremely rare bone cancer it links to fluoride, which collects over time in bones. Other ammunition includes ambivalent studies on fluoride’s connection to hip fractures in the elderly, as well as widespread claims of allergic reactions to fluoride. Members of the scientific consensus ably swat away these claims, which nonetheless provide sustenance for the doubters. In 2000, 26 cities sponsored public referendums on fluoridation. Only 12 passed.

In January 2011 the U.S. Department of Health and Human Services announced a proposal to reduce the recommended fluoride level to 0.7 ppm, citing an increase in dental fluorosis among children since 1980. Regardless of the state of their drinking water, the agency suggests American children receive plenty of fluoride. The announcement set off a new round of chants of “I told you so” among anti-fluoridationists and a new round of corrections by scientists—just another chapter in one of America’s longest-running chemical controversies.

Jesse Hicks teaches in the Science, Technology, and Society program at Pennsylvania State University.