The End of Fluoride?

Detail of fluoride poster from the National Institute of Dental Research. Image courtesy the National Library of Medicine.

A recent article in The New York Times carried the headline, “Looking to Save Money, More Places Decide to Stop Fluoridating the Water.” It follows last year’s report from the National Center for Health Statistics, which showing an increased occurrence of dental fluorosis, a flecking or mottling of the tooth enamel that occurs when children ingest too much fluoride. Does the combination of increased fluorosis and cash-strapped governments mean the end of fluoridated water?

Probably not any time soon. 72% of Americans using community water supplies receive naturally or artificially fluoridated water, according to a 2008 CDC report. And while the Times headline emphasizes cost, underlying it are the same two questions that have fueled the controversy for decades: whether fluoridation is safe and effective, and whether it constitutes mass medication undertaken by the government. As I detailed in Chemical Heritage, the former question seems largely settled but for a vocal minority; the latter is a more abstract, semantic argument, and one influenced by related disagreements over government’s role in society. Like much public policy in America, positions have become entrenched, with neither side likely to convince the other.

That said, the consensus pro-fluoride position has evolved since 1945. No longer do researchers think that fluoride has to be ingested; topical use, as in toothpaste and mouthwash, confers the same benefits. The increase in fluorosis may mean children are ingesting more fluoride than before – not just via tap water, but also in soft drinks and other beverages, or produce grown with fluoridated water. That possibility led the government to lower its recommended fluoridation levels, highlighting another issue: the difficulty in managing fluoride treatments for a mass public. The official standard of 0.7-1.2 ppm hadn’t been revisited in over 50 years.

If research proves fluoride works just as well in toothpaste and mouthwash as in drinking water, without the risk of fluorosis, why continue fluoridation? Pinellas County, Florida, according to the Times, will save $205,000 annually by not adding fluoride to its water. Pro-fluoride groups would argue that’s a small price to pay for fewer cavities – an ounce of prevention that’s worth a pound of cure, especially among those who can’t afford regular dental check-ups. For decades, this argument has been a foundation of the prevailing, pro-fluoridation view. As Freeze and Lehr point out in The Fluoride Wars, however, there’s often a disconnect between the “establishment” view and public perception. The decision to fluoridate, for example, has a much better chance of succeeding if it’s decided by administrators in local government, rather than by referendum.

The Times finds 11 “small cities or towns” that have stopped fluoridation in 2011. To put that in perspective, the CDC reports 16,977 communities providing naturally or artificially fluoridated water. So what do you think, readers? Is this the twilight of the age of fluoridation?

Jesse Hicks is a freelance writer who has taught in the Science, Technology, and Society program at Pennsylvania State University. His feature on the history of the fluoride controversy in the United States was published in the Summer 2011 issue of Chemical Heritage.

Pipe Dreams: America’s Fluoride Controversy [Chemical Heritage]

Posted In: History | Policy | Technology

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