According to the CDC, public fluoridation of public water has been identified as one of the 10 greatest public health achievements. The first documented use of fluoridation of public water supply was in Michigan in1945.
There are many reasons to add fluoride to the water supply, but the reasons appear to be cost of delivery and ease of delivery. Public water systems are maintained by local water municipalities throughout the United States. The federal government sets the recommended rate. (Center for Oral Health, 2011)
When looked at in comparison with other modes of fluoride delivery, i.e. toothpaste, dentist application, and Rx supplements.
Water fluoridation is the least costly. Studies as far back as the 1940’s have shown that communities with fluoridated water supplies have fewer individuals with caries than those without fluoridated water supplies. In studies conducted prior to 1980 which showed 50 percent less tooth decay in communities with fluoridated water vs. those with non-fluoridated water; it was inferred that the cost of averted disease has been found to exceed the cost to implement and maintain fluoridation.
(Griffin, 2001) In a 2000 study conducted on the economic evaluation of community water fluoridation the authors found, that, based on the data available on the effectiveness and cost of fluoridation, caries increment and cost and longevity of dental restorations, that water fluoridation offers significant cost savings.(J of Public Health Dentistry, 2001)
Opponents to public fluoridation of community water supplies cite that adding fluoride to the water supply increases the risk of certain kinds of cancer. However, in a report from the National Cancer Institute, it was found in several studies, that both humans and animals have shown no association between fluoridated water and cancer risk. (Griffin, 2012) Studies have actually shown that the adverse effects of water fluoridation are in fact negligible.
While many tout the benefits of fluoridation in the public water supply systems, there are many who are very much opposed to it. In the United States, approximately 64% of the US population is receiving fluoridated water. There are a total of 55,396 community water supplies in the US and of those, 16,977 are providing fluoridated water (CDC, 2008).
In Western Europe 99% of the countries are opposed to fluoridation of the public water supply for various reasons. The chief complaint being that fluoridation of the public water supply is unethical.
Many opponents site that the benefits from fluoridation are topical and post eruptive and that water fluoridation may actually delay the eruption of permanent teeth. While this in effect does actually reduce caries, it may also have a negative effect on tooth development. Other concerns are that it is unethical to force a medication on a person and that fluoride is in fact a medication. This is also a major concern for some European countries.
There are also concerns that the dosage for the fluoride can not be controlled and that children may be exposed to unnecessarily high levels of fluoride. This is a valid concern since fluoride is a toxic substance. The Department of Health and Human Services has set the recommended level of fluoride in water at 0.7mg per liter, however this is only a voluntary recommendation and communities can set different levels. (CDC, 2011)
Since fluoride is a toxic substance, exposure to excessive levels of fluoride can lead to a myriad of problems. The most susceptible population for excessive exposure is children 8 years old or younger. Children in this age range have an increased risk of developing pits in the enamel of their teeth. In adults there is the risk of bone fractures due to a lifetime expose to excessive levels of fluoride. (CDC, 2011)
Should we continue to fluoridate our water supplies? In my opinion, I think not. It appears to me that fluoridation of the water supply is only beneficial in reducing caries. I don’t think that that is worth having to ingest fluoride for a lifetime. The other delivery methods of fluoride appear to be safer and most of all they can be controlled. I think that there is not enough evidence to support that children cannot get enough fluoride from using toothpaste and dental treatments or supplements.
While studies abound on the benefits of water fluoridation, there is scarce little written about the negative effects. Most of the information available does not come from government agencies, but from grassroots and advocacy groups or other public interest groups. I believe that this hinders people in making informed decisions on whether or not to support local water fluoridation efforts in that when people are searching for information, they are more likely to place trust in the government groups that not.
Fluoridated water is endorsed by the Centers for Disease Control and Prevention, the U.S. surgeon general, the American Dental Association, and the medical establishment as a whole. While I understand that there have been many studies conducted for many years on the efficacy of public water fluoridation, I am not convinced that there are enough studies on the long term effects to human organ systems, other than teeth. What about the effects on the ecosystem. Anything that is a part of our water supply is also a part of the water supply for the ecosystem. Where are the extensive studies on this?
My opinion is also that the data that is being used may not be as up to date as it should be. Many sources are still quoting the extensive caries at were evident in the beginning of the 20 century and how fluoridating the water supply has decreased those numbers. However, those same studies fail to point out that the practice of dentistry has also made advances.
Dental care is much more evolved, now, which contributes to the education of individuals in the US. So what if a person doesn’t want to be subjected to fluoride, what do they do? If they are at home, they can invest in a home water filtration system that using distillation and osmosis to filter their water. (CDC, 2011) But, does that make a difference if they eat or drink anything outside of the home. Chances are it will contain some form of fluoridated water.
Griffin, S, Jones, K, Tomar, S. (2012). An Economic Evaluation of Community Water National Cancer Institute. Fact Sheet: Flouridated Water. Retrieved September 8, 2012 from: www.cancer.gov/cancertopics; National Institute of Health.
CDC, Center for Oral Health. (2011). Fact Sheet: Community Water Fluoridation, Questions and Answers. Retrieved September 8, 2012 from: www.cdc.gov/fluoridation/fact_sheets/cwf_qa.htm.
Division of Oral Health. (2008).
Water Fluoridation Statistics. Retrieved Septermber 8, 2012, from CDC: National Center for Chronnic Disease Prevention and Health Promotion: http://cdc.gov/fluoridation/statistics/2008stats.htm.
CDC. (1999). Achievements in Public Health, 1900- 1999: Fluoridation of Drinking Water to Prevent Dental Caries. Retrieved from: Morbidity and Mortality Weekly (MMWR) 1999; 48:933-40.
Watson, ML. (1985). The Opposition to fluoride Programs: Report of a Survey. Retrieved September, 8, 2012, from: Journal of Public Health Dentistry. Summer, 45(3):142-48