MYTH: “Fluoride doesn’t belong in drinking water.”
FACT: Fluoride occurs naturally in water, though rarely at the optimal level to protect teeth.
It’s already there. Fluoride exists naturally in virtually all water supplies and even in various brands of bottled water. If the people making this statement truly believed it, they would no longer drink water or grape juice — or eat shellfish, meat, cheese or other foods that contain trace levels of fluoride.
What’s at issue is the amount of fluoride in water. There are proven benefits for public health that come from having the optimal level of fluoride in the water — just enough to protect our teeth. In 2011, federal health officials offered a new recommended optimal level for water fluoridation: 0.7 parts per million. That’s our goal: getting just enough to help all of us keep our teeth longer.
MYTH: “Adding fluoride is like forcing people to take medication”
FACT: Numerous scientific studies and reviews have recognized fluoride as an important nutrient for strong healthy teeth.
Fluoride is not a medication. It is a mineral, and when present at the right level, fluoride in drinking water has two beneficial effects: preventing tooth decay and contributing to healthy bones.
There are several examples of how everyday products are fortified to enhance the health of Americans — iodine is added to salt, folic acid is added to breads and cereals, and Vitamin D is added to milk.
MYTH: “Our city council can save money by ending fluoridation of our water system.”
FACT: Fluoridation is one of the most cost-effective health strategies ever devised.
A community that stops fluoridating or never starts this process will find that local residents end up spending more money on decay-related dental problems. Evidence shows that for most cities, every $1 invested in fluoridation saves $38 in unnecessary treatment costs.
MYTH: “Fluoridation is a ‘freedom of choice’ issue. People should choose when or if they have fluoride in
FACT: Fluoridation is a public health measure where a modest community-wide investment benefits everyone.
Fluoride exists naturally in virtually all water supplies, so it isn’t a question of choosing to get fluoride. The only question is whether people receive the optimal level that’s documented to prevent tooth decay.
MYTH: “We already can get fluoride in toothpaste, so we don’t need it in our drinking water.”
FACT: Fluoridated water is the best way to protect everyone’s teeth from decay.
The benefits from water fluoridation build on those from fluoride in toothpaste. Studies conducted in communities that fluoridated water in the years after fluoride toothpastes were common have shown a lower rate of tooth decay than communities without fluoridated water.
The CDC reviewed this question in January 2011. After looking at all the ways we might get fluoride — including fluoride toothpaste — the CDC recommended that communities fluoridate water at 0.7 parts per million. Any less than that puts the health of our teeth at risk.
Fluoride toothpaste alone is insufficient, which is why pediatricians and dentists often prescribe fluoride tablets to children living in non-fluoridated areas.
MYTH: “Fluoridation causes fluorosis, and fluorosis can make teeth brown and pitted.”
FACT: Very high fluoride concentrations can lead to a condition called fluorosis. Nearly all fluorosis in the U.S. is mild. This condition does not cause pain, and does not affect the health
Nearly all cases of fluorosis are mild — faint, white specks on teeth — that are usually so subtle that only a dentist will notice this condition. Mild fluorosis does not cause pain, and it does not affect the health or function of the teeth.
The pictures of dark pitted teeth that anti-fluoride opponents circulate show severe cases of fluorosis, a condition that is almost unheard of in the U.S. Many of these photos are from India, and the reason is natural fluoride levels over there that are dramatically higher than the level used in the U.S. to fluoridate public water systems.
In 2011, the CDC proposed a new level for fluoridation — 0.7 parts per million — that is expected to reduce the likelihood of fluorosis while continuing to protect teeth from decay.
MYTH: “Fluoridation causes cancer and other serious health problems.”
FACT: Leading health and medical organizations agree: fluoridated water is both safe and effective.
The American Academy of Family Physicians, the Institute of Medicine and many other respected authorities endorse water fluoridation as safe. The Centers for Disease Control and Prevention reports that “panels of experts from different health and scientific fields have provided strong evidence that water fluoridation is safe and effective.”
More than 3,200 studies or reports had been published on the subject of fluoridation. Even after all of this research, the best that anti-fluoride groups can do is to claim that fluoride could cause or may cause one harm or another. They can’t go beyond speculating because the evidence simply doesn’t back up their fears.
An analysis of two similarly sized, adjacent communities in Arkansas showed that residents without access to fluoridated water had twice as many cavities as those with access to fluoridated water.
In New York, Medicaid recipients in less fluoridated counties required 33% more treatments for tooth decay than those in counties where fluoridated water was prevalent.
The benefits of fluoridation are long-lasting. A recent study found young children who consumed fluoridated water were still benefiting from this as adults in their 40s or 50s.
National Research Council. “Earth Materials and Health: Research Priorities for Earth Science and Public Health.” National Academies Press. 2007.
Readey v. St. Louis County Water Co., supranote 25 at 628, 631 for the court’s statement that it could not assume that the addition of 0.5 parts per million of fluoride to water that already contained 0.5 parts per million would result in infringement of any constitutional rights; Roemer, Ruth. “Water Fluoridation PH Responsibility and the Democratic Process.” American Journal of Public Health. Vol. 55 (9), 1965. (2) Chapman v. City of Shreveport, supra note 25 at 146.
ADA Fluoridation Facts, 2005. http://www.ada.org/sections/professionalResources/pdfs/fluoridation_facts.pdf.
American Dental Association Website. www.ada.org/4052.aspx.
U.S. Centers for Disease Control and Prevention. “Water Fluoridation: Nature’s Way to Prevent Tooth Decay,” 2006, www.cdc.gov/fluoridation/pdf/natures_way.pdf
Pew Center on the States. http://www.pewcenteronthestates.org/initiatives_detail.aspx?initiativeID=42360
Nadereh Pourat and Gina Nicholson, “Unaffordable Dental Care Is Linked to Frequent School Absences,” Health Policy Research Brief. (UCLA Center for Health Policy Research, Los Angeles, California) November 2009.
American Dental Association, “Statement on FDA Toothpaste Warning Labels,” (July 19, 1997), http://www.ada.org/1761.aspx.
Advanced Dental Hygiene Practitioners Frequently Asked Questions. NNDHA Spring 2008, p. 8. http://www.nddha.org/DH%20FAQ.pdf
M. Neidell, K. Herzog and S. Glied, “The Association Between CommunityWater Fluoridation and Adult Tooth Loss,” American Journal of Public Health, (2010).
M. Willis, C. Esqueda, and R. Schact, “Social Perceptions of Individuals Missing Upper Front Teeth,” Perceptual and Motor Skills, 106 (2008): 423–435.
Thomas M. Leiendecker, Gary C. Martin et al., “2008 DOD Recruit Oral Health Survey: A Report on Clinical Findings and Treatment Need,” Tri-Service Center for Oral Health Studies, (2008) 1 (accessed August 19, 2010).
B. Dye, et al., “Trends in Oral Health Status: United States, 1988-1994 and 1999-2004,” Vital Health and Statistics Series 11, 248 (2007), Table 5, http://www.cdc.gov/nchs/data/series/sr_11/sr11_248.pdf (accessed December 4, 2009).
National Cancer Institute Website. Water Fluoridation Fact Sheet. http://www.cancer.gov/cancertopics/factsheet/Risk/fluoridated-water Accessed July 28, 2010.
Dr. Bill Bailey, CDC Podcast 7/17/2008. http://www2c.cdc.gov/podcasts/player.asp?f=9927#transcript
National Health and Medical Research Council (Australia) (2007). “A systematic review of the efficacy and safety of fluoridation” (PDF). http://www.nhmrc.gov.au/PUBLICATIONS/synopses/_files/eh41.pdf.
Centers for Disease Control and Prevention. “ Water Fluoridation” Homepage. http://www.cdc.gov/fluoridation/65_years.htm.
Centers for Disease Control and Prevention. “Public Health Service report on fluoride benefits and risks.” Journal of the American Medical Association 1991; 266(8).
Mouden, L. “Fluoride: The Natural State of Water.” Arkansas Dentistry; Summer 2005; 77(2): 15-16.
Kumar, J. “Geographic Variation in Medicaid Claims for Dental Procedures in New York State: Role of Fluoridation Under Contemporary Conditions”. Public Health Reports. Vol. 125, 2010.
Texas Department of Oral Health Website. www.dshs.state.tx.us/dental/pdf/fluoridation.pdf.
U.S. Department of Health and Human Services (USDHHS). Review of fluoride benefits and risks: report of the Ad Hoc Subcommittee on Fluoride of the Committee to Coordinate Environmental Health and Related Programs. Washington: U.S. Department of Health and Human Services, Public Health Service; 1991.
“Ten Great Public Health Achievements – United States, 1900-1999,” Centers for Disease Control and Prevention, 1999, http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm.
Guidelines on the use of fluoride in children: An EAPD policy document. European Archives of Pediatric Dentistry, 10 (3), 2009.
The British Fluoridation Society, The UK Public Health Association, The British Dental Association, The Faculty of Public Health of the Royal College of Physicians. “One in a million—the facts about water fluoridation.” Manchester, England, 2004.
National median fee for a two-surface amalgam (silver) filling among general dentists. (Procedure code D2150, amalgam, two surfaces, primary or permanent.) See American Dental Association, “2007 Survey of Dental Fees”; Centers for Disease Control and Prevention, Division of Oral Health, “Cost Savings of Community Water Fluoridation” (August 9, 2007), http://www.cdc.gov/fluoridation/fact_sheets/cost.htm.