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Howard Speaks: The Fluoride Wars Continue Howard Farran, DDS, MAGD, MBA, DICOI; Publisher, Dentaltown Magazine

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The Fluoride Wars Continue
by Howard Farran, DDS, MAGD, MBA, DICOI, Publisher, Dentaltown Magazine

Almost 70 years since the first American city – Grand Rapids, Michigan – introduced fluoride to its water supply, the fluoride debate continues. The media in Albuquerque, New Mexico, has been abuzz about fluoride because the city recently voted to stop adding supplemental fluoride to its water supply (citing budget constraints and that an acceptable amount of fluoride already appears in the water), and the cities of Portland, Oregon, and Phoenix, Arizona (my backyard, and the city I helped fluoridate in 1989), recently took another gander at regulating fluoride in their own water supplies.

As a dental professional you are well aware of the oral health benefits we all receive from fluoride. You give fluoride to your patients during their cleanings and you insist your patients use a fluoridated toothpaste at home because it promotes stronger teeth and less decay. What you might not be fully aware of is the benefit fluoridating a city's water supply provides to its citizens, and I am writing this column for the community water fluoridation dentists (CWFDs) out there who, over the course of their career, might be questioned by either their patients or concerned citizens about water fluoridation.

When I opened up my dental practice – Today's Dental in Phoenix, Arizona – in 1987, tooth decay was rampant. I couldn't understand why all of my patients were presenting with such horrible oral health problems. I went to dental school in Kansas City, Missouri, and I didn't see even a tenth of the amount of decay in the patients I worked on there. I looked into it and found out the difference in the areas was that the water of Kansas City was fluoridated and the water of Phoenix was not. For a year, myself and some close professional friends of mine like Jack Dillenberg, who is currently the Dean of the Arizona School of Dentistry & Oral Health – A.T. Still University in Mesa, Arizona, championed the movement for Phoenix to fluoridate its water, and it passed.

Once the city of Phoenix fluoridated the water supply in 1989, my practice witnessed a noticeable drop in cavities in all of my patients. Economists have crunched the numbers and found that for every 40 cents spent on fluoridating a community's water supply, it saves each patient nearly $40 in dental care. That's why, in America, fluoridating the water has been classified as one of the top 10 greatest public health measures in the last 100 years.

As I mentioned, the common council of the city of Phoenix recently voted on whether or not it should continue fluoridating its water supply, and on September 5, 2012, I took part in a public debate over this issue. This debate drew a large audience and consisted of interested observers, several local dental and health-care professionals, as well as some members of the community who oppose fluoridating city water supplies. I entered the debate with a side to present, but I decided to keep an open mind, anticipating that the opposition might provide some key evidence to the contrary, but nothing the opposition presented changed my opinion about fluoride.

The evidence against regulating acceptable fluoride levels in the water doesn't add up. All legitimate studies on water fluoridation find that it does not cause any adverse health affects at the levels U.S. citizens are exposed to, but what all of the studies find is that it significantly decreases tooth decay when compared to people who drink water containing no fluoride in it. The fringe studies that anti-fluoridationists often locate to bolster their arguments tend to be based in foreign countries with water supplies that have fluoride levels of up to 11 parts per million (acceptable levels of fluoride in the United States are 0.7 parts per million).

Anti-fluoridationists also like to point out that European countries don't fluoridate their water supplies. The infrastructure of European countries is quite a bit older than that of the United States – by several hundred years, in fact. In the States, it's easy and cost effective to set up a single fluoride installation facility to treat all of the city's water, whereas in Europe, you might have to set up 25 or 30 of them. Not very cost effective. Europeans do get fluoride, however, because they fluoridate their salt just like we iodize our salt to prevent goiter!

The big flap opponents of fluoride have is about the city adding fluoride to the water supply, but what they tend to leave out is fluoride actually appears naturally in water; this is actually one of the reasons Albuquerque gave for not adding supplemental fluoride to its water supply – it naturally appears in the water already. The ocean, for another example, contains fluoride! In fact it contains an even higher level of fluoride than the water we drink. While some cities have to add fluoride to the water supply to get it up to an acceptable level, there are some communities that actually have to filter the fluoride out of their water because it naturally shows up in their supply and the levels are higher than the acceptable amount of .7 parts per million. When cities regulate the amount of fluoride in the water, they're regulating an element – not a man-made medication like Keflex or Viagra.

Another argument I hear is that there's already quite a bit of fluoride in toothpaste. That's true. And that does help fight tooth decay. But what we also need to understand is that poor children may not have access to toothpaste. Given a choice between spending what little money a family might have on food, or toothpaste and a toothbrush, a family in dire straits will choose food all day long. Fluoride in the water helps build stronger teeth so these families can actually eat their food. We also need to understand that, while it is important to brush our teeth with toothpaste that contains fluoride, it is equally important that we ingest fluoride to get it into our blood supply and help build teeth and strong bones.

I applaud the passion of anti-fluoridationists, but a lot of their ammunition stems from misinformed hysteria, a supreme distrust of the American government and baseless conspiracy theories. When you pull fluoride out of the water supply of an American city, you see a rise of almost 25 percent in tooth decay immediately.

You can digest this column and take my word, but for a deeper analysis of the fluoride debate, you really should read The Fluoride Wars: How a Modest Public Health Measure Became America's Longest Running Political Melodrama by authors R. Allan Freeze and Jay H. Lehr. This book should be sitting on the desk or nightstand of every dentist and dental hygienist in the world. I'm not kidding. It is thoroughly researched and well written, and I highly suggest every single one of you read this, because if the fluoride debate hasn't happened in your neck of the woods, you can bank on it probably happening some time during your life, and it will continue happening throughout the country 100 years from now.

The Fluoride Wars:
How a Modest Public Health Measure Became America's Longest Running Political Melodrama
by authors R. Allan Freeze and Jay H. Lehr.

What are your thoughts about fluoridated water? When you're done reading this, sign on to Dentaltown.com, click on the link under my online column this month which will take you to a message board already in progress on this topic, and post your response! I will see you online!

Howard Live
Howard Farran, DDS, MBA, is an international speaker who has written dozens of published articles. To schedule Howard to speak to your next national, state or local dental meeting, e-mail colleen@farranmedia.com
2012-2013
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