The Fluoride Debate

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TABLE OF CONTENTS

INTRODUCTION

HISTORY/
ENVIRONMENT

CENSORSHIP

THE FLUORIDE
DEBATE

BENEFITS
Question 1
Question 2
Question 3
Question 4
Question 5
Question 6
Question 7
Question 8

ALTERNATIVES
Question 9
Question 10
Question 11
Question 12


SAFETY
Question 13
Question 14

OVERDOSE
Question 15
Question 16
Question 17

DISEASES
Question 18
Question 19
Question 20
Question 21
Question 22
Question 23
Question 24
Question 25
Question 26
Question 27
Question 28
Question 29
Question 30
Question 31
Question 32
Question 33

PUBLIC
POLICY

Question 34
Question 35
Question 36
Question 37
Question 38
Question 39
Question 40

COST
EFFECTIVENESS
Question 41
Question 42
Question 43

CONCLUSION

BENEFITS

Question 5.
What happens if fluoridation is discontinued?

ADA's Fluoridation Facts Short Answer
Dental decay can be expected to increase if water fluoridation in a community is discontinued for one year or more, even if topical products such as fluoride toothpaste and fluoride rinses are widely used.

ADA's Fluoridation Facts Long Answer
The following paragraphs provide a summary of some of the historical studies that have been conducted on the discontinuation of water fluoridation.

Antigo, Wisconsin began water fluoridation in June 1949, and ceased adding fluoride to its water in November 1960. After five and one-half years without optimal levels of fluoride, second-grade children had over 200% more decay, fourth-graders 70% more, and sixth-graders 91% more than those of the same ages in 1960. Residents of Antigo reinstituted water fluoridation in October, 1965 on the basis of the severe deterioration of their children's oral health.44

Because of a government decision in 1979, fluoridation in the northern Scotland town of Wick was discontinued after eight years. The water was returned to its sub-optimal, naturally occurring fluoride level of 0.02 ppm. Data collected to monitor the oral health of Wick children clearly demonstrated a negative health effect from the discontinuation of water fluoridation. Five years after the cessation of water fluoridation, decay in permanent (adult) teeth had increased 27% and decay in primary (baby) teeth increased 40%. This increase in decay occurred during a period when there had been a reported overall reduction in decay nationally and when fluoride toothpaste had been widely adopted.45 These data suggest that decay levels in children can be expected to rise where water fluoridation is interrupted or terminated, even when topical fluoride products are widely used.

In a similar evaluation, the prevalence of decay in 10-year-old children in Stranraer, Scotland, increased after the discontinuation of water fluoridation, resulting in a 115% increase in the mean cost of restorative dental treatment for decay and a 21% increase in the mean cost of all dental treatment. These data support the important role water fluoridation plays in the reduction of dental decay.46

A U.S. study of 6- and 7-year-old children who had resided in optimally fluoridated areas and then moved to the nonfluoridated community of Coldwater, Michigan, revealed an 11% increase in decayed, missing or filled tooth surfaces (DMFS) over a 3-year period from the time the children moved. These data reaffirm that relying only on topical forms of fluoride is not an effective or prudent public health practice.31, 47 Decay reductions are greatest where water fluoridation is available in addition to topical fluorides, fluoride toothpaste and fluoride rinses.

Finally, a study that reported the relationship between fluoridated water and decay prevalence focused on the city of Galesburg, Illinois, a community whose public water supply contained naturally occurring fluoride at 2.2 ppm.

In 1959, Galesburg switched its community water source to the Mississippi River. This alternative water source provided the citizens of Galesburg a sub-optimal level of fluoride at approximately 0.1 ppm. During the time when the fluoride content was below optimal levels, data revealed a 10% decrease in the number of decay-free 14-year-olds (oldest group observed), and a 38% increase in dental decay. Two years later, in 1961, the water was fluoridated at the recommended level of 1.0 ppm.48

Repeat of Question 5.
What happens if fluoridation is discontinued?

Opposition's Response

People, animals and plant life will be healthier. (See Diseases and History / Environment sections). The ADA (statement above) again gives examples in which they totally ignore the "delay in decay" that occurs due to fluoridation. (See 5-1: Antigo, by Harvey Petraborg, M.D., July 14, 1965).

Durham, NC, fluoridated since 1962, had an 11-month cessation of fluoridation between September, 1990, and August, 1991. The purpose of this study was to assess the effects of this break on the development of caries and fluorosis in children."

"It was concluded that while the break had little effect on caries, dental fluorosis is sensitive to even small changes in fluoride exposure from drinking water, and this sensitivity is greater at 1 to 3 years of age than at 4 or 5 years." (J Dent Res 2000 Feb;79(2):761-9, Burt BA, Keels MA, Heller KE, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor 48109-2029, USA.) See www.fluoridealert.org.

"Caries levels for the 12-year-olds of both towns significantly decreased during the years 1993-96, following the cessation of water fluoridation. In Spremberg, DMFT fell from 2.36 to 1.45 (38.5%) and in Zittau from 2.47 to 1.96 (20.6%)". (Community Dent Oral Epidemiol 2000 Oct; 28 (5): 382-9,Kunzel W, Fischer T, Lorenz R, Bruhmann, Dental School of Erfurt, Department of Preventive Dentistry, Friedrich-Schiller-University of Jena, Germany.) See www.fluoridealert.org.

Kuopio, Finland was fluoridated in 1959 and discontinued the practice in 1992. "In 1995, a decline in caries was seen in the two older age groups in this nonfluoridated town. In spite of discontinued water fluoridation, no indication of increasing trend of caries could be found in Kuopio." (See 5-2: "Caries frequency in permanent teeth before and after discontinuation of water fluoridation," from Community Dental Oral Epidemiol, 1998: 26).

Cuba was fluoridated in 1973. "In 1997, following the cessation of drinking water fluoridation, in contrast to an expected rise in caries prevalence — there was a significant decrease, DMFT (decayed, missing and filled teeth) from 2.1 to 1.1: DMFS (decayed, missing and filled surfaces) from 3.1 to 1.5, while the percentage of caries-free children of this age group had increased from 4.8 (1973) and 33.3 (1982) up to 55.2%. (See 5-4: "Caries Prevalence after Cessation of Water Fluoridation in La Salud, Cuba," from Caries Research 2000: 34:20-25, by W. Kunzel, T. Fischer).

"The dentists and the World Health Organization (WHO) experts have predicted a very large carries increase (a tide of caries) after a stop of water fluoridation. The analyses of data however, show a significant decrease of dental caries (caries decline) after the stop of water fluoridation in Japan, in the Netherlands, in Prague, in the German Democratic Republic, and in others. Never was an increase of dental caries found after a stop of water fluoridation. Furthermore, many fluoride tablet measures (use of the fluoride tablets) were stopped also. In Graz, Austria for instance, the dental caries of children had increased during the fluoride tablet actions in schools since 1956 and decreased after the stop in 1973." (Arbeitsgemeinschaft fur Alternative Gesundheitspolitik, by Rudolph Ziegelbecker, Graz, Austria, June 1, 1998.)

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