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 6.
Is water fluoridation still an effective method for preventing dental caries?

ADA's Fluoridation Facts Short Answer
Water fluoridation continues to be a very effective method for preventing tooth decay for children, adolescents and adults. Continued assessment, however, is important as the patterns and extent of dental decay change in populations. Although other forms of fluoride are available, persons in nonfluoridated communities continue to demonstrate higher dental decay rates than their counterparts in communities with water fluoridation.

ADA's Fluoridation Facts Long Answer
Numerous recent studies indicate a trend toward decreased decay prevalence in children living in the United States. This trend also has been reported for children in other developed countries. One of several factors that explains these findings is the increased use of fluorides, including water fluoridation and fluoride toothpaste. In studies conducted from 1976 through 1987,31 the level of decay reduction achieved through water fluoridation in industrialized countries was:

  • 30-60% in the primary dentition or baby teeth
  • 20-40% in the mixed dentition* (aged 8 to 12)
  • 15-35% in the permanent dentition or adult teeth (aged 14 to 17)
  • 15-35% in the permanent dentition (adults and seniors)

*A mixed dentition is composed of both baby teeth and adult teeth.

Additional discussion on this topic may be found in Question 4.

Community water fluoridation remains the safest, most cost-effective and most equitable method of reducing tooth decay in a community in the United States and in other countries.11, 32, 34, 49-52

A controlled study conducted in 1990 demonstrated that average tooth decay experience among schoolchildren who were lifelong residents of communities having low fluoride levels in drinking water was 61-100% higher as compared with tooth decay experience among schoolchildren who were lifelong residents of a community with an optimal level of fluoride in the drinking water.36

In addition, the findings of this study suggest that community water fluoridation still provides significant public health benefits and that dental sealants can play a significant role in preventing tooth decay.

Baby bottle tooth decay is a severe type of early childhood decay that seriously affects babies and toddlers in some populations. Water fluoridation is highly effective in preventing decay in baby teeth, especially in children from low socioeconomic groups.33 For very young children, water fluoridation is the only means of prevention that does not require a dental visit or motivation of parents and caregivers.53

In the 1940s, children in communities with optimally fluoridated drinking water had reductions in decay rates of approximately 60% as compared to those living in non-fluoridated communities. At that time, drinking water was the only source of fluoride other than fluoride that occurs naturally in foods.

Recent studies reveal that decay rates are lower in naturally or adjusted fluoridated areas and nonfluoridated areas as well because of the universal availability of fluoride from other sources including food, beverages, dental products and dietary supplements.54 Foods and beverages processed in optimally fluoridated cities can contain optimal levels of fluoride. These foods and beverages are consumed not only in the city where processed, but may be distributed to and consumed in non-fluoridated areas.11 This "halo" or "diffusion" effect results in increased fluoride intake by people in nonfluoridated communities, providing them increased protection against dental decay.32, 52 As a result of the widespread availability of these various sources of fluoride, the difference between decay rates in fluoridated areas and nonfluoridated areas is somewhat less than several decades ago but still significant.55

A British study conducted in 1987 compared the decay scores for 14-year-old children living in South Birmingham, fluoridated since 1964, with those of children the same age living in nonfluoridated Bolton. The two cities had similar social class profiles and similar proportions of unemployed residents and minority groups. The average decayed, missing, and filled tooth score for the children of South Birmingham was 2.26, compared to an average score of 3.79 for children in nonfluoridated Bolton. These scores indicate a statistically significant difference of 40% between the decay rates in the two cities. Because of the similarity in social and demographic factors, the investigators attributed difference in decay experience found in this study to differences in water fluoride level.56

In the United States, an epidemiological survey of nearly 40,000 schoolchildren was completed in 1987.50 Nearly 50% of the children in the study aged 5 to 17 years were decay-free in their permanent teeth, which was a major change from a similar survey in 1980 in which approximately 37% were decay-free. This dramatic decline in decay rates was attributed primarily to the widespread use of fluoride in community water supplies, toothpastes, supplements and mouthrinses. Although decay rates had declined overall, data also revealed that the decay rate was 25% lower in children with continuous residence in fluoridated communities when the data was adjusted to control for fluoride exposure from supplements and topical treatments.

More recently, data from the Third National Health and Nutrition Examination Survey (NHANES III), conducted from 1988 to 1991, yielded weighted estimates for over 58 million U.S. children. Nearly 55% of the children aged 5 to 17 years had no decay in their permanent teeth.57

Additional discussion on this topic may be found in Question 8.

Repeat of Question 6.
Is water fluoridation still an effective method for preventing dental caries?

Opposition's Response

It never has been. (See Benefits section). A recent study showed that 83% of all caries in North American children are the "pit and fissure" type, which even the proponents admit, aren't preventable by fluoride. They say they are prevented by sealants. (See 10-1 in Alternatives section for details).

"Let me begin by saying that fluorides are most effective in preventing decay on the smooth surfaces of teeth. However, the chewing surfaces of posterior are not smooth. They have crevices and pits and it is our experience that fluorides don't really get access to these pitted areas." (Hearings: "Subcommittee of the Committee on Appropriations, House of Representatives." Mar. 1984. Dr. Loe, Director of the National Institute of Dental Research.)

As far back as 1929, it was an established fact that 95% of decay was in pits and fissures. (See 6-1: The Dental Cosmos, Vol. LXX1, Aug. 1929).

The ADA says (in their statement above): "Baby bottle tooth decay is a severe type of early childhood decay that seriously affects babies in some populations. Water fluoridation is highly effective in preventing decay in baby teeth." This statement leads the reader to believe that fluoridation prevents baby bottle tooth decay, which it does not. (See 6-2: "Baby Bottle Tooth Decay (BBTD) or Early Childhood Caries," compiled by Maureen Jones, Citizens for Safe Drinking Water).

In California, which at the time was only 15.7% population fluoridated, only 33% of the tested Head Start children (defined as poor children) had "baby bottle tooth decay" (BBTD). In the U.S., which is 56% population fluoridated, 50% of the Head Start children had BBTD. California is doing better without fluoridation. (Summary of Findings of the California Oral Health Needs Assessment of Children, 1993-94.)

Regarding medical statistics: to prevent bias in a study's sample (the children chosen for dental examinations) the sample must be a representative sample of the total population. (See 6-3: Bradford Hill's Principles of Medical Statistics, 20th Edition). In this California study, they broke all the rules. (See 6-4: details by Richard G. Foulkes, B.A., M.D., Sept. 22, 1997).

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