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

COST EFFECTIVENESS

Question 41.
Is water fluoridation a cost-effective means of preventing tooth decay?

ADA's Fluoridation Facts Short Answer
Yes. Data from generally accepted scientific studies continue to confirm that fluoridation has substantial lifelong decay preventive effects and is a highly cost-effective means of preventing tooth decay in the United States, regardless of socioeconomic status.58, 61, 62, 230-232

ADA's Fluoridation Facts Long Answer
It has been calculated that the annual cost of community water fluoridation in the U.S. is approximately $0.50 per person.233 The annual cost ranges between $0.12 and $5.41 per person, depending mostly on the size of a community, labor costs, and type of fluoride compounds and equipment utilized.27, 62, 231, 232, 234 It can be calculated from these data that the lifetime cost per person to fluoridate a water system is less than the cost of one dental filling. With the escalating cost of health care, fluoridation remains a preventive measure that benefits members of the community at minimal cost.

Historically, the cost to purchase fluoride compounds has remained fairly constant over the years in contrast to the continued rising cost of dental care.27 School-based dental disease prevention activities (such as fluoride mouthrinse or tablet programs), professionally applied topical fluorides and dental health education are beneficial but have not been found to be as cost-effective in preventing tooth decay as community water fluoridation.230 Fluoridation remains the most cost-effective and practical form of preventing decay in the United States and other countries with established municipal water systems.9, 58, 62, 230, 234

Due to the decay-reducing effects of fluoride, the need for restorative dental care is typically lower in fluoridated communities. Therefore, an individual residing in a fluoridated community will generally have fewer restorative dental expenditures during a lifetime. Health economists at a 1989 workshop concluded that fluoridation costs approximately $3.35 per tooth surface when decay is prevented, making fluoridation, "one of the very few public health procedures that actually saves more money than it costs."234 Considering the fact that the national average fee for a two surface amalgam (silver) restoration in a permanent tooth placed by a general dentist is $75.84*, fluoridation clearly demonstrates significant cost savings.235

The economic importance of fluoridation is underscored by the fact that frequently the cost of treating dental disease is paid not only by the affected individual, but also by the general public through services provided by health departments, welfare clinics, health insurance premiums, the military and other publicly supported medical programs.61

Indirect benefits from the prevention of dental decay may include:

  • freedom from dental pain
  • a more positive self image
  • fewer missing teeth
  • fewer cases of malocclusion aggravated by tooth loss
  • fewer teeth requiring root canal treatment
  • reduced need for dentures and bridges
  • less time lost from school or work due to dental pain or visits to the dentist

These intangible benefits are difficult to measure economically, but are extremely important.58, 231

*The survey data should not be interpreted as constituting a fee schedule in any way, and should not be used for that purpose. Dentists must establish their own fees based on their individual practice and market considerations.

Repeat of Question 41.
Is water fluoridation a cost-effective means of preventing tooth decay?

Opposition's Response

Fluoridation cannot be cost-effective since it does not prevent tooth decay. (See Benefits section).

" ... several recent studies, here and abroad, show that fluoridation is correlated with higher caries, rather than lower ones. ... There has been no study that shows any cost-saving by fluoridation. This claim has been researched by a Rand corporation study and found to be 'simply not warranted by available evidence'." (See 41-1: "The Truth About Mandatory Fluoridation" by John R. Lee, M.D. Apr. 15, 1995).

A study was done to determine "The Amount of MediCal Money Spent in 1995 & 1994 for Dentistry in Relation to Fluoridation in the 15 largest Counties in California, which comprise 83% of the Eligible Recipients." (Tables are shown). "As is obvious from the above tables, fluoridation does not reduce MediCal dental treatment costs." The tables show that the cost is slightly higher in the fluoridated areas. "The statement made by Elizabeth G. Hill and Craig L. Brown, that fluoridated water systems ... reduce costs associated with dental treatment (including) ' ... higher Media-Cal dental costs' is so obviously false that the question of how such a statement could be made is worth examining." (See 41-2: Superior Court of the State of California statement, p.5, by Dr. John Yiamouyiannis, 1997).

Dentists make 17% more profit in fluoridated areas as opposed to non-fluoridated areas. There are no savings. (See 41-3: "Impact of Water Fluoridation on Dental Practice and Dental Manpower" from The Journal of the American Dental Association, Vol. 84, Feb. 1972, pp. 355-367).

The Natick Fluoridation Committee Report, dated September 27, 1999, included this statement on the cost-effectiveness of fluoridation:

"One has to consider the savings due to (possibly) fewer cavities in some children and the cost to treat those children. However, it is also true that there will be increased treatment costs due to dental fluorosis (between 10-30% of children in communities that fluoridate develop some form of dental fluorosis). Although these costs are not borne by the community at large, they should be considered in any assessment of cost-effectiveness. ... it seems clear that there will be a greater increase in fluorosis than there will be a reduction in cavities.

"The committee has also identified indirect costs that should be included in the cost effectiveness calculations. These include the costs borne by individual Natick residents who choose not to drink fluoridated water and individual Natick residents who may incur medical or dental costs due to drinking fluoridated water. Finally, there are other costs to the town such as amortization, repair, etc., of equipment necessary to the program. These cost include (but are not limited to) the following identifiable items:

  • Increased dental costs (not covered by insurance) to treat fluorosis.
  • Purchase of unfluoridated water from other sources ($3-4 per week)
  • Increased medical costs
  • Legal costs to the town to defend against lawsuits (see below)
  • Increased plumbing costs resulting from corrosion (See 41-5)

"When a claimed 20% decrease in tooth decay is compared to a 600% increase in bone cancer or a 41% increase in hip fractures, when the cost of a tooth filling is compared to the cost of a hip fracture or cancer treatment, it is obvious that the human and economic costs of fluoridation are staggering." (Fluoridation-Why the Controversy?, by Janet Nagel, Ed.D., from National Health Federation.)

Fluoridation is also a financial hazard to the electronics industry who rely on pure water. Lucent Microelectronics states it will probably cost them $5,000,000 to remove fluoride from the water they buy from the city.

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First Edition
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