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The enthusiastic announcer declared that this was “the same substance dentists use to fight tooth decay.” The viewing public was impressed, and so was the American Dental Association (ADA), which awarded Crest its Seal of Approval. Soon, Crest was the best-selling toothpaste in America. Every kid wanted to be “a Crest kid.” But this joyous link between fluoride and cavity prevention was made only after decades of speculation, research, and trials. And the first dental detectives were greeted with far less enthusiasm than was the child in the commercial.
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The initial connection between cavities and fluoride was the result of an investigation begun in 1909 by a Colorado Springs, Colorado dentist named Frederic McKay, who noted discoloration on the teeth of area children. McKay pursued the cause of this phenomenon, known as Colorado Brown Stain, even though his contemporaries expressed little interest. He invited a noted researcher, Dr. G.V. Black, to study the problem. Black was likewise amazed at the prevalence of Brown Stain, and noted that these same children experienced markedly fewer cavities. McKay correctly hypothesized that the local water supply, which contained high levels of fluorine, caused mottling in the emerging teeth. They renamed the phenomenon fluorosis.
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Fluorine, the 13th most abundant element on earth, occurs in all water sources, even the ocean, but only in combination with other elements as fluoride compounds. The question arose: Could fluoride compounds actually offer a solution to the ancient problem of tooth decay? We humans have long been susceptible to painful decay and tooth loss because bacteria eak down the foods we eat and create enamelcorroding acids. Subsequent investigation found that fluoride compounds not only slowed the natural deterioration of tooth enamel, but actually aided in reconstituting it. The dental community had its eureka moment.
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Over the next several decades, dental researchers finally picked up McKay's baton and ran with it. In 1942, the National Institutes of Health (NIH) completed a study of 7,000 children and determined that just one part per million of fluoride in drinking water would minimize decay and avoid discoloration. In 1945, the federal government implemented trials in four communities to test the effectiveness of adding fluoride to public drinking water.
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The first was in Grand Rapids, Michigan. After only six years into what was to be a 10-year test, the National Academy of Sciences' Research Council (NRC) determined the process to be “safe, effective, and beneficial” in reducing cavities in the population. The National Institute of Dental and Craniofacial Research (NIDCR) found that cavities dropped by 60 percent, and declared that water fluoridation “promised to revolutionize dental care, making tooth decay for the first time in history a preventable disease for most people.”
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By 2010, 74 percent of the U.S. population was served by fluoridated water systems. Maryland is currently the most fluoridated state in the nation, with 99.8 percent of its citizens having access to fluoridated water. The last county to fluoridate was Cecil County in 2009, which at that time had the highest rate of tooth decay in the state. The yearly cost to fluoridate drinking water is minimal, around 50 cents per citizen. Experts estimate that for every $1 spent on fluoridation, $38 is saved in dental fees.
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Over the years, fluoridation of public water has had many proponents. The Center for Disease Control and Prevention (CDC) has pronounced public water fluoridation “one of the 10 great public health achievements of the 20th century.” In 2006, they reported that 60 percent of young people aged 6 to 19 had never had a cavity in their permanent teeth, an increase from 30 percent in 1980. The ADA has been a longtime champion, calling fluoridation “unquestionably one of the safest and most beneficial, cost-effective public health measures.” Even the World Health Organization has applauded its potential to “benefit poor communities and deprived areas, where water fluoridation may be a key factor in reducing inequalities in dental health.”
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However, the process is not without its detractors. Some see it as compulsory mass medication and an infringement on individual rights. During the Cold War era, it was even suspected of being a communist plot to lower American IQ.
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One of the most vocal opponents is the Fluoride Action Network, a group that calls fluoride “a toxic substance.” In fact, fluoride in large quantities can be toxic, and in 1997 the Food and Drug Administration (FDA) required all fluoride toothpastes to carry a “poison label” warning of misuse. Even though the only certified side effect of the additive seems to be mottled teeth, claims of cancer, bone weakness, and thyroid damage regularly circulate. Those who challenge the need to fluoridate point to the declining rate of tooth decay throughout the Western industrialized world, in both fluoridated and non-fluoridated countries. In fact, worldwide acceptance of the practice is dwindling, with most countries in Europe either eschewing or discontinuing the practice.
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Individuals and municipalities, including Cumberland, Maryland, have ought suit against the process, but no state or appellate court has ever found water fluoridation unlawful. Concern still exists, however, about maintaining levels that are safe for the public. Available sources of fluoride have increased significantly since the Grand Rapids experiment. Most toothpastes, as well as mouthwashes, supplements, and dental sealants now contain it. Some bottled water, soft drinks, and food contain fluoride, depending on their source of preparation. Last year, the Environmental Protection Agency (EPA) and the U.S. Department of Health and Human Services (HHS) issued a joint statement recommending new, lower standards for fluoride levels in drinking water. The new recommendation of 0.7 milligrams per liter of water, replaces the old range of 0.7 to 1.2 in order to avoid “the unwanted health effects from too much fluoride.”
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In 2011, the Maryland House of Representatives passed HB 901 which mandated that a statewide survey on fluoridation levels be conducted jointly by the Department of Health and Mental Hygiene and the Department of the Environment. (The data must be analyzed and reported to the General Assembly by September 30, 2012, after our press deadline. Visit WhatsUpMag.com for updates.)
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It is unlikely, however, that we will be able to say, “Look Ma, no controversy!” for many years to come. The issue of when and how to provide citizens with fluoridation is a complex and far-reaching one. In the meantime, most of us will continue to reap the benefits of a natural substance that makes the prospects for a 21st century of oral health something we can all smile about.
