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 4.
Is further proof of the effectiveness of water fluoridation needed?

ADA's Fluoridation Facts Short Answer
Overwhelming evidence already exists to prove the effectiveness of water fluoridation.

ADA's Fluoridation Facts Long Answer
The effectiveness of water fluoridation has been documented in scientific literature for well over 50 years. Even before the first community fluoridation program began in 1945, epidemiologic data from the 1930s and 1940s revealed lower decay rates in children consuming naturally occurring fluoridated water compared to children consuming fluoride-deficient water.4, 5 Since that time, numerous studies have been done which continue to prove fluoride's effectiveness in decay reduction. Three selected reviews of this work follow.

In 1993, the results of 113 studies in 23 countries were compiled and analyzed.30 (Fifty-nine out of the 113 studies analyzed were conducted in the United States.) This review provided effectiveness data for 66 studies in primary teeth and for 86 studies in permanent teeth. Taken together, the most frequently reported decay reductions observed were:

  • 40-49% for primary teeth or baby teeth
  • 50-59% for permanent teeth or adult teeth

In a second review of studies conducted from 1976 through 1987,31 when data for different age groups were isolated, the decay reduction rates in fluoridated communities were:

  • 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.

Lastly, a comprehensive analysis of the 50-year history of community water fluoridation in the United States further demonstrated that the inverse relationship between higher fluoride concentration in drinking water and lower levels of dental decay discovered a half-century ago continues to be true today.32

(Additional discussion on this topic may be found in Question 6.)

Many well-documented studies have compared the decay rates of children before and after fluoridation in the same community, as well as with children in naturally fluoridated and/or nonfluoridated communities. The earlier studies were conducted at a time when sources of topical fluoride, such as toothpastes, mouthrinses and professionally applied fluoride gels were not available. The results from these early studies were dramatic. Over the years, as sources of topical fluoride became more readily available, the decay reductions observed in these comparative evaluations, although still significant, tapered off. Because of the high geographic mobility of our populations and the widespread use of fluoride toothpastes, supplements and other topical agents, such comparisons are becoming more difficult to conduct.31

Nevertheless, recent data continue to demonstrate that decay rates are higher for individuals who reside in nonfluoridated communities than that of individuals living in fluoridated communities.30, 33-36 The following paragraphs provide a sample of studies conducted in the subsequent decades on the effectiveness of water fluoridation.

In Grand Rapids, Michigan, the first city in the world to fluoridate its water supply, a 15-year landmark study showed that children who consumed fluoridated water from birth had 50-63% less tooth decay than children who had been examined during the original baseline survey.37

Ten years after fluoridation in Newburgh, New York, 6- to 9-year-olds had 58% less tooth decay than their counterparts in Kingston, New York, which was fluoride-deficient. After 15 years, 13- to 14-year-olds in Newburgh had 70% less decay than the children in Kingston.38

After 14 years of fluoridation in Evanston, Illinois, 14-year-olds had 57% fewer decayed, missing or filled teeth than control groups drinking water low in fluoride.39

In 1983, a study was undertaken in North Wales (Great Britain) to determine if the decay rate of fluoridated Anglesey continued to be lower than that of nonfluoridated Arfon, as had been indicated in a previous survey conducted in 1974. Decay rates of life-long residents in Anglesey aged 5, 12 and 15 were compared with decay rates of similar aged residents in nonfluoridated Arfon. Study results demonstrated that a decline in decay had occurred in both communities since the previous survey in 1974. However, the mean decay rate of the children in fluoridated Anglesey was still 45% lower than that of those living in nonfluoridated Arfon.40 These findings indicated a continuing need for fluoridation although decay levels had declined.41

A controlled study conducted in 1990 demonstrated that average tooth decay experience among school-children 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.

Using data from the dental surveys in 1991-2 and 1993-4, a British study predicted that on average, water fluoridation produces a 44% reduction in tooth decay in 5-year-old children. The study further demonstrated that children in lower socioeconomic groups derive an even greater benefit from water fluoridation with an average 54% reduction in tooth decay. Therefore, children with the greatest dental need benefit the most from water fluoridation.42

In 1993-4, an oral health needs assessment of children in California found that children living in nonfluoridated areas had more tooth decay than those in fluoridated areas.43 Of most concern was the high decay rate affecting young children from low income families. Specifically, children in grades K-3, whose families were lifetime residents of nonfluoridated communities and whose income was below 200% of the Federal Poverty Level, had 39% more decay in their baby teeth when compared to counterparts who were lifetime residents of optimally fluoridated areas.35

Repeat of Question 4.
Is further proof of the effectiveness of water fluoridation needed?

Opposition's Response

No, the original studies and many since then have proven that fluoridated water merely delays decay; it does not prevent it.

The belief in fluoride as a tooth decay remedy persists despite the fact that H. Trendley Dean, DDS, its original promoter, admitted 40 years ago under oath, that his data purporting to prove the fluoridation hypothesis were not valid. (H. Trendley Dean: Proceedings, City of Oroville vs. Public Utilities Commission of the State of California, Oroville, California, Oroville, California, October 20-21, 1955.)

From the day the United States Public Health Service (USPHS) completed their original 10-year Newburgh and Kingston (New York) fluoridation experiment, fluoride promoters have repeatedly claimed that fluoride added to drinking water can reduce tooth decay by as much as 60 to 70%. They arrived at that figure by misreading the statistics. This is how they did it:

They ignored the fact that fluoride interferes with proper growth of children's permanent teeth, which causes the teeth to erupt later than normal. Teeth that have not yet erupted cannot decay, therefore, at first (at age 6) the fluoridated Newburgh children had 100% less tooth decay, by age 7 also 100% less, age 8 - 67% less, age 9 - 50% less, and by age 10 - 40% less. Realizing their experiment was going downhill, the USPHS stopped their experiment early, totaled the five reductions shown, then divided by 5 to obtain what they called "an over-all reduction of 70%." Obviously, the only reduction that really counted at that time was the 40% (age 10).

Had the Health Department continued their survey beyond age 10, they would have found that the percentage of reduction continued down hill to 30%, 20%, 0%, and eventually these children had more cavities — not less. The rate of decay is identical, once the children's teeth erupt. (See 4-1: "Fluoridation Benefits — Statistical Illusion." Testimony of Konstantin K. Paluev, Research and Development Engineer, Mar. 6, 1957).

John A. Forst, M.D., a New York public health official, found that after ten years of fluoridation in Newburgh, 63.2% of the school children had decayed teeth compared with fluorine-free Kingston, which had only 41.7% with tooth defects. (See 4-2: statement from John A. Forst, M.D., from The University of the State of New York, Oct. 26, 1954).

Data by Dr. David B. Ast, who was in charge of the fluoridation experiment (Tables, page 319, Journal American Dental Association, 1961) shows delay in decay only until age 15. Then Newburgh passes non-fluoridated Kingston in decayed and filled teeth, after 16 years of fluoridation. Newburgh, with a 9% increase in population, added 18% more dentists. Kingston, with 1% increase, dropped 3% of its dentists. (See 4-3: statement and chart).

Journal of American Dental Association (JADA), 1972, 84; 355-367, stated that dentists made 17% more profit in fluoridated areas, as opposed to non-fluoridated areas. There are no cost savings. (See Cost Effectiveness section).

This "65% less dental decay" is just a statistical illusion. When the Health Department's own statistics are read correctly, they prove that fluoridation merely causes a temporary delay in decay. (See 4-4: Fluoridation Fallacies — ExposŽ of Fluoridation Claims Based on Advocates Own Statistics, by Charles Klint). By ignoring this delay factor, the fluoride promoters have continued reading statistics incorrectly to this day.

The above mentioned 1993-94 California Oral Health Needs Assessment was performed by the Dental Health Foundation (DHF). This foundation was created in 1985 for the sole purpose of promoting statewide fluoridation. As a result, the findings were very biased.

The first-ever independent review of the California Oral Health Needs Assessment of 1993-94 was delivered to the City of Escondido, California, on February 1, 2000. The analysis of the Needs Assessment was performed by the international renowned Senes Oak Ridge Inc., Center for Risk Assessment in Tennessee. (See 4-5: "Review of the California Oral Health Needs Assessment 1993-94," Jan. 31, 2000).

Escondido City Council Member Marie Waldron said the Needs Assessment report was "a classic example of the manipulation of science to prove a case. This study, in effect, compares non-poor children in fluoridated communities, with protective sealants on their teeth, against poor children in Head Start programs in non-fluoridated communities, with no sealants on their teeth."

She went on to say, "This Oral Health Needs Assessment was an intentionally non-published, non peer-reviewed, expensive study that they expected not one of us without a background in science would want to read. So they offered summarizing bullet points and glossy brochures to our Council, and evidently to many others throughout the entire state, as proof that we should convert our precious water supply into a delivery system for special interests, forcing those who cannot afford bottled water to drink industrial-waste fluoride every day of their lives."

The California law to fluoridate was passed on the strength of the final figures of this study, without the DHF ever divulging the details. They claimed that this study proved the children of California desperately needed fluoride in their water. However, it actually proved just the opposite. The study showed that California had only about a quarter as much water fluoridation as the nation as a whole, yet the 15-year-old California children had less tooth decay than the national average. (See 4-6: San Diego Union Tribune. Article, Sept. 1, 1999).

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