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

ALTERNATIVES

Question 10.
In areas where water fluoridation is not feasible because of engineering constraints, are alternatives to water fluoridation available?

ADA's Fluoridation Facts Short Answer
Yes. Some countries outside the United States that do not have piped water supplies that can accommodate community water fluoridation have chosen to use salt fluoridation.

ADA's Fluoridation Facts Long Answer
Studies evaluating the effectiveness of salt fluoridation outside the U.S. have concluded that fluoride delivered via salt produces decay reductions similar to that of optimally fluoridated water.78 Salt fluoridation is used in over 30 countries, including Switzerland, Columbia, Jamaica, Costa Rica, Mexico, France, Spain and Germany.79, 80 Published results of studies in many of these countries show that, for 12-year-old children, the initial level of decay reduction due to salt fluoridation is between 35% and 80%.81

An advantage of salt fluoridation is that it does not require a centralized piped water system. This is of particular use in many developing countries that do not have such water systems. When both domestic salt and bulk salt (used by commercial bakeries, restaurants, institutions, and industrial food production) is fluoridated, the decay-reducing effect may be comparable to that of water fluoridation over an extended period of time.81 On the other hand, when only domestic salt is fluoridated, the decay-reducing effect may be diminished.78

Salt fluoridation has several disadvantages that do not exist with water fluoridation. Challenges occur with implementation of salt fluoridation when there are multiple sources of drinking water in an area. The natural fluoride level of each source must be determined and, if the level is optimal or excessive, fluoridated salt should not be distributed in that area. Also, salt fluoridation requires refined salt produced with modern technology and technical expertise.82 Finally, there is general agreement that a high consumption of sodium is a risk factor for hypertension (high blood pressure).83, 84 People who have hypertension or must restrict their salt intake may find salt fluoridation an unacceptable method of receiving fluoride.

Fluoridated milk has been suggested as another alternative to community water fluoridation in countries outside the United States. Studies among small groups of children have demonstrated a decrease in dental decay rates due to consumption of fluoridated milk; however, these studies were not based on large-scale surveys. More research is needed before milk fluoridation can be recommended as an alternative to water or salt fluoridation.85 The rationale for adding fluoride to milk is that this method "targets" fluoride directly to children.

Concerns have been raised about decreased widespread benefits due to the slower absorption of fluoride from milk than from water and the considerable number of persons, especially adults, who do not drink milk for various reasons.86 The monitoring of fluoride content in milk is technically more difficult than for drinking water because there are many more dairies than communal water supplies. In addition, because fluoridated milk should not be sold in areas having natural or adjusted fluoridation, regulation would be difficult, and established marketing patterns would be disrupted.17

Additional discussion on this topic may be found in Question 40.

Repeat of Question 10.
In areas where water fluoridation is not feasible because of engineering constraints, are alternatives to water fluoridation available?

Opposition's Response

Yes. Sealants appear to be quite effective. "Fluoride primarily protects the smooth surfaces of teeth, and sealants protect the pits and fissures (grooves), mainly on the chewing surfaces of the back teeth. Although pit and fissure tooth surfaces only comprise about 15% of all permanent tooth surfaces, they were the site of 83% of tooth decay in U.S. children in 1986-87," (See 10-1: "The Oral Health of California's Children," from the California Oral Health Needs Assessment of Children, 1993-94). Proponents of fluoridation made this statement.

"It is estimated that 84% of the caries experience in the 5 to 17 year-old population involves tooth surfaces with pits and fissures. Although fluorides cannot be expected appreciably to reduce our incidence of caries on these surfaces, sealants can." (Preserving the perfect tooth," Editorial, Journal of the American Dental Association, Vol. 108, Mar. 1984.)

"The program focused on four caries-prevention techniques: sealants, a plastic-like coating applied to the chewing surfaces of back teeth and to pits and fissures on the sides of teeth (these surfaces are most prone to decay and ones which fluorides cannot protect adequately)". ("Dental study upsets the accepted wisdom," in Science News, Vol. 125, No. 1., Jan. 7, 1984.)

"The type of caries now seen in British Columbia's children of 13 years of age, is mostly the pit and fissure type. Knudsen in 1940, suggested that 70% of the caries in children was in pits and fissures. Recent reports indicate that today, 83% of all caries in North American children is of this type. Pit and fissure cavities aren't considered to be preventable by fluorides, they are prevented by sealants," ("Fluoridation: Time For a New Base Line?" By A.S. Gray, DDS. FRCD©, Journal of the Canadian Dental Association, No. 10, 1987. (See 10-5: "Pit and Fissure Tooth Decay").

Possibly the best alternative is to give the children whole grain bread. Children raised on whole grains, instead of white flour, from early childhood have been found in a British study to have less than half as much dental decay as children who are reported to have drunk fluoridated water from birth and have eaten white bread. (See 10-6: "Better Diet vs. Fluoridation," by Albert W. Burgstahler, Ph.D., Professor of Chemistry, University of Kansas, Nov. 1967. Also, see 10-7: chart by Vickery and Turner, Vitalstoffe, 11:99-101, 1966.) Why not use our tax dollars to promote this idea, instead of trying to force the whole country to put a prescription drug in our water supply?

A report by Czechoslovakian researchers indicates that fluoride matters little when it comes to preventing tooth decay. A study of 745 children aged 6 to 14 years, from several localities of Czechoslovakia where the drinking water contains calcium and magnesium in large amounts, showed impressively fewer caries in these children than in others throughout the country. This finding was no surprise to other scientists who reported previously that calcium combined with magnesium has a beneficial effect on the resistance of teeth to caries. Interestingly, in all of the localities where tooth decay was below average, the fluoride content of the water was also low. (Cesk. Stomat., May-June, 1966.)

"Fluoride gets a lot of the credit for preventing tooth decay that should go to magnesium, a University of Colorado dental researcher says. He is Dr. Lewis Barnett, who has been doing research into tooth decay since 1950. Barnett said that magnesium also strengthens teeth and bone. 'It is just as feasible for communities to add magnesium to their water supplies,' he said. Given a choice between fluoride and magnesium, Barnett said, he would choose magnesium." ("Researcher Says Magnesium Aids Dental Health," St. Louis Post-Dispatch, Aug. 28, 1966.

"Herford, Texas has been called the 'TOWN WITHOUT A TOOTH ACHE.' This is not true. But the phrase has been used effectively by the people interested in marketing SODIUM FLUORIDE, ALL OVER THE COUNTRY. — As the years went by I continued to study the local situation. I observed that, as the town grew and more people began to live on processed foods, such as-canned goods, white flour products, soft drinks etc., tooth decay increased. This increase of decay occurred, even though they were drinking the same fluorinated water we had always been drinking. I am now fully convinced that good natural food is the preventive of dental caries as well as other diseases." (See 10-9: Copy of Dentist's Letter from "The Town Without a Toothache," George W. Heard, the dentist who succeeded in getting the dental profession to find out why the people's health was so good in Herford, Texas, 3/15/54).

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