Lentis/Fluoridation

Fluoridation is the controlled addition of fluoride salts to a water supply in order to reduce the incidence of tooth decay in those who drink from it. Fluoridated water prevents tooth decay by regenerating enamel damaged by plaque, resulting in a more acid-resistant surface.Featherstone JD Dental caries: a dynamic disease process Aust Dent J 53 3 286–91 2008 18782377 10.1111/j.1834-7819.2008.00064.x The World Health Organization (WHO) recommends drinking water fluoride concentrations between 0.5 and 1.0 mg/L depending on climate conditions. WHO Expert Committee on Oral Health Status and Fluoride, http://whqlibdoc.who.int/trs/WHO_TRS_846.pdf Fluorides and oral health Fluoride in varying concentrations occurs naturally in most water sources. Over-fluoridated water can cause dental fluorosis, a cosmetic brown discoloration of the enamel,http://ada.org/public/topics/fluoride/facts/compendium.asp ADA Council on Access, Prevention and Interprofessional Relations American Dental Association National and international organizations that recognize the public health benefits of community water fluoridation for preventing dental decay 2005 2008-12-22 http://web.archive.org/web/20080607092909/http://ada.org/public/topics/fluoride/facts/compendium.asp 2008-06-07 and skeletal fluorosis, an affliction that can cause pain and damage to the bones and joints, when consumed at concentrations above recommended levels; such levels occur naturally in some water sources. Environmental occurrence, geochemistry and exposure Fluoride in Drinking-water Fawell J, Bailey K, Chilton J, Dahi E, Fewtrell L, Magara Y World Health Organization 92-4-156319-2 2006 http://www.who.int/water_sanitation_health/publications/fluoride_drinking_water_full.pdf PDF 5–27 Higher fluoride concentrations uncommon to natural water sources can result in acute fluoride poisoning, as in three cases of improper implementation reported in the US from 1991 to 1998.Balbus JM, Lang ME Is the water safe for my baby? Pediatr Clin North Am 48 5 1129–52, viii 2001 10.1016/S0031-3955(05)70365-5 11579665 Fluoridation was first introduced in the United States in the 1950’s, starting in selected test communities before spreading nationwide. Opposition was quick to follow. Though 50 million Americans had access to fluoridated water by 1960 and 170 million had access by 2002,Lennon MA One in a million: the first community trial of water fluoridation Bull World Health Organ 84 9 759–60 2006 17128347 2627472 10.2471/BLT.05.028209 http://scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862006000900020 Dean HT, Arnold FA, Jay P, Knutson JW Studies on mass control of dental caries through fluoridation of the public water supply Public Health Rep 65 43 1403–8 1950 14781280 1997106 10.2307/4587515 opposition remained strong, with minor and major victories across the country. Internationally, fluoridation was adopted in Australia and Ireland within the decade, eventually outpacing the United States in implementation. Other countries such as New Zealand, Brazil, and the United Kingdom also adopted water fluoridation in the same decade.Mullen J History of water fluoridation Br Dent J 199 7s 1–4 2005 16215546 10.1038/sj.bdj.4812863 Akers HF Collaboration, vision and reality: water fluoridation in New Zealand (1952–1968) N Z Dent J 104 4 127–33 2008 19180863 http://espace.library.uq.edu.au/eserv/UQ:159563/Akers_NZDJ_Dec_2008.pdf PDF Buzalaf MA, de Almeida BS, Olympio KPK, da S Cardoso VE, de CS Peres SH Enamel fluorosis prevalence after a 7-year interruption in water fluoridation in Jaú, São Paulo, Brazil J Public Health Dent 64 4 205–8 2004 10.1111/j.1752-7325.2004.tb02754.x 15562942 The efficacy of fluoridation in the modern era is questioned, with some studies suggesting that access to alternative fluoride sources renders water fluoridation unnecessary.Pizzo G, Piscopo MR, Pizzo I, Giuliana G Community water fluoridation and caries prevention: a critical review Clin Oral Investig 11 3 189–93 2007 17333303 10.1007/s00784-007-0111-6 Background thumb|left|upright|1909 photograph by Frederick McKay of his research team studying the Colorado brown stain.Douglas WA History of Dentistry in Colorado, 1859–1959 1959 199 Denver Colorado State Dental Assn 5015927 The history of fluoridation began in 1901 with Frederick McKay, a dentist in Colorado Springs, CO. McKay's work revolved around finding the cause of "Colorado brown stain," a discoloration of the teeth common in and around the Rocky Mountains. His studies conducted in Colorado were inconclusive. Thirty years after he began his search, in 1931, a breakthrough in Bauxite, Arkansas showed that a change in the drinking water was the culprit of a recent outbreak. He also noted, without fully realizing the implications, that teeth with the stain had "a singular absence of decay". Further testing by ALCOA, an aluminium company with a vested interest in the area, showed high levels of fluoride in the water. By 1942, it was shown by studies funded by the U.S. Public Health Service (USPHS) that at concentrations of one part-per-million (ppm), the health benefits of fluoridated water were retained without visible staining of the teeth. The USPHS noted that the addition of fluoride to public water sources appeared to drastically improve dental health, but cautioned against implementation without testing of the long-term effects. Three years later, case studies for water fluoridation began in four cities: Grand Rapids, MI, Newburgh, NY, Sheboygan, WI, and Marshall, TX. Fluoride was added to the water at one ppm in each city to be compared to three control cities over a ten to fifteen year period. If fluoridation proved safe and effective at the end of these studies, the USPHS would push for implementation in more communities. Within a year, however, pressure arose in Wisconsin from progressives for a more aggressive approach, pushing for fluoridation in 50 Wisconsin communities by 1950 and urging other states to follow suit. This campaigning combined with positive initial reports from the case study cities led the USPHS to change its stance from a conservative approach to immediate fluoridation in every community in America. The American Dental Association (ADA) and American Medical Association (AMA) quickly followed suit. In 1950, the first major opposition to fluoridation arose in one of the WI progressives' 50 communities, the small town of Stevens Point, WI. The city council's first fluoridation proposal was turned down, and a later referendum confirmed the decision not to fluoridate. This victory for anti-fluoridation was highly publicized, influencing the spread of anti-fluoridation sentiment to parties such as the Citizens Medical Reference Bureau and Prevention magazine. Similar opposition occurred in small towns across the US afterwards, as well as some larger cities such as Los Angeles and Seattle.McNeil Donald R. America's Longest War: The Fight over Fluoridation, 1950– The Wilson Quarterly 9 3 140-153 Summer 1985 http://www.jstor.org/stable/40256913 Participants The participants of the fluoridation controversy are broad and varied. Proponents generally support fluoridation for the dental health benefits. The World Health Organization (WHO), the Center for Disease Control (CDC), and the Surgeon General have all expressed explicit support of fluoridation of municipal drinking supplies Fawell et al. Fluoride in Drinking-water 2-4 2015 http://www.who.int/water_sanitation_health/publications/fluoride_drinking_water_full.pdf Center for Disease Control Community Water Fluoridation 1-10 2015 http://www.cdc.gov/fluoridation/ Center for Disease Control Surgeon General's Statement on Community Water Fluoridation 1-2 2011 http://www.cdc.gov/fluoridation/factsheets/sg01.htm/ . Individual citizens concerned about their, or their children’s, health represent both unorganized and organized participants. Unorganized participants also include citizens who are unaware of the fluoridation status of their drinking water, or unaware of fluoridation practices in general. Grassroots organizations both for, and against fluoridation have sprung up all around the country since the controversy first began ActionPA Water Fluoridation in Pennsylvania 2015 http://www.actionpa.org/fluoride/ . Healthy Kids, Healthy Pportland Fluoridation 1-3 2015 http://healthykidshealthyportland.org/ . Participants who oppose fluoridation are diverse. Some groups reject fluoridation on the grounds of personal freedom – generally these groups value personal privacy, and object to over-regulation by governmentRaleigh Against Fluoridation Citizens United Against the Forced Medication of Our Water Supplies 2015 http://raleighagainstfluoride.com/ . In fact, some groups have even claimed fluoridation of drinking water was a government tool for mind controlBronner, E. The Use of Fluoridation for Mass Mind Control 2015 http://www.rense.com/general79/hd3.htm . Perhaps the biggest group to oppose fluoridation is citizens concerned about health; these participants cite fluoride as a toxic chemical and unnatural additive to public water. Alternative medicine supporters and smaller religious groups also reject mass fluoridation. A small subset of the health opposition is simply concerned with over-fluoridation in the form of dental fluorosis or fluoride poisoning. Other organized participants include contractors involved in installing, maintaining, and improving municipal fluoridation systems. These groups, as well as fluoride manufacturers and distributors, have a vested interested in large scale adoption of fluorinated water supplies. On the other side of industry, companies that sell products containing fluoride for health purposes (e.g. toothpaste with added fluoride) stand to lose market share if municipal water supplies were to be fluorinated. Opposition Historical thumb|A 1955 flier by the Keep America Committee associating water fluoridation with other alleged Communist schemes, explaining that fluoride, a "rat poison" would allow saboteurs to wipe out entire army camps. The anti-fluoridation campaign in Stevens Point, WI was led by Alexander Wallace, a concerned citizen and local poet. His efforts forced a referendum for fluoridation in the town; however, before the referendum was carried out, the city council secretly voted to add fluoride anyways. When Wallace discovered this decision, he used it to further fuel his efforts, suggesting that the groups pushing fluoridation in Stevens Point were looking to experiment on the citizens of the town. His use of populist tactics such as mass meetings and handbills calling citizens to action resulted in the ultimate success of his campaign: fluoridation in Stevens Point was rejected by referendum. This success was publicized nationally, and demonstrated to opponents of fluoridation that an organized, properly executed campaign could be successful in overturning fluoridation, even when the pro-fluoridation group had experts on their side. The success at Steven's point was picked up by anti-communist groups such as the publishers of The Dan Smoot Report and the John Birch Society, who framed fluoridation as a result of communist infiltration into the government; these groups suggested that fluoridation was a communist plot to give drugs to the entire American population.Hicks Jesse https://www.sciencehistory.org/distillations/pipe-dreams-americas-fluoride-controversy Pipe Dreams: America's Fluoride Controversy Chemical Heritage Foundation Another prominent event in the 1950's which fueled popular anti-fluoridation opinion in the US was a study by Texas biochemist Dr. Alfred Taylor. His study concluded that sodium fluoride, the most common salt used to fluoridate water,Water fluoridation: a manual for engineers and technicians Reeves TG http://www.cdph.ca.gov/certlic/drinkingwater/Documents/Fluoridation/CDC-FluoridationManual-1986.pdf PDF 2008-12-10 Centers for Disease Control 1986 caused cancer to occur sooner (but not more frequently) in laboratory mice. This study was later to be found faulty after review by the US Public Health service, but the results still prevented the implementation of fluoridation in over 20 Texas towns, including Austin, Dallas, and Fort Worth. Other groups historically associated with opposition to fluoridation are natural food activists, chiropractors, and Christian Scientists. The combination of these groups influences led to the denial of a proposal to implement fluoridation in Seattle, WA in 1951. Another significant figure in the anti-fluoridation was John Y. Yiamouyiannis, former science director of the National Health Federation, an alternative medicine organization. His studies in Los Angeles, dismissed by the CDC, National Cancer Institute, and National Academy of Science as insubstantial, nevertheless influenced the public and policymakers enough to defeat a fluoridation proposal in 1975. Modern 300px|thumb|alt=World map showing countries in gray, white and in various shades of red. The U.S. and Australia stand out as bright red (which the caption identifies as the 60–80% color). Brazil and Canada are medium pink (40–60%). China, much of western Europe, and central Africa are light pink (1–20%). Germany, Japan, Nigeria, and Venezuela are white (<1%).|Percentage of population receiving fluoridated water, including both artificial and natural fluoridation.#aa0000 80–100% 1px solid#aaa #ff0000 60–80% 1px solid #aaa #ff8080 40–60% 1px solid #aaa #ffaaaa 20–40% 1px solid #aaa #ffd5d5   1–20% 1px solid #aaa #ffffff < 1% 1px solid #aaa #b9b9b9 unknown 1px solid #aaa Currently, fluoridation is widespread in the United States, Malaysia, Singapore, Australia, New Zealand, Brazil, Chile, and the Republic of Ireland.The extent of water fluoridation http://bfsweb.org/onemillion/09%20One%20in%20a%20Million%20-%20The%20Extent%20of%20Fluoridation.pdf http://bfsweb.org/onemillion/onemillion.htm One in a Million: The facts about water fluoridation 2nd 2004 The British Fluoridation Society; The UK Public Health Association; The British Dental Association; The Faculty of Public Health 0-9547684-0-X 55–80 British Fluoridation Society Manchester PDF Many western European nations, including Austria, Denmark, Finland, the Netherlands, and Sweden, do not fluoridate their water at all; others, such as Germany, Portugal, Spain and the United Kingdom, have some level of fluoridation.Cheng KK, Chalmers I, Sheldon TA Adding fluoride to water supplies BMJ 335 7622 699–702 2007 17916854 2001050 10.1136/bmj.39318.562951.BE http://www.appgaf.org.uk/data/433-water-fluoridation.pdf PDF Currently over 144 cities in United States are also without fluoridated municipal drinking water NoFluoride Cities Rejecting Fluoridation Since 1990 1 2015 http://www.nofluoride.com/cities_rejecting.cfm. Globally, only 5.7% of the population has access to water with recommended levels of fluorine. Fluoridation is rare in Europe, with only 2% of Europeans having access to fluoridated water; instead European countries promote use of alternative sources. Many of the successful tactics used in the historical fight can be easily seen in use by modern day anti-fluoridation groups. The unification of unorganized participants into integrated, active networks continues to be the most successful strategy.http://www.fluoridation.com/ Fluoride: Protected Pollutant or Panacea? Today, these groups in the US generally attempt to argue against fluoridation on the basis of toxicity, individual rights, or forced medication.http://fluoridealert.org/articles/50-reasons/ Connett Paul Fluoride Action Network 50 Reasons to Oppose Fluoridation A common argument from modern opponents of fluoridation is the proliferation of alternatives such as fluoride toothpaste and their effectiveness in regions without artificially fluoridated water. Fluoridation Alternatives Fluoride naturally occurs in groundwater and in crops. Drinking water, however, is usually the largest contributor to daily fluoride intakeWorld Health Organization Water Sanitation and Health 1-5 2015 http://www.who.int/water_sanitation_health/naturalhazards/en/index2.html . In fact, almost all water contains fluoride – though generally not enough to produce the desired health effects seen with artificially fluoridated drinking suppliesCenter for Disease Control Community Water Fluoridation 1 2015 http://www.cdc.gov/fluoridation/faqs/ . The fluoride concentration of groundwater varies with geography; water with high fluoride content are mostly found in calcium deficient groundwater. Large parts of Africa, China, the Middle East, and southern Asia are known to contain relatively high concentrations of fluoride. The United States, too, has similar geographical areas of naturally high fluoride concentration in the water supply. In addition to naturally occurring fluoride in food and water, fluoride has been added to commercial products with the intention of improving dental health. Toothpaste and mouthwash are some of the most common commercial products to increase the daily fluoride intake. Fluoride supplements or professional dental fluoride treatments can also provide forms of natural or synthetic fluoride. In some counties with limited naturally occurring fluoride or fluoridated drinking supplies, salt has been fortified with fluoride to provide improved dental health Nguyen, Thoa Dentistry for Kids 1 2015 http://www.dentistryjustforkids.com/fluoride.html. All of these products require conscious and consistent application or use, appealing to those who recognize the health benefits of fluoride but believe fluoridation of public water supply to be immoral on the grounds of enforced medication. References