Fluoridation: A White Paper (1974)

This is Bill Hanrahan in Fairfield, Connecticut, a city with a population of 55,000. In 1967, this city voted to flidate its public water supplies. Today, it is one of close to 10,000 cities and communities in this country that have fluoridated water. Over a 100 million Americans now use fluoridated water daily. What are the facts on flidation today? What are the results of this once controversial effort to improve the health of all our people? Let's take a look at the facts on fidation. [Music] [Music] Dr. Joe Reinhardt is a practicing dentist in Detroit who feels very strongly about fluoridation. Dr. Reinhardt, what have seven years of flidation meant to your patients? It has meant a pronounced reduction in the number of decayed, missing and filled teeth for those patients exposed to the fluoridated water. I see. Can you actually tell the difference say for uh in a child who was from the Detroit area and a child from uh from outside the area? A a child who has grown up in an area with fluorides in the proper percentages in the water exhibits first of all uh about a 50% reduction in decayed missing and filled teeth. Well, now if there is this tremendous reduction in cavities as a result of fluidation. Why are dentists so uh so much behind this program? because it permits us as dentists to devote our efforts to those more sophisticated areas of dentistry as opposed to the emergency pain relief areas or the removal or the extraction of teeth that are hopeless. Well, then now do you feel that flidation is an important enough subject for community action? very definitely and for the same reasons mentioned earlier economics and improvement of the health of the community and the individual. I'm a few miles outside of Denver, Colorado, speaking with Mr. Dean Chossece, a water supply engineer with the Environmental Protection Agency. Mr. Chosy, just what is chloride? The chloride occurs as a natural substance in nature and it's part of the mineral containing rock material and you can see as water flows over some of these rocks it picks up some of the natural fluoride and it's dissolved in the water. So all waters have some natural fluoride in them. Now there are others that do not have a sufficient amount of fluoride at the optimum level for good dental health. So that fluoride content can be adjusted by adding some fluoride compounds. These materials are added by feeders and uh added to the water supply generally at the water treatment plant. Is it possible for too much fluoride to be added to the water supply? No. The machinery is very precise and it controls the fluoride content going into the water supply. And then also there are tests run daily by the water treatment plant and also tests are taken from the water distribution system to determine the amount of fluoride. So there's constant surveillance on them. Can fluoride be harmful? No, certainly not at the level which is being used in the water supply when we're adding approximately one part per million fluoride to the water supply. Uh there's certainly no danger at that level or anywhere close to that level. Is fluoride the only substance being added to the water supply? No. There are many other chemicals which are used to actually treat the water to remove particles and remove color and so forth in the water treatment process. This is a biology laboratory in the University of California at San Francisco where Dr. Ernest Nubran is professor of oral biology and chairman of the section of biological sciences. Dr. Nubran, can you tell us exactly how fluidation works? Well, fluoride works in reducing tooth decay because teeth are made up of mineral and fluoride is capable of entering into the mineral part of the body and forming more perfect crystals than we have when there's no fluoride present. Fluoride containing enamel is more resistant to attack by acid formed by bacteria on the tooth surface and teeth which are formed in the presence of fluoride are more resistant to decay. Why couldn't fluoride be provided through other means besides water? Well, it can and it is provided by other means besides water. All the other techniques of providing fluoride uh are certainly more expensive than providing it in the water supplies. We know also that it costs over $2 billion a year to repair the damages caused by tooth decay. It just seems to me that adding fluoride to the water supply is a practical, safe, and economic way of reducing the damages, the pain, the discomfort, and the disfiguration that can occur from tooth decay. This is Harvard University where we will be speaking with Dr. Jean Meyer, one of the world's foremost authorities in the field of nutrition. Dr. Mayer, why do you think that fluoridation is important? Well, fluoridation is important because preventive medicine, preventive dentistry are important. In this country, we have a tendency to think of medicine as something which happens after the fact. We get sick, then we go to hospital, uh we have a cavity, then we go to the dentist, and then the doctors do what they can. Well, how does fluoridation relate to nutrition? Well, it's it is a problem of nutrition. The uh element fluoride is apparently needed not only uh to make a solid tooth which will not easily become carious but also as a matter of fact for growth. At least we have data now showing that if animals are uh raised on a synthetic diet containing all the known vitamins and minerals and nutrients except fluoride they do not grow properly and the addition of fluoride restores growth. So that we have to look at fluoride as a nutritional element which is needed and which is often in inadequate amounts not to prevent growth but to prevent the formation of solid teeth. How can we be sure that fluidation is safe? It is now 30 years since some of the artificially fluidated community started receiving fluoride in their in their water supply and those communities have been followed very carefully and there is no change and no deterioration in the state of health of these communities as a result of fluidation just a decrease in the number of carries in children I'm in the offices of Mr. Mr. William Butler, prominent Detroit attorney. Mr. Butler, have any courts decided against flidation? This is one of the unusual things about this phase of the law. In almost any other field, you're going to find some decisions which may disagree. You don't usually have a continuity. But uh I've been able to say successfully that there is no court of last resort in any jurisdiction in this country which has after a full hearing on the merit decided against fidation. Mr. Mr. Bartler, do the courts actually look upon fluoridation as a medication? No. Now, you want to realize that most water, in fact, virtually all water has all manner of minerals in it. And fluoride is probably present in virtually every bit of water that's being consumed in this country. Now, it may not be present in an adequate enough level to become a good public health measure. So, that this is merely supplementation of the existing fluoride content. When it is put to a public vote, why does it lose so often? Well, this is one of the sad things about the whole issue of supplementing existing fluoride content of water. The pro the opponents of it have not always been honest. In fact, they play upon emotions. And you know, in any time in the political arena, there's very little restraint upon whether you tell the truth or not. And these campaigns are very frequently uh put on in such a way as to actually frighten people. But in those communities where the people have really sought enlightenment and listened to both sides of the issues and the proponents of supplementing the existing Florida have had an opportunity to be heard, you've had success. Dr. Charles Gish is Indiana's state dental director and is also associate professor at Indiana University School of Dentistry. Dr. Gish, as a public health dentist, what are your feelings concerning the safety of flidation? Well, actually in regard to the state health department, our first responsibility is to determine that any measure is beneficial to people and not harmful. We're in an area here where we have a medical center. We have physicians, dentists, pathologists, research people, and toxicologists who work with the fluorides and do research in the area of fluorides. And certainly, if there was any possible chance for harm or danger, we wouldn't have it in our water supply. and we've had it for more than 20 years and are quite happy that we do. Dr. Gish, does fluoridation only benefit children? Well, in the beginning it benefits the younger children, but as these children become older and become adults, the benefits last for a lifetime. Why are you so committed to flidation? Well, I think because we've had the opportunity of here in the clinic with children out in school systems with many surveys uh across the state and the country in actually looking at children in fluoride and non-flloride areas and in every case and we've examined hundreds of thousands of children and in every case they've had more than a 50% reduction in tooth decay. Is flidation the only area of preventive dentistry in which you're working? Certainly not. There are many things that we do in the area of dental health every day throughout the state and communities across the country. For example, here is a mobile dental unit and this is out in one of the schools and it's been there all summer treating migrant children. And I think there's some important things to to remember here in regard to a program like this which we see and come back to the point that we have to recommend flidation. For example, this unit is an expensive unit. When we start treating the boys and girls here, it involves a lot of dental personnel and time and it really becomes expensive when you compare it to something like fluidation where we put fluoride in the water supply. It's by far the cheapest method. We can reach large numbers of children and it reaches all children. What does it all add up to? Well, let's look at it this way. This little girl is one of a 100 million persons in this country using fluoridated water daily. What can she look forward to in the way of dental health? She will have up to 65% fewer cavities than a child living in a community without fluoridated water. She will lose no teeth because of decay. And as an adult, she will continue to have fewer cavities. The amount of money spent for her dental care will be far below that spent for a person who has not used fluoridated water. Lastly, and perhaps most importantly, she will be spared much of the pain and discomfort that often accompany tooth decay. The history of our quest for health and self-improvement is as old as humanity itself. In this century alone, we have witnessed great achievements in technology, in education, in nutrition, and in healthcare, where flidation can afford the basis for improving the dental health of our entire population. This has been Bill Hanrahan with a report on flidation. [Music]