Zymflour

Fluoridation: Don't Let the Poisonmongers Scare You

Bob Sprague
Mary Bernhardt
Stephen Barrett, M.D.

Fluoride is a mineral that occurs naturally in most water supplies. Fluoridation is the adjustment of the natural fluoride concentration to about one part of fluoride to one million parts of water. Although fluoridation is safe and effective in preventing tooth decay, the scare tactics of misguided poisonmongers have deprived many communities of its benefits.

The history of fluoridation in the United States underlines its unique standing as a public health measure copied from a natural phenomenon. In the early 1900s, Dr. Frederick S. McKay began an almost 30-year search for the cause of the staining of teeth that was prevalent in Colorado, where he practiced dentistry. In his investigation, McKay found the condition common in other states, including Texas, where it was known as "Texas teeth." In 1928, he concluded that such teeth, although stained, showed "a singular absence of decay," and that both the staining and the decay resistance were caused by something in the water. In 1931, the "something" was identified as fluoride.

The Public Health Service then took over to determine precisely what amount of fluoride in the water would prevent decay without causing staining. Years of "shoeleather epidemiology" by Dr. H. Trendley Dean traced the dental status of 7,000 children who drank naturally fluoridated water in 21 cities in four states. In 1943, he reported that the ideal amount of fluoride was one part per million parts of water. This concentration was demonstrated to result in healthy, attractive teeth that had one-third as many cavities as might otherwise be expected—and no staining.

The next step was to determine whether water engineering could copy nature's amazing dental health benefit. At several test sites, the fluoride concentration of the public water supply was adjusted to one part per million.

One such test was conducted in the neighboring cities of Newburgh and Kingston, New York. First, the children in both cities were examined by dentists and physicians; then fluoride was added to Newburgh's water supply. After ten years, the children of Newburgh had 58% fewer decayed teeth than those of nonfluoridated Kingston. The greatest benefits were obtained by children who had drunk the fluoridated water since birth. Other studies showed that teeth made stronger by fluoride during childhood would remain permanently resistant to decay. As the evidence supporting fluoridation accrued, thousands of communities acted to obtain its benefits.

Fluoridation opponents like to cite CDC statistics showing that the incidence of fluorosis among adolescents aged 12-15 rose from 22.6% in 1986-87 to 40.7% in 1999-2004. Taken by itself, that statement is factual but misleading. Questionable, very mild, and mild fluorosis and most cases of moderate fluorosis are barely visible and pose no problem whatsoever. In addition, it's been shown that teeth with fluorosis are more resistant to decay than teeth without fluorosis. The teeth may appear whiter than otherwise, but they are neither unattractive nor structurally damaged. Moreover, many people think that extra whiteness make the teeth more attractive. Severe fluorosis that adversely affects both appearance and function is close to zero among people who drink water that is optimally fluoridated.

In recent years, fluoridation has been reducing the incidence of cavities 20% to 40% in children and 15% to 35% in adults. The reduction is less than it used to be, probably due to improved dental hygiene and widespread use of fluoride toothpaste. Currently, more than 200 million Americans live in fluoridated communities. But many others receive public water supplies that are not fluoridated—thanks largely to the efforts of poisonmongers.

How Poisonmongers Work

The antifluoridationists' ("antis") basic technique is the big lie. Made infamous by Hitler, it is simple to use, yet surprisingly effective. It consists of claiming that fluoridation causes cancer, heart and kidney disease, and other serious ailments that people fear. The fact that there is no supporting evidence for such claims does not matter. The trick is to keep repeating them—because if something is said often enough, people tend to think there must be some truth to it.

A variation of the big lie is the laundry list. List enough "evils," and even if proponents can reply to some of them, they will never be able to cover the entire list. This technique is most effective in debates, letters to the editor, and television news reports. Another variation is the simple statement that fluoridation doesn't work. Although recent studies show less difference than there used to be in decay rates between fluoridated and nonfluoridated communities, the benefit is still substantial. In fact, the Public Health Service estimates that every dollar spent for community fluoridation saves about fifty dollars in dental bills.

A key factor in any anti campaign is the use of printed matter. Because of this, antis are very eager to have their views printed. Scientific journals will rarely publish them, but most local newspapers are willing to express minority viewpoints regardless of whether facts support them. A few editors even welcome the controversy the antis generate—expecting that it will increase readership.

The aim of anti "documents" is to create the illusion of scientific controversy. Often they quote statements that are out of date or out of context. Quotes from obscure or hard-to-locate journals are often used. Another favored tactic is to misquote a profluoridation scientist, knowing that even if the scientist protests, the reply will not reach all those who read the original misquote.

Half-truths are commonly used. For example, saying that fluoride is a rat poison ignores the fact that poison is a matter of dose. Large amounts of many substances—even pure water—can poison people. But the trace amount of fluoride contained in fluoridated water will not harm anyone.

"Experts" are commonly quoted. It is possible to find someone with scientific credentials who is against just about anything. Most "experts" who speak out against fluoridation, however, are not experts on the subject. There are, of course, a few dentists and physicians who oppose fluoridation. Some of them object to fluoridation as a form of government intrusion, even though they know it is safe and effective.

Innuendo is a technique that has broad appeal because it can be used in a seemingly unemotional pitch. Some antis admit that fluoridation has been found safe "so far," but claim that its long-range effects have "not yet" been fully explored. The waiting game is a related gambit in which antis suggest that waiting a bit longer will help to resolve "doubt" about fluoridation's safety. No doubt, some antis will continue to use this argument for a few hundred more years.

A few antis have offered a "reward" for proving that fluoridation is safe. During the 1970s, a $100,000 offer required the pros to post a bond "to cover any costs which the offerers of the reward might incur if the proof is deemed invalid." The offer did not state who would judge the evidence, but it was safe to assume that the antis themselves would have appointed the judges. If a suit had been filed to collect the reward, the court might have ruled that the offer was a gambling bet that should not be enforced by a court. Such a suit would have required at least $25,000 for the bond and legal fees. Even if it had been won, however, there was no assurance that the money would have been recovered from the individuals who sponsored the reward. Most of them were elderly and scattered widely throughout the United States and Canada.

Scare words will add zip to any anti campaign. Not only the more obvious ones like "cancer" and "heart disease," but also more specialized terms like "mongoloid births" and "sickle-cell anemia." Ecology words are also useful. Calling fluoride a "chemical" (rather than a nutrient) can strike fear in the minds of many Americans who fear we are already too "chemicalized." The fact that water itself is a chemical and the fact that responsible use of chemicals is extremely helpful to our society will not reassure everyone. Fluoride is also called "artificial" and "a pollutant," which is "against nature."

Faced with the fact that fluoridation merely copies a natural phenomenon, the antis reply that "natural" fluoride differs from "artificial" fluoride—a "fact" as yet undiscovered by scientists.

Suggesting alternatives is another common tactic. Here the antis propose that the community distribute free fluoride tablets to parents who wish to give them to their children. The suggested program sounds "democratic," but it will not be effective from a public health standpoint. Most parents are not motivated to administer the 4,000+ doses needed from birth through age twelve. The plea for alternatives is often made by a "neutral" individual who sounds like he will support an alternative program if water fluoridation is defeated. Don't bet on it. Such advocacy is almost always a propaganda ploy.

Once fluoridation has begun in a community, antis can resort to the "cause-of-all-evil" gambit—blaming fluoridation for everything that occurred after it started. An example of this tactic, one that backfired on opponents, took place in Cleveland on June 1, 1956—when fluorides were to be added to the city's water supply. That day, the phone calls began: "My goldfish have died." "My African violets are wilting." "I can't make a decent cup of coffee." "My dog is constipated." Although the basis of such complaints is emotional rather than physical, this time fluoridation's innocence was beyond question. Last-minute problems had delayed its start until July!

"Let the People Decide"

The antis' most persuasive argument, both to legislators and to the general public, is to call for a public vote. On the surface, this appears to be the democratic way to settle the issue. But the antis are dealing from a stacked deck. First, the people who need fluoridation the most—the children—do not vote. Second, it is not difficult to confuse voters by flooding the community with scare propaganda. Average citizens do not have the educational background to sort out claim and counterclaim or to judge which "authorities" to believe. To turn against fluoridation, they don't need to accept all the anti arguments—only one. The sheer bulk of the controversy is itself likely to arouse doubt in the minds of most voters.Antis who say, "Let the people decide," may sound as if they wish to use a democratic process to make the decision, but experience in many cities has shown otherwise. If fluoridation wins a referendum, the usual anti response is to work for another one. In some communities that allow repeated referendums on the same subject, fluoridation has been in and out, and in and out again. When this happens, not only do children suffer, but taxpayers are saddled with the cost of the referendums.Curiously, studies have shown that referendums can lose even in communities where public opinion favors fluoridation. People will usually go to the polls to vote against what they don't like. So the crucial factor in many referendums is the ability of proponents to mobilize the supporters. A 1998 Gallup Poll commissioned by the American Dental Association found that when asked "Do you believe community water should be fluoridated?" 70% of respondents believed that community water should be fluoridated, 18% did not, and 12% were undecided. Yet small numbers of vocal critics still manage to impede its implementation in many communities.

Cancer Scares

In the mid-1970s, John Yiamouyiannis, Ph.D. and another anti began issuing a series of reports claiming that fluoridation causes cancer. Experts concluded that these reports were based on a misinterpretation of government statistics. They had compared cancer death rates in fluoridated and nonfluoridated cities but failed to consider various factors in each city (such as industrial pollution) that are known to raise the cancer death rate. By 1977, independent investigations by eight of the leading medical and scientific organizations in the English-speaking world had refuted the claims, but they still surface today in many communities that consider fluoridation. In 1990, the cancer charge was raised again following an unauthorized release of data from an experiment in which rats and mice were exposed to high dosages of fluoride. The experiment was conducted by the National Toxicology Program, a branch of the National Institute of Environmental Health Sciences. The agency's final report stated that there was no evidence of cancer-causing activity in female rats or in male and female mice and only "equivocal evidence" in male rats. Subsequent review by a U.S. Public Health Service panel concluded that the data were insignificant and that fluoridation posed no risk of cancer or any other disease.

Don't Be Misled

As a public health measure, fluoridation is unusual in several ways. It is a copy of a naturally occurring phenomenon. It is supported by libraries full of articles that document its safety and effectiveness—more so than any other public health measure. It is supported by a variety of health, scientific, and civic groups that could hardly be expected to agree on any other single measure. But most significant, it is the only health measure that is often put to public vote.If you live in a community with fluoridated water, consider yourself lucky. If you do not, don't let the poisonmongers scare you. Fluoridation is still a modern health miracle.

For More Information

• The American Dental Association
• U. S. Centers for Disease Control and Prevention (CDC)
• Dental Fluorosis: Much Ado about Nothing
• Fluoridation: A Roadmap for Legislators
• Fluoridation status of 50 largest U.S. cities (PDF document)
• Fluoride supplementation for children in nonfluoridated communities Dr. John Yiamouyiannis, Fluoridation Opponent, Dead at 58.
• National Center for Fluoridation
• Review of Fluoride: Benefits and Risks (1991): Public Health Service report
• Statement of support from Dr. Linus Pauling
• Statement of support from Dr. Benjamin Spock
• A Critical Look at Yolanda White, MD
• Database: Status of Fluoridation in Your Community

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This article was adapted from The Health Robbers: A Close Look at Quackery in America. In 1993, when the book was published, Bob Sprague was an assistant professor of journalism at Emerson College in Boston. Mary Bernhardt, a freelance journalist who specializes in dental topics, was administrator of the Research and Education Foundation of the American Association of Endodontists. From 1968 to 1976, she served as secretary of the American Dental Association's Council on Dental Health. Dr. Barrett has updated portions of this article.