The Big Bad Fluoride Monster
Jenson Hagen
I thumbed through the Oregonian today and saw Mel Rader's opinion piece on why we need fluoride. If you read the article, you'd think anyone against water fluoridation is a monster that hates kids and grandmothers. I think that proponents of water fluoridation need to wake up from this cloud of 1980s research that they've all been sitting on.
Do you know why the target for fluoridating Portland's water is .7ppm? According to the old standards, it should be 1.2ppm. It's because the standards were changed DOWNWARD to .7ppm to help avoid negative effects from excess exposure to fluoride. Mel Rader has us all cry about the sad child with missing teeth, but perform a google images search for fluorosis and you'll see plenty of sad children with damaged teeth from too much fluoride.
Water fluoridation is not 100%. It will not erase 100% of all cavities. You will still have cavities and you will still need to address either the underlying cause or provide access to dental care so the cavities can be treated before they progress to abscessed teeth. Mel Rader has us believe that Portland is this evil place that allows untreated tooth decay to persist. "The tri-county area has 40% more untreated tooth decay in children than in King County, WA (Seattle)," which he says fluoridates water. Hogwash! The Oregon Smile Survey 2007 puts the rate of untreated tooth decay in Portland at 21%. King County's public health website puts its rate at 23%. What? The nonfluoridated city has lower untreated tooth decay! The Oregonian should fact check articles before littering our minds with such garbage.
The proponents of fluoride are stuck in the 1950s when access to fluoridated products was limited. Now these products are ubiquitous and dumping more fluoride into our water is becoming dangerous to teeth and bones. Mel Rader makes the claim that fluoride strengthens teeth. It does nothing of the sort. Adding fluoride to the tooth or bone matrix makes it less susceptible to bacterial decay, but it actually weakens the matrix overall. Is this why Oregon has one of the lowest rates of tooth loss among elderly citizens? Because we have NOT been fluoridating our water.
If you are someone that wants our water to be fluoridated, you are simply being placated. Bringing the levels up to .7ppm will not achieve the level of cavity reduction that your precious research and CDC references would lead you to believe. Most of the research out there is based on higher fluoridation levels so you'd be lucky to get a 10-15% reduction at best. The level of untreated tooth decay is already incredibly low here in Portland so think more in terms of a 1-2% reduction. We already get a lot of fluoride from multiple sources. What we really need is to keep kids off junk food, which will probably help with behavioral and learning disorders as well. And we need to ensure people have access to dental care no matter the case--cavities or no cavities.
The world premiere of the Inconvenient Tooth will be showing tonight at 7:30pm at the Mission Theater.
4:30 p.m.
Nov 20, '12
Jenson Hagen is a monster that hates kids and grandmothers.
5:55 p.m.
Nov 20, '12
Kids can already get free fluoride treatments at school. No reason to ruin Cascadia's pristine water over the humanist cries of 'thing of the children!'.
We have no right to alter the water in such a way when it clearly will have untold environmental consequences as the fluoride will obviously begin to accumulate in lakes, rivers, and soil.
The people of Portland have rejected fluoride repeatedly, and the 40,000+ signatories that are putting the decision on the ballot are a good sign that the people will once again shoot down this foolish plan from the industrial 1950's.
11:05 p.m.
Nov 21, '12
There is a ton of current scientific literature which was done under modern conditions. The Louisiana study above, the Iada/Kumar study which showed that the mild fluorosis associated with CWF prevents cavities. Is it conceivable that the entire public health scientific community has somehow missed that it is no longer 1950??
11:06 p.m.
Nov 21, '12
Hart . . the first problem with school programs being enough has to do with the most compelling benefit from community water fluoridation (CWF). It prevents 2/3rds of the operations preschoolers need for mouthfuls of severe cavities.
This finding has been shown in Louisiana, Texas, New York, Scotland, Australia and data was presented to the City Council showing a 70% decrease in fluoridated The Dalles compared to non-fluoridated Hood River.
These operations are under general anesthesia and include extractions, fillings, stainless steel crowns and root canals.
Quite obviously, school programs will not help preschoolers.
Also, the failure of school programs was the clincher for Commissioner Fritz whose mind was not made up until after the hearings.
And here's my bet . . even if you concede that your idea of school programs being good enough is a non-starter public health idea, you will oppose. You will oppose if the next 10 ideas are shown to be mistaken.
In PDX we are dealing with exactly the same problem we have with the Right Wing denying climate change. Psychologic important values prejudge the issue. No matter that there is scientific consensus that climate change is real; no matter that an even larger expert consensus exists for CWF.
School programs are not enough, toothpaste is not enough, exhortation for better oral hygiene is not enough. CWF just prevents cavities. It is indeed a huge social justice issue which progressive Portlander's should neither ignore nor deny.
7:00 p.m.
Nov 26, '12
Swallowing fluoride won't stop tooth decay. Putting kids on a healthy diet free of processed junk food and soda will. Let's be smart and not cave to false humanist claims of 'think of the children!' progressivism.
9:18 p.m.
Nov 20, '12
Hi Jenson,
I'm honored that you choose to write a critique of my opinion piece. And, I respect your perspective on this subject. But, let's stick to the facts. And, here are the facts:
(1) Portland's rate of untreated decay is 40% higher than King County. You can read their report here: http://www.kingcounty.gov/healthservices/health/personal/OralHealth/~/media/health/publichealth/documents/oralhealth/2010SmileSurvey.ashx
You were referencing the data for low-income children, not the rate for all children. So, please fact check your own article and make the correction.
(2) The current recommended range for fluoridation is 0.7 to 1.2, and they are suggesting changing that to 0.7ppm. This seems like a good thing, because you get almost the same benefits at 0.7ppm as you do at 1.2. But, some water systems are as high as 4ppm from natural fluoride, and even at this level, the EPA says there is no health risk, just mild fluorosis which is a cosmetic issue not a health issue.
(3) You say we are relying on studies from the 1980s or that we are stuck in the 1950s. I'm not sure why you are saying this. In 1960, 50 million people in the U.S. drank fluoridated water, and in 2010, 200 million drink fluoridated water. So, it is hard to see how this is a policy based in the 1950s. Also, here are links to a number of recent studies showing fluoride's benefits: http://www.ilikemyteeth.org/fluoridation/savings/
(4) Fluoride does strengthen teeth and bones. This is the language that the CDC uses: http://www.cdc.gov/fluoridation/fact_sheets/cwf_qa.htm#3
Plus, studies show that tooth and bone density increase. For example, this study shows that drinking optimally-fluoridated water increases bone density and decreases hip fractures by 31% after controlling for confounding factors: http://www.bmj.com/content/321/7265/860
(5) You suggest that the benefit would be only 1-2% reduction in cavities with no reference whatsoever. This is just plain wrong. The CDC says cavities are reduced by 18 to 40% and the American Dental Association says cavities would be reduced by 25% over and above all other sources of fluoride.
(6) You suggest that access to dental care is an alternative. However, multiple studies show fluoridation dramatically reduces dental costs. Three studies show that Medicaid dental costs are cut in half. So, we could cover twice as many people with dental insurance with the same amount of tax payer dollars dollars if we choose to fluoridate. So, increased access to dental services and fluoridation really go hand in hand.
Let's stick to the facts. If you have a problem with fluoridation, let's talk about your ethical concerns with the practice instead of citing false information.
11:26 a.m.
Nov 21, '12
Mel, Thanks for the references.
However, the fact that fluoridation in King County does not reduce untreated decay for poor kids there relative to Portland raises questions about the equity argument for fluoridation.
My biggest concern about fluoridation is that it may be an attempt to get health equity on the cheap, rather than investing in dental care for poor kids at the level required to really reduce disparities. I'm not suggesting that's your motive, or UPH's, but may it be the effect?
Another reason why we need comprehensive publicly funded health care for all ("single payer"). Health care is a human right.
5:06 p.m.
Nov 21, '12
Hi Chris,
I agree with you that fluoridation won't erase the health disparities between rich and poor, but it certainly helps. In fact, fluoridation is the only solution that benefits everyone, regardless of race or class. I believe there are three primary strategies to reduce dental disease: (1) increasing access to dental care, (2) effective school based sealant programs, and (3) water fluoridation.
Water fluoridation is often described as the foundational solution for dental health, because it prevents cavities instead of treating them after they occur. I believe this is a smarter and more cost-effective approach. Fluoridation for Portland will run around $1 per person per year, and savings in dental costs would be around $30 per person per year. (See info about cost savings here: http://www.ilikemyteeth.org/fluoridation/savings/ )
The CDC estimates the return on investment to be 38 to 1. So, fluoridation is also the only solution that saves a lot of money overall. Therefore, I see fluoridation going hand in hand with increased access to dental care. Fluoridation reduces the burden of dental disease, making it easier to expand dental coverage and serve the needs of everyone.
And, I hope if fluoridation is passed that we will see policymakers used the savings in dental costs to expand coverage.
11:21 p.m.
Nov 21, '12
It is a mistake to just find factoids here and there and pretend they apply to the scientific analysis of community water fluoridation (CWF).
For starters your phrase "untreated decay" is really not a legitimate measure of fluoridation's effect. Proper research measures Diseased, Missing, or Filled tooth Surfaces (DMFS).
Fluoridation has a much bigger effect on severity than it does on the incidence of cavities. It is a very common ploy for anti-fluoridation propagandists to quote "decay rates" or use some other measurement of disease prevalence. This is known as Disease, Missing or Filled Teeth (DMFT).
Imagine one molar completely destroyed from cavities & with an abscess (needs root canal or extraction) and another with a tiny pinpoint cavity, perhaps visible only to the dentist using a diagnostic probe.
Your phrase and the DMFT methodology score shows NO DIFFERENCE
Totally Destroyed Tooth: 1 Tooth w Tiny Barely visible Cavity: 1
Score using DMFS (surfaces) shows a BIG DIFFERENCE
Totally Destroyed Tooth: 4 Tooth w Tiny Barely visible Cavity: 1
Is it small wonder that a scoring system that only recognizes the incidence of cavities misses important benefits.
This is exactly what the anti-fluoridationist's revered guru Dr. John Yiamouyiannis (who believed that AIDS was not from a virus) did in his infamous reprocessing of the 1990 Brunelle and Carlos data.
Likely you are totally unaware of these distinctions. Likely most of the readers here are also. All of which argues against these amateur ad-hoc arguments and councils acknowledging the overwhelming professional consensus which holds CWF safe, effective and inexpensive. This is a very important decision which, as Mel Rader said in his editorial, will help real people with real disease to have fewer cavities. To argue against CWF is to argue for greater pain, greater health inequality and lifelong oral health disadvantage.
9:29 a.m.
Nov 26, '12
Game. Set. Match.
12:49 p.m.
Nov 29, '12
Rader's point (1) pretty much destroys the argument for water fluoridation. It does not decrease caries among low income kids. Other kids can afford access to other fluoride sources. that is likely why my 26 year old daughter who never drank fluoridated water has never had a tooth filled or extracted. She had fluoridated toothpaste, rinses, and office treatments because we could afford it.
12:00 a.m.
Nov 21, '12
I trust the CDC.
Source.
12:21 p.m.
Nov 21, '12
Kari, the CDC is just a front organization for the eugenicists.
10:07 p.m.
Nov 28, '12
The bombastic comment about the CDC doesn't even rise to the level of sophistry.
2:08 a.m.
Nov 29, '12
Logan is being silly.
9:48 a.m.
Nov 21, '12
I am 43 years old and have consumed fluoridated water my whole life. I have NEVER had a cavity in my life and I would never be confused for the poster child for great dental hygiene practices.
My hygienist, who worked in Salem for many years before working in Portland for 2 years commented that she had never seen such bad teeth as she did in Portland.
Not saying the presence of fluoride is or isn't the cause of either, just my personal observations.
11:21 a.m.
Nov 21, '12
I grew up with fluoridated water and had lots of cavities due to poor dental hygiene. My dad had perfect teeth because he took great care of his teeth.
On the other hand, growing up fluoridated didn't affect my IQ or those of my schoolmates in our very successful suburban public school system, despite the scare-mongering of some anti-fluoride folks.
The referendum is an opportunity to reset the debate for greater transparency and respectful dialogue. Anecdotes don't get us where to go.
10:09 a.m.
Nov 21, '12
The anti-fluoride people seem to be the ones who are retrogressive throwbacks to the 1950s when we heard about fluoridation as a communist plot to undermine America, destroy fertility, and weaken our minds. My grandmother was raised in a community with large levels of naturally occurring fluoride. She died at 83 with not one cavity in her mouth and with all her teeth. I wish I had received the same fluoride exposure.
11:29 a.m.
Nov 21, '12
Personal anecdotes about our experiences with flouride/cavities aren't really viable as there are multiple factors that contribute to cavaties, some within our control, some not and you can find people on both sides of the argument. For example, Michael's experience is that having consumed flouride his whole life, he's only had one cavity in 43 years. I had flouridated water until I moved to Portland in my early 20s. I had cavities in over half my teeth when I moved here. After moving here, where there is no flouride in the water, I've had three cavaties. I'm 47.
What disturbs me more is HOW the decision was made to add flouride: first, that the city council rammed something through that should have been put to voters; and second, that the Portland City Council didn't even bother to discuss the issue with surrounding cities that contract with Portland for water, like Gresham.
I still lean personally against flouride since we have such great water here naturally, but if it's put in, I won't be up in arms about it. But I WILL be pissed if Portland runs roughshod over surrounding communities and its own citizens.
12:01 p.m.
Nov 21, '12
Jenson, I wish your tone here were less snide. Just as I wish pro-fluoride people were less dismissive and arrogant and snide than they often are. (Bill Ryan, I'm looking at you.)
Many activist friends whom I respect are on the anti-fluoride side. Many activist and public health friends and colleagues are on the pro-fluoride side. Many of these folks are allies on other issues, and I worry that their cooperation in the future may be harmed by stupidly and unnecessarily nasty or dismissive debate.
I signed the petition even though at present I am pro-fluoridation because I thought the process was rotten.
By the same token, the anti-fluoride people have raised some serious arguments that I think need to be taken on more seriously, along with others that don't persuade me. I want to pursue some of those things. I might change my mind.
The debate tends to be poorly organized and not to distinguish several issues.
1) Is fluoridation safe? Most of the arguments that it's not seem to me grossly overblown or simply false. (This also gets into side issues about "industrial by-product" that mostly seem to be spurious, and completely unevidenced accusations of corporate influence or motives in the Portland effort.) This is an area where I am critical of many of my anti-fluoride friends.
2) Is fluoridation effective? Here there seems to be much more of a question. It seems that some of the evidence shows benefit, leading to conclusions like those Mel Rader cites above. But it seems that other real scientific literature does not show effectiveness of drinking water fluoridation. And a separate kind of literature seems to show that really strong effectiveness is best achieved by intensive topical applications, rather than minor rinsing incidental to drinking. This second type of literature undermines anti-fluoride people's claims that fluoride has no dental benefit, but also undermines pro-fluoride people's claims that drinking water fluoridation is the best way to achieve benefit, at least to a degree.
(continued below)
12:01 p.m.
Nov 21, '12
(continued from above)
3) How do we best support improvement of equity in dental health? To me the equity arguments are the most powerful reasons to consider drinking water fluoridation. I also believe they are what persuaded many supporters including the commissioners who voted for it. I think the opponents are excessively dismiss of them, including Jenson here. In fact poor people often cannot easily afford fluoride products, and people with limited education about health may not know about the choices at the times most relevant to their kids. Likewise I think many opponents underplay the associations of poor dental health and dental caries with other aspects of bad health. (This is also a problem with our general "health reform" as well, of course.)
But if our goal is to improve dental health equity by providing publicly supported fluoride access and treatment, is drinking water fluoridation really the best way to achieve that? I have not heard any serious debate by fluoridation proponents about the trade-offs of this approach vs. more targeted intensive application approaches focused on poor kids that might be more effective. I worry that we are buying a less effective but cheaper approach that sacrifices equity for expedience.
4) Ethical issues about freedom of choice, public health, paternalism in public health, and scientistic arrogance (not scientific, but scientistic, involving ideological claims about science).
I am a believer in science and to a degree a public health scientist of a sort, but I also am strong critic of excessive claims for science that become unscientific in attitude, and that have underwritten various kinds of social abuses historically, but most especially scientistic racism, against which society in general and public health specifically still struggle (racism and its interaction with class has been a core focus of my scholarship as a historian).
This 4th area is hugely complicated and comes to how we weigh different kinds of goods and costs against one another. But the lack of open and respectful debate and the dismissiveness of people's genuine concerns that partly arise from other experiences of arrogant and abusive assertions of spurious "scientific" authority (e.g. relating to nuclear safety, or public health and equity issues around environment justice, or about GMO food labeling) will alienate a lot of people from public health specifically and science more generally. This is the area where I am most critical of many fluoridation opponents.
We have an opportunity to reset the debate, to treat each other more fairly and gently and respectfully and transparently. We have an opportunity to abandon the unevidenced and stereotype-based motives attacks used in both directions the last few months.
I hope we take it.
12:05 p.m.
Nov 21, '12
Correction: I meant to say that scientistic arrogance is where I am most critical of fluoridation proponents, not opponents.
10:18 p.m.
Nov 28, '12
The overwhelming evidence that fluoridation of drinking water has a positive effect on the overall dental health of communities where it is used must be the determining factor when compared to the anecdotal, unfounded, overemotional opposition. The City of Portland is a prime example of the negative effects when drinking water is not fluoridated. There exists no empirical data to dispute the benefits of fluoridation. The junk science of opposing fluoridation is more absurd than the junk science which opposes global warming.
6:21 p.m.
Nov 21, '12
I have been a general dentist for 36 years, graduating from Northwestern University Dental School in the fluoridated city of Chicago. I practiced in Chicago for 4 additional years before moving to Portland in May, 1980. I retired from my clinical practice at the end of 2008 and now devote my time, volunteering my dental skills to low-income children and adults.
Part of my time in Chicago was devoted to treating the poorest of the poor citizens. I was somewhat ambivalent about fluoridation, because, guess what, poor people got the most cavities. It wasn't until I relocated to Portland that I realized first hand that fluoridation made a difference. I saw more cavities and fillings, more root cavities in adults, and more early childhood cavities in their children (greater than 7 cavities). For the first time in my career, I saw a 20 year old in a full denture. For the past 13 years, I have been studying the science, the politics (yes, politics), and the opponents and their arguments to fluoridation. Their goal is to create fear and doubt in the general public whenever fluoridation is recommended in a community. Their rallying cry is, "When in doubt, leave it out". These allegations change from year to year, they are disproved by medical and scientific experts, they disappear, only to get recycled years down the road. I have observed the misrepresentation of science by the opponents, which quite frankly, makes me angry.
A couple of Sundays ago, there was an editorial on climate change. One paragraph resonated with me:
"But "believing" in global warming is not like believing in reincarnation or original sin. It's not even like believing in states' rights or the progressive income tax. There are many subjects on which one person's beliefs and opinions are just as good as anyone else's. The science of climate change is not one of those subjects. It is either a scientific reality or it is not. Our personal preferences or opinions are irrelevant. Debate over global warming has to be based on scientific evidence and the scientific method."
Substitute "fluoridation" for "climate change" and the statement is still spot on.
While I believe that there is no such thing as final knowledge, no public health measure has been more scrutinized and studied than fluoridation.
When CDC and public health leaders in this country call fluoridation an outdated practice and there is a new, improved strategy to deal with the environment stress caused by oral disease that disproportinately affects the poor, I will be first in line to support it.
Fluoridation is egalitarian access to oral care.
10:43 a.m.
Nov 25, '12
Flouridation aside, the most depressing and dangerous trend in Oregon politics is our increasing insistence for the "right to vote on something". Its a tactic being employed by the Tea Baggers in Clackamas and Progressives in Portland and it undermines the whole concept of representational democracy.
7:05 p.m.
Nov 26, '12
How about all the other plants and animals that depend on water? Do they get to vote on how we're planning on changing their water? And what if they don't have teeth? What is the benefit for them? What if there is none? What if the accumulation of this industrial byproduct is actually harmful to living things besides humans? Where has the testing on this been published? I would really like to know since nobody is talking about this in any terms besides a very narrow humanist vocabulary.