How Fluoride Works

Dental caries, commonly known as cavities, are created when certain oral bacteria utilize sugars and carbohydrates from the food we eat and secrete an acid. This acid removes minerals from the teeth, causing dental caries. Fluoride adds minerals back to the tooth enamel, strengthening it and making it resistant to caries. (http://oralhealth.suite101.com/article.cfm/water_fluoridation)

            A variety of different types of fluoride compounds are used, with differing sources. Historically, the fluoride used is a byproduct of aluminum manufacturing and the creation of certain fertilizers. Prior to commercialization as a way to enrich the water, many of these compounds were considered hazardous waste. Fluoride sources for municipal water are abundant and inexpensive. Fluoride is added by water utility companies, at varying degrees of concentration depending on the natural fluoride content of the water. The optimum level is considered 1ppm.

Supporters of Fluoridation

            The original push for water fluoridation was heavily touted by dentists as a safe and effective measure to reduce cavities. The American Dental Association has officially endorsed municipal fluoridation for over 40 years. (http://www.ada.org/2467.aspx) They support universal fluoridation and point to a body of peer reviewed scientific evidence to support their claims. In 2005 the ADA released a 72 page report entitled ‘Fluoridation Facts’ which was made available on their website. The stated goal of this report is “setting the facts straight” on fluoride. This document dismisses the counter claims as “junk science” and warns against “erroneous health claims made against water fluoridation” (pg. 41) that are found on the internet. Recently, counterclaims have become prevalent that this report itself is based on outdated science. In the last few months, as part of a broader a website redesign, the ADA has removed their prominent link to this pdf. I host this PDF here. It is worthy of note however, that the ADA has also recently recommended limiting fluoride intake for infants and babies.

            The Center for Disease Control also supports community water fluoridation, as do less widely known groups including the American Academy of Family Pediatricians and the American Council on Science and Health. They cite the same primary reasons for support as the ADA.

Opponents of  Fluoridation

            The anti-fluoridation movement tends to get a bad rap. This is in part due to its origins. When fluoridation first began in the cold war era, many anti-fluoridation activists opposed the practice due to suspicions that it was part of a communist plot to poison US drinking water. When the Soviet Union began fluoridating their own water, this group lost a great deal of steam and credibility. They have since rebounded with concerns raised by scientific evidence.

            The best umbrella term to describe opponents of community water fluoridation these days is “concerned citizens.” While often stereotyped as conspiracy theorists and alarmists, this group actually consists of a number of medical professionals, scientists and even dentists in addition to a vocal citizen’s movement. In terms of scientific clout, one of the biggest members of the anti-fluoridation movement is the Environmental Protection Agency Headquarters Union of Scientists – a union that represents approximately 1,500 scientists, engineers, lawyers, and other EPA staff in Washington, D.C.

            The EPA Headquarters Union initially opposed the EPA administration’s decision to label dental fluorosis a cosmetic problem rather than a health concern. The Union believed that the maximum allowable concentrations of fluoride in municipal water should be lowered to prevent dental fluorosis. Since that time the union has made the fight broader, pointing to a growing body of scientific literature that raises concerns about the effects of fluoride. The Unions' official statement mentions hazards including “acute toxic hazard, such as to people with impaired kidney function, as well as chronic toxic hazards of gene mutation, cancer, reproductive effects, neurotoxicity, bone pathology and dental fluorosis.” (http://www.nteu280.org/Issues/Fluoride/NTEU280-Fluoride.htm) The Union advocates lowering the maximum allowable level of fluoride in municipal water from 4 mg/L as well as lowering the recommended level from 1ppm.

            The other most visible group of anti-fluoridationists are found on the internet. When covering a fluoridation dispute in Bellingham, Washington, Time magazine reported that at least one couple joined the anti-fluoridation activists after they Googled the term fluoridation and found that “Nine of the first 10 items that came up were decidedly antifluoride.” (http://www.time.com/time/magazine/article/0,9171,1118379,00.html) While there are a variety of websites dedicated to the anti-fluoridation movement, most link back to the Fluoride Action Network (FAN) at http://www.fluoridealert.org/, an umbrella organization which compiles fluoridation related news, and ‘fact sheets.’ In private correspondence with the FAN, one employee listed the creation of the FAN in 2000 as one of the most important momentum changers in the last decade of fluoridation controversy. They also emphasized FAN’s decision to focus on the science of the controversy, rather than more farfetched claims (such as communist conspiracies).

            One last group worthy of note is The National Academy of Sciences. While it was this groups initial report on fluoridation in Grand Rapids that paved the way for the widespread implementation of community water fluoridation – they have since raised concerns about how much fluoride is too much. Their 2006 report claims that the EPA standard of 4 mg/L is too high and leads to adverse health effects. (http://dels.nas.edu/dels/rpt_briefs/fluoride_brief_final.pdf)