Water fluoridation in the United States

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U.S. residents served with community water fluoridation, 1992 and 2006. The percentages are the proportions of the resident population served by public water supplies who are receiving fluoridated water.[1]

As with some other countries water fluoridation in the United States is a contentious issue. As of May 2000, 42 of the 50 largest U.S. cities had water fluoridation.

Fluoridation became an official policy of the U.S. Public Health Service by 1951, and by 1960 water fluoridation had become widely used in the U.S., reaching about 50 million people.[2] By 2006, 69.2% of the U.S. population on public water systems were receiving fluoridated water, amounting to 61.5% of the total U.S. population; 3.0% of the population on public water systems were receiving naturally occurring fluoride.[3]

While doctors, dentists, and public health scientists largely supported water fluoridation in the U.S., waterworks engineers were initially divided in their position despite having faced controversy earlier with chlorination.[4]

U.S. regulations for bottled water do not require disclosing fluoride content, so the effect of always drinking it is not known.[5] Surveys of bottled water in Cleveland and in Iowa found that most contained well below optimal fluoride levels.[6]

History

Main article: History of water fluoridation
1909 photograph by Frederick McKay of G.V. Black (left) and Isaac Burton and F.Y. Wilson, studying the Colorado Brown Stain.[7]

Community water fluoridation in the United States is partly due to the research of Dr. Frederick McKay, who pressed the dental community for an investigation into what was then known as "Colorado Brown Stain."[8] The condition, now known as dental fluorosis, when in its severe form is characterized by cracking and pitting of the teeth.[9][10][11] Of 2,945 children examined in 1909 by Dr. McKay, 87.5% had some degree of stain or mottling. All the affected children were from the Pikes Peak region. Despite the negative impact on the physical appearance of their teeth, the children with stained, mottled and pitted teeth also had fewer cavities than other children. McKay brought this to the attention of Dr. G.V. Black, and Black's interest was followed by greater interest within the dental profession.

Initial hypotheses for the staining included poor nutrition, overconsumption of pork or milk, radium exposure, childhood diseases, or a calcium deficiency in the local drinking water.[8] In 1931, researchers from the Aluminum Company of America (ALCOA) concluded that the cause of the Colorado stain was a high concentration of fluoride ions in the region's drinking water (ranging from 2 to 13.7 mg/L) and areas with lower concentrations had no staining (1 mg/L or less).[12] Pikes Peak's rock formations contained the mineral cryolite, one of whose constituents is fluorine. As the rain and snow fell, the resulting runoff water dissolved fluoride which made its way into the water supply.

Dental and aluminum researchers then moved toward determining a relatively safe level of fluoride chemicals to be added to water supplies. The research had two goals: (1) to warn communities with a high concentration of fluoride of the danger, initiating a reduction of the fluoride levels in order to reduce incidences of fluorosis, and (2) to encourage communities with a low concentration of fluoride in drinking water to add fluoride chemicals in order to help prevent tooth decay. By 2006, 69.2% of the U.S. population on public water systems were receiving fluoridated water, amounting to 61.5% of the total U.S. population; 3.0% of the population on public water systems were receiving naturally occurring fluoride.[3]

Early studies

H. Trendley Dean set out in 1931 to study fluoride's harm, but by 1950 had demonstrated the benefits of small amounts.[13]

A study of varying amounts of fluoride in water was led by Dr. H. Trendley Dean, a dental officer of the U.S. Public Health Service.[14][15] In 1936 and 1937, Dr. Dean and other dentists compared statistics from Amarillo, which had 2.8 - 3.9 mg/L fluoride content, and low fluoride Wichita Falls. The data is alleged to show fewer cavities in Amarillo children, but the studies were never published.[16] Dr. Dean's research on the fluoride-dental caries relationship, published in 1942, included 7,000 children from 21 cities in Colorado, Illinois, Indiana, and Ohio. The study concluded that the optimal amount of fluoride which minimized the risk of severe fluorosis but had positive benefits for tooth decay was 1 mg per day, per adult. Although fluoride is more abundant in the environment today, this was estimated to correlate with the concentration of 1 mg/L.

In 1937, dentists Henry Klein and Carroll E. Palmer had considered the possibility of fluoridation to prevent cavities after their evaluation of data gathered by a Public Health Service team at dental examinations of Native American children.[17] In a series of papers published afterwards (1937-1941), yet disregarded by his colleagues within the U.S.P.H.S., Klein summarized his findings on tooth development in children and related problems in epidemiological investigations on caries prevalence.[citation needed]

In 1939, Dr. Gerald J. Cox[18] conducted laboratory tests using rats that were fed aluminum and fluoride. Dr. Cox suggested adding fluoride to drinking water (or other media such as milk or bottled water) in order to improve oral health.[19]

In the mid 1940s, four widely cited studies were conducted. The researchers investigated cities that had both fluoridated and unfluoridated water. The first pair was Muskegon, Michigan and Grand Rapids, Michigan, making Grand Rapids the first community in the world to add fluoride chemicals to its drinking water to try to benefit dental health on January 25, 1945.[20] Kingston, New York was paired with Newburgh, New York.[21] Oak Park, Illinois was paired with Evanston, Illinois. Sarnia, Ontario was paired with Brantford, Ontario, Canada.[22]

In 1952 Nebraska Representative A.L. Miller complained that there had been no studies carried out to assess the potential adverse health risk to senior citizens, pregnant women or people with chronic diseases from exposure to the fluoridation chemicals.[16] A decrease in the incidence of tooth decay was found in some of the cities which had added fluoride chemicals to water supplies. The early comparison studies would later be criticized as, "primitive," with a, "virtual absence of quantitative, statistical methods...nonrandom method of selecting data and...high sensitivity of the results to the way in which the study populations were grouped..." in the journal Nature.[23]

Water fluoridation

Main article: Water fluoridation

As of May 2000, 42 of the 50 largest U.S. cities had water fluoridation.[24] According to a 2002 study,[25] 67% of U.S. residents were living in communities with fluoridated water at that time.

The U.S. Centers for Disease Control has identified community water fluoridation as one of ten great public health achievements of the 20th century.[26] The CDC recommends water fluoridation at a level of 0.7–1.2 mg/L, depending on climate. The CDC also advises parents to monitor use of fluoride toothpaste, and use of water with fluoride concentrations above 2 mg/L, in children up to age 8.[27] There is a CDC database for researching the water fluoridation status of neighborhood water.[28]

In 1998, 70% of people polled in a survey conducted by the American Dental Association (ADA) believed community water should be fluoridated, with 18% disagreeing and the rest undecided.[29] In November 2006, the ADA began recommending to parents that infants from 0 through 12 months of age should have their formula prepared with water that is fluoride-free or contains low levels of fluoride to reduce the risk of fluorosis.[30]

The issue of whether or not to fluoridate water supplies frequently arises in local governments. For example, on November 8, 2005, citizens of Mt. Pleasant, Michigan voted 63% to 37% in favor of reinstating fluoridation in public drinking water after a 2004 ballot initiative ceased water fluoridation in the city.[31] At the same time, voters in Xenia, Ohio; Springfield, Ohio; Bellingham, Washington; and Tooele City, Utah all rejected water fluoridation.[32]

In Skagit County, in Washington, the county commissioners have voted 2 to 1 to order the local public utility district to begin fluoridating the public water supply by Jan. 2009. $1.2 million could be provided by the privately funded Washington Dental Service Foundation to begin building the equipment needed to add fluoride chemicals to the Judy Reservoir, which supplies the majority of Skagit Valley's water customers. The source and type of fluoride to be added to the drinking water of more than 70,000 citizens has not been disclosed.[33]

The cost of adding fluoridation chemicals to the water of 44 Florida communities has been researched by the State Health Office in Tallahassee.[34] In communities with a population of over 50,000 people, fluoridation costs were estimated at 31 cents per person per year. The estimated cost rises to $2.12 per person in areas with a population below 10,000. Unintended consequences, such as equipment malfunction, can substantially raise the financial burden, as well as the health risks, to the consumer.[35][36] [37] [38] [39] [40][41] [42]

In the U.S., Hispanic and Latino Americans are significantly more likely to consume bottled instead of tap water,[43] and the use of bottled and filtered water grew dramatically in the late 1990s and early 2000s.[5]

Court cases

See also: Opposition to water fluoridation

Fluoridation has been the subject of many court cases wherein activists have sued municipalities, asserting that their rights to consent to medical treatment and due process are infringed by mandatory water fluoridation.[44] Individuals have sued municipalities for a number of illnesses that they believe were caused by fluoridation of the city's water supply. In most of these cases, the courts have held in favor of cities, finding no or only a tenuous connection between health problems and widespread water fluoridation.[45] To date, no federal appellate court or state court of last resort (i.e., state supreme court) has found water fluoridation to be unlawful.[46]

Early cases

A flurry of cases were heard in numerous state courts across the U.S. in the 1950s during the early years of water fluoridation. State courts consistently held in favor of allowing fluoridation to continue, analogizing fluoridation to mandatory vaccination and the use of other chemicals to clean the public water supply, both of which had a long-standing history of acceptance by courts.

In 1952, a Federal Regulation was adopted that stated in part, "The Federal Security Agency will regard water supplies containing fluorine, within the limitations recommended by the Public Health Service, as not actionable under the Federal Food, Drug, and Cosmetic Act."[47]

The Supreme Court of Oklahoma analogized water fluoridation to mandatory vaccination in a 1954 case.[48] The court noted, "we think the weight of well-reasoned modern precedent sustains the right of municipalities to adopt such reasonable and undiscriminating measures to improve their water supplies as are necessary to protect and improve the public health, even though no epidemic is imminent and no contagious disease or virus is directly involved .... To us it seems ridiculous and of no consequence in considering the public health phase of the case that the substance to be added to the water may be classed as a mineral rather than a drug, antiseptic or germ killer; just as it is of little, if any, consequence whether fluoridation accomplishes its beneficial result to the public health by killing germs in the water, or by hardening the teeth or building up immunity in them to the bacteria that causes caries or tooth decay. If the latter, there can be no distinction on principle between it and compulsory vaccination or inoculation, which, for many years, has been well-established as a valid exercise of police power."[48]

In the 1955 case Froncek v. City of Milwaukee, the Wisconsin Supreme Court affirmed the ruling of a circuit court which held that "the fluoridation is not the practice of medicine, dentistry, or pharmacy, by the City" and that "the legislation is a public health measure, bearing a real, substantial, and reasonable relation to the health of the city."[49]

The Supreme Court of Ohio, in 1955's Kraus v. City of Cleveland, said, "Plaintiff's argument that fluoridation constitutes mass medication, the unlawful practice of medicine and adulteration may be answered as a whole. Clearly, the addition of fluorides to the water supply does not violate such principles any more than the chlorination of water, which has been held valid many times."[50]

Fluoridation consensus

In 1973, as cases continued to be brought in state courts, a consensus developed that fluoridation, at least from a legal standpoint, was acceptable.[45] In 1973's Beck v. City Council of Beverly Hills, the California Court of Appeal, Second District, said, "Courts through the United States have uniformly held that fluoridation of water is a reasonable and proper exercise of the police power in the interest of public health. The matter is no longer an open question."[45]

Contemporary challenges

Advocates continue to make contemporary challenges to the spread of fluoridation. For instance, in 2002, the city of Watsonville, California chose to disregard a California law mandating fluoridation of water systems with 10,000 or more hookups, and the dispute between the city and the state ended up in court. The trial court and the intermediate appellate court ruled in favor of the state and its fluoridation mandate, and the Supreme Court of California declined to hear the case in February 2006.[51] Since 2000, courts in Washington,[52] Maryland,[53] and Texas[54] have reached similar conclusions. Citizens for Safe Drinking Water is raising money to support a lawsuit in federal court seeking an injunction against public water districts' use of unapproved drugs in the drinking water supply in the United States.[55] A group led by former American Gladiator Jonathan Byrne has repeatedly attempted to end water fluoridation in North Carolina. [56]

See also

References

  1. ^ Klein RJ (2008-02-07). "Healthy People 2010 Progress Review, Focus Area 21, Oral Health". National Center for Health Statistics. Retrieved 2009-01-05.
  2. ^ Lennon MA (2006). "One in a million: the first community trial of water fluoridation". Bull World Health Organ. 84 (9): 759–60. doi:10.1590/S0042-96862006000900020. PMID 17128347.
  3. ^ a b Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, CDC (2008-09-17). "Water fluoridation statistics for 2006". Retrieved 2008-12-22.{{cite web}}: CS1 maint: multiple names: authors list (link)
  4. ^ Hunt E (1996). "Water and turf: fluoridation and the 20th-century fate of waterworks engineers". Am J Public Health. 86 (9): 1310–7. doi:10.2105/AJPH.86.9.1310. PMC 1380598. PMID 8806387. {{cite journal}}: Unknown parameter |month= ignored (help)
  5. ^ a b Hobson WL, Knochel ML, Byington CL, Young PC, Hoff CJ, Buchi KF (2007). "Bottled, filtered, and tap water use in Latino and non-Latino children". Arch Pediatr Adolesc Med. 161 (5): 457–61. doi:10.1001/archpedi.161.5.457. PMID 17485621.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  6. ^ Lalumandier JA, Ayers LW (2000). "Fluoride and bacterial content of bottled water vs tap water". Arch Fam Med. 9 (3): 246–50. doi:10.1001/archfami.9.3.246. PMID 10728111.
  7. ^ Douglas WA (1959). History of Dentistry in Colorado, 1859–1959. Denver: Colorado State Dental Assn. p. 199.
  8. ^ a b History of Dentistry in the Pikes Peak Region,Colorado Springs Dental Society webpage, page accessed 25 February, 2006.
  9. ^ [1]
  10. ^ McGraw-Hill's AccessScience
  11. ^ Report Judges Allowable Fluoride Levels in Water : NPR
  12. ^ Meiers, Peter: "The Bauxite Story - A look at ALCOA", from the Fluoride History website, page accessed 12 May, 2006.
  13. ^ Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, CDC (1999). "Achievements in public health, 1900–1999: Fluoridation of drinking water to prevent dental caries". MMWR Morb Mortal Wkly Rep. 48 (41): 933–40.{{cite journal}}: CS1 maint: multiple names: authors list (link) Contains H. Trendley Dean, D.D.S. Reprinted in: JAMA. 283 (10): 1283–6. 2000. doi:10.1001/jama.283.10.1283. PMID 10714718. {{cite journal}}: Missing or empty |title= (help)
  14. ^ Dean, H.T. "Classification of mottled enamel diagnosis." Journal of the American Dental Association, 21, 1421 - 1426, 1934.
  15. ^ Dean, H.T. "Chronic endemic dental fluorosis." Journal of the American Dental Association, 16, 1269 - 1273, 1936.
  16. ^ a b Questionable Fluoride Safety Studies: Bartlett - Cameron, Newburgh - Kingston
  17. ^ Klein H., Palmer C.E.: "Dental caries in American Indian children", Public Health Bulletin, No. 239, Dec. 1937
  18. ^ Meiers, Peter: "Gerald Judy Cox".
  19. ^ Cox, G.J., M.C. Matuschak, S.F. Dixon, M.L. Dodds, W.E. Walker. "Experimental dental caries IV. Fluorine and its relation to dental caries. Journal of Dental Research, 18, 481-490, 1939. Copy of original paper can be found here.
  20. ^ After 60 Years of Success, Water Fluoridation Still Lacking in Many Communities. Medical News Today website, accessed 26 February, 2006.
  21. ^ Ast, D.B., D.J. Smith, B. Wacks, K.T. Cantwell. "Newburgh-Kingston caries-fluorine study XIV. Combined clinical and roentgenographic dental findings after ten years of fluoride experience." Journal of the American Dental Association, 52, 314-25, 1956.
  22. ^ Brown, H., M. Poplove. "The Brantford-Sarnia-Stratford Fluoridation Caries Study: Final Survey, 1963." Canadian Journal of Public Health,56, 319–24, 1965.
  23. ^ Diesendorf, Mark The mystery of declining tooth decay Nature, July 10, 1986
  24. ^ The Benefits of Fluoride, from the Centers for Disease Control and Prevention website, accessed 19 March, 2006.
  25. ^ Fluoridation Status: Percentage of U.S. Population on Public Water Supply Systems Receiving Fluoridated Water, from the Centers for Disease Control and Prevention website, accessed 19 March, 2006.
  26. ^ Community Water Fluoridation
  27. ^ Community Water Fluoridation FAQ
  28. ^ Oral Health - My Water's Fluoride
  29. ^ American Dental Association Survey Center. 1998 consumers' opinions regarding community water fluoridation. Chicago, Illinois: American Dental Association, 1998
  30. ^ What is the ADA’s interim guidance on infant formula and fluoride? American Dental Association Website accessed May 28, 2008 [2]
  31. ^ Crozier, Stacie. "Michigan town votes to return fluoridation" November 30, 2005.
  32. ^ No Forced Fluoride in Bellingham, Washington (Fluoride)
  33. ^ goskagit.com
  34. ^ Ringelberg, M. L., S. J. Allen, L. J. Brown. "Cost of fluoridation: 44 Florida communities.", abstract from PubMed website, page accessed 19 March, 2006.
  35. ^ Flanders, R. A.; Marques, L. (May-June 1993). "Fluoride overfeeds in public water supplies". Illinois dental journal 62 (3): 165-169.
  36. ^ ^ Gessner, B. D.; Beller, M.; Middaugh, J. P.; Whitford, G. M. (January 1994). "Acute fluoride poisoning from a public water system". New England journal of medicine 330 (2): 95-99.
  37. ^ Fluoride overfeed at a well site near an elementar...[J Environ Health. 2002] - PubMed Result
  38. ^ Fluoride suspected as 23 in Dublin California grow ill
  39. ^ Outbreak of acute fluoride poisoning caused by a f...[Public Health Rep. 1997 Sep-Oct] - PubMed Result
  40. ^ CHICAGO SUN-TIMES, July 31, 1993, Fluoride Blamed in 3 Deaths: Traces found in Blood of U. of C. Dialysis Patients Gary Wieby
  41. ^ EVENING CAPITAL (Annapolis, Maryland), November 29, 1979, Fluoride Linked to Death, Mary Ann Kryzankowicz
  42. ^ Examples of Acute Poisoning from Water Fluoridation
  43. ^ Williams BL, Florez Y, Pettygrove S (2001). "Inter- and intra-ethnic variation in water intake, contact, and source estimates among Tucson residents: Implications for exposure analysis". J Expo Anal Environ Epidemiol. 11 (6): 510–21. doi:10.1038/sj.jea.7500192. PMID 11791167.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  44. ^ Cross DW, Carton RJ (2003). "Fluoridation: a violation of medical ethics and human rights". Int J Occup Environ Health. 9 (1): 24–9. PMID 12749628.
  45. ^ a b c Beck v. City Council of Beverly Hills, 30 Cal. App. 3d 112, 115 (Cal. App. 2d Dist. 1973) ("Courts through the United States have uniformly held that fluoridation of water is a reasonable and proper exercise of the police power in the interest of public health. The matter is no longer an open question." (citations omitted)). Cite error: The named reference "beck" was defined multiple times with different content (see the help page).
  46. ^ Pratt, Edwin, Raymond D. Rawson & Mark Rubin, Fluoridation at Fifty: What Have We Learned, 30 J.L. Med. & Ethics 117, 119 (Fall 2002)
  47. ^ 17 Fed. Reg. 6743 (July 23, 1952).
  48. ^ a b 273 P.2d 859, 862-63 (Okl. 1954) (available at FindLaw for Legal Professionals)
  49. ^ 69 N.W.2d 242, 252 (Wis. 1955)
  50. ^ 127 N.E.2d 609, 613 (Ohio 1955)
  51. ^ Jones, Donna "Supreme Court turns down Watsonville's appeal to keep fluoride out of its water." Santa Cruz Sentinel. February 10, 2006.
  52. ^ Parkland Light & Water Co. v. Tacoma-Pierce County Bd. of Health, 90 P.3d 37 (Wash. 2004)
  53. ^ Pure Water Committee of W. MD., Inc. v. Mayor and City Council of Pure Water Comm. of W. MD., Inc. v. Mayor and City Council of Cumberland, MD. Not Reported in F.Supp.2d, 2003 WL 22095654 (D.Md. 2003)
  54. ^ Espronceda v. City of San Antonio, Not Reported in S.W.3d, 2003 WL 21203878 (Tex. App.-San Antonio 2003)
  55. ^ Citizens uniting against fluoride. Large-scale lawsuit seeks to ban chemical poisoning of water supply. May 13, 2008. Chelsea Schilling. WorldNetDaily.
  56. ^ Local Group Opposes Water Fluoridation

External links

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