History of water fluoridation

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Main article: Water fluoridation

The history of water fluoridation can be divided into three periods. The first (c. 1901–33) was research into the cause of a form of mottled tooth enamel called the Colorado Brown Stain, which later became known as fluorosis. The second (c. 1933–45) focused on the relationship among fluoride concentrations, fluorosis, and tooth decay. The third period, from 1945 on, focused on water fluoridation, which added fluoride to community water supplies.[1]

In the first half of the 19th century, investigators established that fluoride occurs with varying concentrations in teeth, bone, and drinking water. In the second half they speculated that fluoride would protect against tooth decay, proposed supplementing the diet with fluoride, and observed mottled enamel (now called severe dental fluorosis) without knowing the cause.[2] In 1874, the German public health officer Carl Erhardt recommended potassium fluoride supplements to preserve teeth.[3] In 1892 the British physician James Crichton-Browne noted in an address that fluoride's absence from diets had resulted in teeth that were "peculiarly liable to decay", and who proposed "the reintroduction into our diet ... of fluorine in some suitable natural form ... to fortify the teeth of the next generation".[4]


This depicts mild fluorosis, primarily on the upper right teeth, which Dean discovered may occur when fluoride concentration exceeds 1ppm.

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."[5] The condition, now known as dental fluorosis, is characterized in its severe form by cracking and pitting of the teeth.[6][7][8] Chemical analysis in 1931 revealed the correlation between mottled teeth and high concentrations of fluoride.

H. Trendley Dean, a dental officer at the newly created National Institute of Health was appointed to study dental fluorosis in 1930. Through a series of surveys, Dean analyzed fluoridation levels and mottling of teeth in different communities and determined that at concentrations below 1ppm, fluoride does not stain teeth.[9] Dean and other dentists began investigating the use of fluoride in low concentrations to prevent dental caries. Many of these studies implicated fluoride as an effective prevention measure, and by the early 1940s the NIH began conferences and studies on the possibility of introducing fluoride into the public water supply. [9]

Widespread use[edit]

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.[10] 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.[11] In some other countries the pattern was similar. Fluoridation was introduced into Brazil in 1953, was regulated by federal law starting in 1974, and by 2004 was used by 71% of the population.[12] In other locations, fluoridation was used and then discontinued; for example, in Kuopio, Finland, fluoridation was used for decades but was discontinued because the school dental service provided significant fluoride programs and the cavity risk was low.[13]

McKay's work had established that fluorosis occurred before tooth eruption. Dean and his colleagues assumed that fluoride's protection against cavities was also pre-eruptive, and this incorrect assumption was accepted for years. By 2000, however, the topical effects of fluoride (in both water and toothpaste) were well understood, and it had become known that a constant low level of fluoride in the mouth works best to prevent cavities.[14]

See also[edit]


  1. ^ Ripa LW (1993). "A half-century of community water fluoridation in the United States: review and commentary" (PDF). J Public Health Dent 53 (1): 17–44. doi:10.1111/j.1752-7325.1993.tb02666.x. PMID 8474047. Retrieved 2009-01-01. 
  2. ^ Cox GJ (1952). "Fluorine and dental caries". In Toverud G, Finn SB, Cox GJ, Bodecker CF, Shaw JH (eds.). A Survey of the Literature of Dental Caries. Washington, DC: National Academy of Sciences—National Research Council. pp. 325–414. OCLC 14681626.  Publication 225.
  3. ^ Eckardt [sic] (1874). "Kali fluoratum zur Erhaltung der Zähne". Der praktische Arzt (in German) 15 (3): 69–70.  A followup was translated into English in: Friedrich EG (reporter) (1954). "Potassium fluoride as a caries preventive: a report published 80 years ago". J Am Dent Assoc 49: 385. 
  4. ^ Crichton-Browne J (1892). "An address on tooth culture". Lancet 140 (3592): 6–10. doi:10.1016/S0140-6736(01)97399-4. 
  5. ^ History of Dentistry in the Pikes Peak Region,Colorado Springs Dental Society webpage, page accessed 25 February 2006.
  6. ^ [1]
  7. ^ McGraw-Hill's AccessScience
  8. ^ Report Judges Allowable Fluoride Levels in Water : NPR
  9. ^ a b Frees, Allan 4; Lehr, Jay H. 4 (2009). Fluoride Wars: How a Modest Public Health Measure Became America's Longest-Running Political Melodrama. Wiley. pp. 92–129. ISBN 9780470463673. 
  10. ^ Lennon MA (2006). "One in a million: the first community trial of water fluoridation". Bull World Health Organ 84 (9): 759–60. doi:10.2471/BLT.05.028209. PMC 2627472. PMID 17128347. 
  11. ^ 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. 
  12. ^ Buzalaf MA, de Almeida BS, Olympio KPK, da S Cardoso VE, de CS Peres SH (2004). "Enamel fluorosis prevalence after a 7-year interruption in water fluoridation in Jaú, São Paulo, Brazil". J Public Health Dent 64 (4): 205–8. doi:10.1111/j.1752-7325.2004.tb02754.x. PMID 15562942. 
  13. ^ Mullen J; European Association for Paediatric Dentistry (2005). "History of water fluoridation". Br Dent J 199 (7 Suppl): 1–4. doi:10.1038/sj.bdj.4812863. PMID 16215546. 
  14. ^ Burt BA, Tomar SL (2007). "Changing the face of America: water fluoridation and oral health". In Ward JW, Warren C. Silent Victories: The History and Practice of Public Health in Twentieth-century America. Oxford University Press. pp. 307–22. ISBN 0-19-515069-4.