Fluoridation Facts DEDICATION This 2005 edition of Fluoridation Facts is dedicated to Dr. Herschel Horowitz, talented researcher, renowned dental epidemiologist and tireless advocate of community water fluoridation. ABOUT FLUORIDATION FACTS ACKNOWLEDGMENTS Fluoridation Facts contains answers to frequently asked This publication was developed by the ADA’s Council on questions regarding community water fluoridation. Access, Prevention and Interprofessional Relations. A number of these questions are based on myths and misconceptions advanced by a small faction opposed Principal staff contributions to this edition of Fluorida- to water fluoridation. The answers to the questions tion Facts were made by: Ms. Jane S. McGinley, RDH, that appear in Fluoridation Facts are based on gener- MBA, Manager and Ms. Nicole M. Stoufflet, RDH, MHS, ally accepted, peer-reviewed, scientific evidence. They Coordinator, Fluoridation and Preventive Health Activi- are offered to assist policy makers and the general ties, Council on Access, Prevention and Interprofession- public in making informed decisions. The answers are al Relations. supported by thousands of credible scientific articles, In addition to his legal review, Mr. Mark Rubin, Esq., As- including the more than 350 references within the sociate General Counsel, Division of Legal Affairs, made document. It is hoped that decision-makers will make significant contributions to the vision of this booklet. sound choices based on this body of generally accepted, peer-reviewed science. Other significant staff contributors included: Mr. Paul O’Connor, Legislative Liaison, Department of State Gov- ernment Affairs; Ms. Helen Ristic, Ph.D., Director of Sci- ence Information, Council on Scientific Affairs and Mr. Chakwan Siew, Ph.D., Senior Director, Research and Laboratories, Council on Scientific Affairs. A special thanks to the National Fluoridation Advisory Committee members who contributed to this edition: Ms. Diane Brunson, Dr. Robert N. Crawford, Jr., Dr. Lisa P. Howard, Dr. Jayanth V. Kumar, Dr. Ernest Newbrun, Mr. Thomas G. Reeves and Dr. Michael S. Swartz. Disclaimer This publication is designed to answer frequently asked questions about community water fluoridation, based on a summary of relevant published articles. It is not intended to be a comprehensive review of the extensive literature on fluoridation and fluorides. Readers must also rely on their own review of the literature, including the sources cited herein and any subsequent published, for a complete understanding of these issues. © 2005 American Dental Association This publication may not be reproduced in whole or in part without the express written permission of the American Dental Associa- tion except as provided herein. ADA Statement Commemorating the 60th Anniversary of Community Water Fluoridation Sixty years ago, Grand Rapids, Michigan became the world’s first city to adjust the level of fluoride in its water supply. Since that time, fluoridation has dramatically improved the oral health of tens of millions of Americans. Community water fluoridation is the single most effective public health measure to prevent tooth decay. Additionally, the Centers for Disease Control and Prevention proclaimed community water fluoridation as one of 10 great public health achievements of the 20th century. Fluoridation of community water supplies is simply the precise adjustment of the existing naturally occurring fluoride levels in drinking water to an optimal fluoride level recommended by the U.S. Public Health Service (0.7 – 1.2 parts per million) for the prevention of dental decay. Based on data from 2002, approximately 170 million people (or over two-thirds of the population) in the United States are served by public water systems that are fluoridated. Studies conducted throughout the past 60 years have consistently indicated that fluoridation of community water supplies is safe and effective in preventing dental decay in both children and adults. It is the most efficient way to prevent one of the most common childhood diseases – tooth decay (5 times as common as asthma and 7 times as common as hay fever in 5- to17-year-olds). Early studies, such as those conducted in Grand Rapids, showed that water fluoridation reduced the amount of cavities children get in their baby teeth by as much as 60% and reduced tooth decay in permanent adult teeth nearly 35%. Today, studies prove water fluoridation continues to be effective in reducing tooth decay by 20-40%, even in an era with widespread availability of fluoride from other sources, such as fluoride toothpaste. The average cost for a community to fluoridate its water is estimated to range from approximately $0.50 a year per person in large communities to approximately $3.00 a year per person in small communities. For most cities, every $1 invested in water fluoridation saves $38 in dental treatment costs. The American Dental Association continues to endorse fluoridation of community water supplies as safe and effective for preventing tooth decay. This support has been the Association’s position since policy was first adopted in 1950. The ADA’s policies regarding community water fluoridation are based on the overwhelming weight of peer- reviewed, credible scientific evidence. The ADA, along with state and local dental societies, continues to work with federal, state, local agencies and community coalitions to increase the number of communities benefiting from water fluoridation. 2005 211 East Chicago Avenue Chicago, Illinois 60611-2678 Permission is hereby granted to reproduce and distribute this ADA Statement Commemorating the 60th Anniversary of Community Water Fluoridation in its entirety, without modification. To request any other copyright permission please contact the American Dental Association at 1-312-440-2879. Fluoridation Facts 1 Table of Contents ADA Statement Commemorating the 1 SafetY 22 60th Anniversary of Community Water Fluoridation Question Topic Page 17. Harmful to humans? 22 Executive Summary 4 18. More studies needed? 23 Introduction 6 19. Total intake? 24 20. Daily intake? 25 21. Prenatal dietary fluoride 26 Benefits 10 supplements? 22. Body uptake? 26 Question Topic Page 23. Bone health? 27 1. What is fluoride? 10 24. Dental fluorosis? 28 2. How does fluoride help 25. Prevent fluorosis? 30 prevent dental decay? 10 26. Warning label? 31 3. What is water fluoridation? 11 27. Toxicity? 31 4. How much fluoride is in your water? 11 28. Cancer? 32 5. Fluoride additives? 12 29. Enzyme effects? 33 6. Natural vs adjusted? 12 30. Thyroid gland? 34 7. Effectiveness? 13 31. Pineal gland? 34 8. Still effective? 14 32. Allergies? 34 9. Discontinuance? 15 33. Genetic risk? 35 10. Is decay still a problem? 16 34. Fertility? 35 11. Adult benefits? 16 35. Down Syndrome? 35 12. Dietary supplements? 17 36. Neurological impact? 36 13. Fluoride for children? 18 37. Lead poisoning? 37 14. Alternatives? 19 38. Alzheimer’s disease? 37 15. Bottled water? 19 39. Heart disease? 38 16. Home treatment (filter) systems? 21 40. Kidney disease? 38 41. Erroneous health claims? 39 2 American Dental Association Fluoridation Practice 40 Call to Action 57 Question Topic Page References 58 42. Water quality? 40 Statements from Five Leading Health 68 43. Regulation? 41 Organizations Regarding Community 44. Standards? 42 Water Fluoridation 45. Source of additives? 43 Compendium 69 46. System safety concerns? 43 47. Engineering? 44 48. Corrosion? 44 49. Environment? 45 Figures 1. Reviewing Research 7 2. Effectiveness List 13 PUBLIC POLICY 46 3. ADA.org – Bottled Water 20 Question Topic Page 4. Safety List 23 50. Valuable measure? 46 5. 1998 Consumers’ Opinions 48 51. Courts of law? 47 6. Approval of Fluoridating 48 Drinking Water 52. Opposition? 47 7. Opposition Tactics 50 53. Internet? 51 8. ADA.org – Fluoride and 51 54. Public votes? 51 Fluoridation 55. International fluoridation? 54 9. Largest Fluoridated Cities 52 56. Banned in Europe? 54 10. States Meeting National Goals 53 Tables COST EffectiVENESS 56 1. Dietary Fluoride Supplements 18 Question Topic Page 2. Bottled Water 20 57. Cost effective? 56 3. Dietary Reference Intakes 25 58. Practical? 57 4. Categories of Dental Fluorosis 28 Fluoridation Facts 3 EXECUTIVE SUMMARY • Fluoridation of community water supplies is the sin- • For most cities, every $1 invested in water fluorida- gle most effective public health measure to prevent tion saves $38 in dental treatment costs. dental decay. • Water that has been fortified with fluoride is simi- • Throughout more than 60 years of research and prac- lar to fortifying salt with iodine, milk with vitamin tical experience, the overwhelming weight of credi- D and orange juice with vitamin C. ble scientific evidence has consistently indicated that fluoridation of community water supplies is safe. • Simply by drinking water, people can benefit from fluoridation’s cavity protection whether they are at • The Centers for Disease Control and Prevention has home, work or school. proclaimed community water fluoridation (along with vaccinations and infectious disease control) as • The average cost for a community to fluoridate its wa- one of ten great public health achievements of the ter is estimated to range from approximately $0.50 a 20th century. year per person in large communities to approximately $3.00 a year per person in small communities. • More than 100 national and international health, ser- vice and professional organizations recognize the pub- • More than two-thirds of the population in the United lic health