Sunday Commentary: Benefits of Fluoridation Not Worth the Costs

fluoride-water

The WAC will meet this Thursday to discuss and make a recommendation to the Davis City Council on the issue of fluoridation, and I personally urge them to vote against making any sort of recommendation.

I have stayed on the sidelines on this issue throughout much of the debate.  Truth be told, I am actually more sympathetic to the yes position.  I read this morning’s op-ed in the Davis Enterprise by former Schools Chief Delaine Eastin and several respected medical professionals including:  Rick Baker, from First 5 Yolo;  Constance J. Caldwell, Yolo County’s current health officer; and Bette Hinton, Yolo County’s former health officer.

They write, “The positive health effects of fluoride have been recognized since the 1930s. Epidemiologists found that populations with higher concentrations of the naturally occurring mineral in their water had a lower prevalence of tooth decay – more than 50 percent lower, which from a scientific perspective is enormously significant. “

I’m also sympathetic to the problems of getting low income children to brush their teeth and use fluoride.  Our nephew arrived with his teeth in horrific condition and it has been a struggle to get him to use proper habits.

“Much of the polemic surrounding fluoride is too shallow to encompass the core issue: Fluoridation is clear-cut social justice. Fluoride in the water improves the oral health of everyone with teeth, regardless of age, income or access to dental care,” they write.

“Recent statistics highlighting 26 percent of Yolo County children with untreated dental decay reveal a sizable population among us with mouths less than excited to smile,” the advocates continue. “Many of these children are absent from school and adults with similar afflictions miss work. Extrapolating from national rates, more than 41,000 work hours and 21,000 school hours were lost last year in Yolo County due to oral health issues.”

And they add, “West Sacramento made the decision to fluoridate its water supply in 2008 and, since that time, preschoolers have seen a 17 percent reduction in frequency rates of visible or urgent decay – a faster rate of decline than in any other city in the county.”

While I tend to lean toward the libertarian sides of things with regard to regulations of this sort, I also find myself not sympathetic to the argument that we are forcibly medicating people.  To me, the idea of forced medication goes beyond what is basically a topical remedy.

The distinction here between medicine and chemical treatments of water or growth hormones in food is not sufficient in my view to be a persuasive argument.  Truth is, there are many legal agents that segments of the population would like to see banned, but until we come to the point where we remove all agents of this sort, it does not seem reasonable that we ban fluoride but not chlorine in the water, and not hormones and other GMOs in the food supply.

Instead, and running the risk of angering everyone, I have come to the idea of not adding fluoride for much more pragmatic reasons.

First, this has been a divisive topic for the last fifty years and, while the actors and even the ideologies have shifted from the 1960 debate, I see no evidence that the populace is less polarized on this issue.  If the council decides to move forward on this issue, they will either have to put it on the ballot themselves or likely face a community-based effort to do so.

An election would be contentious, polarizing and costly.

If the benefits, particularly to low-income children, were really overwhelming, I could see risking this kind of discord.  But in reading the literature myself, I’m somewhat surprised how little real research has been done which can show the impacts of fluoridation in the water on decreased dental decay.

Longitudinal studies have shown that dental health has improved, which is not surprising given what we now know as opposed to in previous generations.  But it is not altogether clear that there is a significant additional impact in communities with fluoridation versus not fluoridation.

The authors cite the West Sacramento rate of decline in tooth decay following 2008, but was the only difference there the decision to fluoridate and it was not accompanied by additional measures?  It might be something to look into.

We have a number of issues that we have to address as a community, and I’m concerned that a fluoridation fight would distract from that.

There will be a cost to putting fluoridation into the water.  The city produces their estimate using 2009 cost estimates from Sacramento County, as well as cost estimates from two of the city’s deep wells completed on June 18, 2013.

The staff report estimates, “The cost to add fluoride to our deep wells is estimated to be between $92,000 and $454,900 per well site. So to equip all six deep wells, the total cost would be between $837,000 and $2,067,400.”

It continues, “The cost to add fluoride at the Woodland Davis Water Treatment Plant (WTP) is estimated to be $602,000. Davis’ portion of this would be 40%, or approximately $240,800. If Davis decides to fluoridate but Woodland does not, then the cost would be closer to ½ of the total for both, or $301,000.”

But there is more – there is also an added Water Treatment Plant to get the fluoride out of the water supply which would be another $1 to $2.4 million.

And remember these are not one-time costs, they would be annual costs because putting fluoride in and taking fluoride out of the water would have to occur on an ongoing basis.

Given this considerable cost, it might be money better spent elsewhere.  But the amount of time and energy and money spent on a ballot measure that is likely to lose would suggest that we at least hit the pause button to see if the issue is even viable.

Right now, as I have argued previously, I don’t believe that there is the same enthusiasm on the part of the pro-fluoridation segment of the population to offset what looks like a formidable coalition on the dominant far left in Davis with the portion on the far right.

The mushy-middle probably leans towards the yes side, but will have they have the incentive to come out and vote in numbers in an off-election?  If the council puts this on the ballot, we are most likely looking at June 2014, which would be with the city council race, the assembly race, and the governor’s race.

But, given that Jerry Brown looks formidable and the assembly race may turn out some voters, we are probably still looking at a relatively low turnout – in the 40s or maybe as much as 50 percent, depending on how nasty and contentious the assembly race becomes.

Fluoridation is the kind of push-button issue that tends to absorb people’s energy, but the city is facing huge revenue shortfalls and budget problems, and needs to figure out how to deliver quality services for less.

That is what the spring council campaign should focus on.  Fluoridation will create a huge distraction from that and, right now, I just do not see the justification.

In the end, with a better grasp of the empirical evidence, I am not predisposed against the idea of fluoridation, but I think the advocates need to work on a longer term education plan outside of the contentious debate that, over time, can deliver this issue.

In the short term, I see the prospects for passage to be fairly low, while I see the opportunity costs to be quite high.

—David M. Greenwald reporting

About The Author

David Greenwald is the founder, editor, and executive director of the Davis Vanguard. He founded the Vanguard in 2006. David Greenwald moved to Davis in 1996 to attend Graduate School at UC Davis in Political Science. He lives in South Davis with his wife Cecilia Escamilla Greenwald and three children.

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14 Comments

  1. Frankly

    [i]While I tend to lean toward the libertarian sides of things with regard to regulations of this sort, I also find myself not sympathetic to the argument that we are forcibly medicating people. To me, the idea of forced medication goes beyond what is basically a topical remedy.[/i]

    Re-read this David and explain how causing everyone to ingest the fluoride is a topical remedy. You do know what the word “topical” means don’t you?

    You actually hit on the primary problem here. It is the practice of forcing people to ingest what is and should be a topical medication. You don’t need to be a libertarian to recognize the absurdity of this. I think the supporters are just stuck on stupid about it. They are stubbornly attempting to continue a practice they have gotten comfortable with even though they know in their dinosaur brain that it is wrong.

    60 years ago when the practice of dumping fluoride drugs into our water systems was started the medical profession was diagnosing mothers of autistic children as “Refrigerator Moms”. The point here is that we have advanced significantly in medical practice. Fluoride and its benefits and risks are well documented. If is included in hundreds of inexpensive products that everyone can purchase and use. Let’s make fluoride toothpaste and toothbrushes available to low income families and teach them how to brush their teeth at a young age. Let’s stop forcing a full population to ingest fluoride when few benefit from it, and some will be harmed by it. It is really a barbaric and Orwellian practice from or past, and it needs to stop. Progressive industrialized countries all over the world have stopped it.

  2. Growth Izzue

    [quote]To me, the idea of forced medication goes beyond what is basically a topical remedy.
    [/quote]

    There are many “topical” remedies I would never dream of ingesting.

  3. alanpryor

    [quote]“…but until we come to the point where we remove all agents of this sort, it does not seem reasonable that we ban fluoride but not chlorine in the water, and not hormones and other GMOs in the food supply.”[/quote]

    David – Residual chlorine is put into the water to ensure safety and lack of pathogenic agents as it runs through our delivery piping system. It is used universally around the world for this purpose. Fluoride is put into the water for medical purposes. That is a huge difference. It is the only chemical put into any drinking water for this purpose anywhere in the world. And the rest of the world is resoundingly rejected fluoridation. Over 80% of the people in the world subjected to fluoridation are in the US. If this is one of the “Top 10 Public Health Achievements” of the last century and it is so inexpensive and cost-effective, then why is the rest of the world running from this practice in droves. Just last month Israel ended mandatory fluoridation.

    I also note the FDA classifies fluoride as an “unapproved drug” because double-blind efficacy and risk exposure tests have never been done on it! Amazing but true. For this reason you cannot get fluoride pills or drops for personal use without a prescription from a doctor or dentist. And any doctor or dentist who wants to keep their license will individually evaluate each patient to determine if this is an appropriate treatment for them and inform them of the benefits and risks and obtain their consent to be medicated. So the proponents of fluoridation are proposing that the City of Davis do what no doctor or dentist can do which is to mass medicate the entire population without individual evaluation or obtaining their individual informed consent. Doesn’t that sound Orwellian to you?

  4. Growth Izzue

    Alan Pryor:
    [quote]without individual evaluation or obtaining their individual informed consent. Doesn’t that sound Orwellian to you? [/quote]

    Hey Alan, sort of like the proponents of the plastic bag ban forcing their views on other individuals without their consent, doesn’t that sound Orwellian to you?

  5. hpierce

    Don’t often agree with Mr Pryor… yet he has this almost “nailed”… when ~ 1% of Davis water is actually ingested (subtracting out irrigation, process water, showers, toilets, garbage disposal, cooking, etc.) it is a very inefficient delivery method. “Social Justice”? give me a freaking break!

    My spouse and I both were “fluoridated”… not harmful… yet, for those prone (by genetics) to have ‘soft spots’ in molars, not effective either. If a five-year old has cavities, so what? Those teeth will be shed. I’d rather spend money on dental care for the less affluent, etc.

    “poisoning the water” is BS at the levels proposed. Fluoridation is just stupid from an economic and societal perspective.

  6. Growth Izzue

    [quote]No, that would be if we were forced TO use plastic bags. [/quote]

    No, that’s one group forcing their views on another group without their individual consent because you always have the choice now whether you want to use plastic or not.

  7. alanpryor

    “sort of like the proponents of the plastic bag ban forcing their views on other individuals without their consent, doesn’t that sound Orwellian to you?”

    Off topic, but I am 100% behind keeping ALL toxics out of our environment for which there are environmentally benign, cost-effective alternatives. This includes fluoride in our water, wood smoke in our air, as well as plastic bags and other non-biodegradable land-filled wastes and litter (such as expanded polystyrene foam). All degrade our environment and contribute to the proven build-up of background hormonal disruptors, cancer-causing chemicals, and other toxic agents in our environment to which we are all exposed and suffer. Fluoridation is mass medication of our water. Plastic bags are mass degradation of our environment. Both are wrong to me. But if the producers and users of plastic bags actually paid their fair share of the true environmental clean-up costs of the production and disposal of their plastic/ chemical waste, I would say, “no problem, let them eat their cake”.

  8. alanpryor

    [quote]From the Enterprise Op-Ed -“West Sacramento made the decision to fluoridate its water supply in 2008 and, since that time, preschoolers have seen a 17 percent reduction in frequency rates of visible or urgent decay – a faster rate of decline than in any other city in the county.”[/quote]

    Hmmm…The drop in decay rates in West Sac preschoolers that the Yolo Health Council reported to the Yolo Co Board of Supervisors a few months ago was only 10% but now they claim it is up to 17%? What a dramatic improvement in only 2 months! Seems hard to believe but, if true, I am glad for the kids.

    But what the pro-fluoridation folks fail to mention in their Op-Ed is that they also admitted to the BOS that they have been putting significant resources into treating West Sac pre-school kids’ dental problems over the past few years and that these expenditures were also “partially” responsible for “some” of the drop in decay rates that were seen. Gosh, do you think that treating a bunch of the West Sac preschoolers for untreated caries could be the real reason that untreated caries rates declined in West Sac preschoolers? This was certainly not made evident in the Enterprise Op-Ed.

    The unanswered question is just how much money has Yolo First 5 and CommuniCare put into treating these West Sac preschoolers? Does it not seem surprising that they are not publicly releasing this information in addition to the reported drop in caries rates? Seems like the pro-fluoridation folks finally agree, though, that the best way to bring down cavity/caries rates in low income, disadvantaged kids kids is to provide preventative and restorative dental care to them. It was in recognition of this obvious and proven fact that at last month’s WAC meeting I recommended a 1% excise tax on our future water bills that would be used exactly for this purpose in Davis. I am convinced that by doing so we will get far better dental health results in susceptible and disadvantaged kids at less cost without poisoning our water supply and environment.

    As an aside, one of the reasons that the Portland OR vote rejected fluoridation by an overwhelming margin of 61 – 39% last month was because of a perceived lack of credibility of the pro-fluoridation forces. A local TV station filed a Freedom of Information Act request for recent cavity rate data that public health authorities had been withholding from the public. They found out and reported right before the election that the local public health authorities were grossly misleading the public about the extent of cavity rates in Portland compared to other areas in Oregon. I think we are seeing a similar lack of credibility of the pro-fluoridation forces in Yolo Co. when they try to give all the credit to decreases in cavity rates to fluoridation while not explaining in detail what else they did to lower those rates.

  9. Don Shor

    [quote]The staff report estimates, “The cost to add fluoride to our deep wells is estimated to be between $92,000 and $454,900 per well site. So to equip all six deep wells, the total cost would be between $837,000 and $2,067,400.”

    It continues, “The cost to add fluoride at the Woodland Davis Water Treatment Plant (WTP) is estimated to be $602,000. Davis’ portion of this would be 40%, or approximately $240,800. If Davis decides to fluoridate but Woodland does not, then the cost would be closer to ½ of the total for both, or $301,000.”

    But there is more – there is also an added Water Treatment Plant to get the fluoride out of the water supply which would be another $1 to $2.4 million.[/quote]

    I’d rather just have the money go directly to First 5 Yolo to expand their dental health programs.

  10. Steve Hayes

    Here is a recent article published in the Portland Tribune: http://portlandtribune.com/pt/…uoridation

    Measure 26-151 to fluoridate the water supply of the City of Portland lost by a resounding 3-2 margin, the fourth time in five tries that Portland voters have turned down the idea of fluoridating the city’s water supply.

    “At a very fundamental level, people understand that we don’t want more chemicals in our water,” said Kim Kaminsky, leader of Clean Water Portland, at a campaign party for fluoride opponents at the On Deck sports bar.

    The nonprofit Upstream Public Health brought the idea of fluoridating Portland’s water to city councilors last year, quietly building majority support on the council before the public really caught wind the fluoride issue was back on track in Portland.

    The council unanimously approved fluoridating Portland’s water last September, but the stealth campaign by supporters may have backfired.

    Fluoridation opponents, with little money or professional political help, quickly gathered enough signatures to force a public referendum on Tuesday. “In 30 days, we put together an operation to gather 43,000 signatures,” said Rick North, a member of Clean Water Portland’s steering committee.

    Portland is the last major city in the U.S. without fluoridated water, and, now that voters have spoken, will remain

  11. coco

    As a long-time organic farmer I am concerned and aware of conventionally accepted practices that can compromise our living environment. For example, the common practice of using industrial slag as the source for micro-nutrients in conventional fertilizers has resulted in the unknowing contamination of conventional farmers’ agricultural fields over time, ultimately limiting cropping choices. Unfortunately, it was only after the damage was already done, and sensitive crops began to fail in Oregon fields, that researchers were able to recognize the problem and trace back to the source of pollution.

    Now we in Davis are being asked to accept the adulteration of our drinking water, and necessarily our bathing water, our play water, our urban agricultural water, and the water we discharge into our living waterways, with fluoride. Notably, municipal fluoridation programs do not use use the calcium fluoride found in natural aquifers and rock deposits, but instead use hydrofluorosilicic acid, a direct byproduct of pollution scrubbers used in the phosphate fertilizer and aluminum industries.

    The United States Department of Agriculture-National Organic Program, with which I am familiar as an organic farmer, safeguards against the risks associated with the unwitting widespread release of industrial waste products into the environment and our food-stream, by requiring that elemental chemicals used in organic production must be from natural mined mineral sources while prohibiting those that are synthetically derived.

    Surely we can investigate the proposed fluoridation more thoroughly, and find ecologically responsible ways to care for our children’s teeth. You can learn more about fluoridation on the Weston A. Price website at , or, more specifically about hydrofluorosilicic acid concerns at .

  12. coco

    Hmmm, seem to be having trouble getting my offered links to post. Those interested can search for “Fluoride:It’s Worse Than We Thought” on the westonaprice.org and for “Hydrofluorosilicic Acid Fluoridation Questions Anybody Can Ask” on the COF-COF site.

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