Sunday Commentary: Both Sides of Fluoridation Issue Need to Address Critical Points

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fluoride-waterI have yet to take a position on the fluoridation issue, and for good reason.  I do not believe that either side has adequately addressed what are my key concerns.  I do not have the fear of fluoridated water, because I grew up for 23 years in a location that had fluoridated water and I do not see the fearful side effects that many seem to believe accompany fluoridated water.

On the other hand, as someone trained in quantitative methodology, the correlation between fluoridated water and reduction in tooth decay is not there.  Proponents of fluoridation can show the longitudinal decline in tooth decay over time, but when you analyze areas with fluoridated water and areas without fluoridated water, the trendlines mirror each other, which would seem to rule out the impact of fluoridated water and point toward a third variable.

As Julie Gallelo from First 5 Yolo, former Woodland Mayor Art Pimentel and Davis Mayor Pro Tem Dan Wolk wrote last week, “Across the nation, more than 70 percent of people utilize community fluoridation, according to the Centers for Disease Control.”

“Since the mid-20th century, community water fluoridation – the careful adjustment of naturally occurring fluoride levels in water to strengthen tooth enamel and reduce dental decay – has proved to be an effective preventative public health measure, reducing tooth decay by about 25 percent over a lifetime, per the American Dental Association,” they argue.

However, as noted, a more careful examination of the statistics do not bear out that claim.  Tooth decay decreased almost equally in areas with fluoridation and without fluoridation.

Nevertheless, while the yes side has not proved their case that fluoridation reduces tooth decay, the no side has a more difficult task.

As I noted last week, I have seen a number of alternatives to fluoridation that were posed.  Anything from the use of the Affordable Care Act to some sort of voluntary fluoridation program.  The problem is that none of these address the most critical area of the problem – those children whose parents are simply not providing adequate medical care for their children.

First of all, none of these proposals are actually different from the current available treatments.  Right now, under Medi-Cal, low income people can obtain a prescription for the type of fluoride supplements that were proposed under Brett Lee’s alternative and under the Affordable Care Act.

All of these types of solutions assume the idea that parents will be responsible and get their children the type of treatment that is needed.  But those parents already have important access – they have Medi-Cal access to fluoride, they can make sure their children brush their teeth, and most Medi-Cal plans – at least the ones my dependents are on – have access to dentists.

If you are on Medi-Cal and go to Communicare, you already have access to dentists.

Now, the critics of fluoridated water automatically assume that this means that I support fluoridation – it does not necessarily mean that.  I’m simply arguing here that if you do not support fluoridation, you have a larger burden, than the ideas offered to this point, to find alternatives.

You still have the problem that there is no actual evidence that fluoridated water is going to solve this problem.  I am not saying it doesn’t, but the statistical analysis alone is lacking here.

How big a problem is this?  Every day in this county thousands of children who have access to Calfresh food programs do not utilize it.  They go to school hungry.  The problem is serious enough that schools have taken to providing meals to children twice a day.  In some cases, those are the only meals those children eat.

The problem here is not free fluoride, through Medi-Cal – people who seek to utilize the programs can get free fluoride for their children.  The problem is getting that fluoride onto the teeth of children.

Some have suggested that one approach may be to go through the schools, as they have with food.  Some treatment is better than no treatment, no doubt, but the key time to brush the teeth is not just after meals, but before bedtime, and no school can address that.

It is important to note that at Head Start programs, they have already utilized this and seek to teach the children to brush their teeth.  Despite this, I have seen horrific stories, firsthand, of young kids six, seven years of age with large numbers of cavities because their parents did not insist on proper brushing habits and failed to take their kids to dentists.

The recourse that many have is to dip to ideology.  They accuse those concerned about this problem of advocating for “a nanny state.”

One commenter wrote, “So free fluoride is provided but since some won’t use it we must fluoridate everyone’s water. What’s next, not all kids eat healthy so should we ban all non healthy foods in Davis so only healthy food is available?”

A few points in argument against this view:

First, I am not arguing for fluoridating the water, I’m only arguing that, so far, the alternatives to fluoridation have not taken this issue into account.

Second, I am all for allowing adults to practice whatever unhealthy habits they wish to practice.  If adults do not wish to get proper medical treatment, that is their choice.  If they wish to allow their teeth to rot, then that is also their choice and I have no intention of stopping them.

However, children are a different matter, and I feel that we as a society must intervene to protect the health and well-being of children.  If that makes us a nanny state, then so be it.

Finally, yes I am concerned about the unhealthy food selections that still exist in our schools.  I have put this matter to the attention of school board members and administrators, and there has been little action on that front.

The question for me is only how do we act, not if we act.  Again, it is incumbent upon the proponents of fluoridation to demonstrate that their proposed treatment works.  I would question how much tap water is being consumed by the kids in greatest need of the treatment, anyway.

But the problem that we face here is real, and, so far, none of the alternatives get help to those who really need it.

—David M. Greenwald reporting

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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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16 thoughts on “Sunday Commentary: Both Sides of Fluoridation Issue Need to Address Critical Points”

  1. Growth Izzue

    [quote]Nevertheless, while the yes side has not proven their case that fluoridation reduces tooth decay, the no side has a more difficult task.[/quote]

    If flouride hasn’t been proven effective in water then the controversy should end right there. Why should it be the no side that has to solve an age old problem of bad parents or guardians not taking care of their children properly or using free medical services available to them?

  2. David M. Greenwald

    Two things.

    I have already stated that for political reasons the debate needs to end here.

    Second though, not everyone agrees with my opinion or assessment here, so that makes it difficult to stop the debate. I believe they need to do more research on whether fluoridation has the positive impacts that some are claiming.

    One question that really is bothering me here is how much tap water are most kids who are not receiving fluoride in other ways actually getting. It may be why we aren’t seeing a huge correlation between those who receive fluoridation in the water and those who don’t.

  3. David M. Greenwald

    It’s the context in which the issue came up. People have put forth alternatives to fluoridation that do not account for that particular problem.

  4. medwoman

    David

    [quote]I believe they need to do more research on whether fluoridation has the positive impacts that some are claiming. [/quote]

    I think that this is a valid point. More research is always a good thing as preventive and curative medicine both individual and public are always changing as new information is obtained and tested in comparison with existing concepts. It is true, as some opponents have put forward, that there are no gold standard, large, double blinded, prospective studies on the efficacy of fluoride. However, this is not because of laziness, or sloppiness, or sneakiness on the part of the proponents. It is simply because the design of such a study is simply not possible any more than it would be possible to double blind a study on the effects of smog on the rates of asthma in a community. However, I do think that it is a reasonable starting point when evaluating the seeming universal drop in tooth decay, to look at the graphs provided by the opponents in a different way.
    The drop has occurred in communities that have fluoridated water as well as in those who have chosen other means of providing fluoride. To me, this speaks to the empiric evidence of efficacy rather than the lack there of.

    The argument however, is not whether or not appropriate amounts of fluoride help to prevent tooth decay. Even the most ardent opponents of water fluoridation admit that it is preventative, but they contend, only when applied in some other fashion. So now we are not talking about fluoride as a poison, but only how best to deliver it. Every westernized country that the opponents have cited as not using water fluoridation, has another means of effective delivery. The problem is that our society has decided against a strategy that ensures that all children are ensured adequate health care. Some societies are dealing with the issue of ineffective parenting by home or school visits on a regular basis. Some are homogenous populations in which virtually all of the population have been raised to the same standard of health awareness. The question for us at the present time, is, what strategy can we adopt that will allow us, with our current level of disparity and diversity, to achieve and maintain similar results.

    As anyone who has read my posts knows, this is not my favored option. However, given the knowledge that we will not get to an option favored by me in my lifetime, I am supporting the option that we have that is available.
    Our pediatricians tell me that when they prescribe drops, the follow through on subsequent prescriptions is very poor. These are not typically parents without resources, access, or the ability or awareness to follow through.
    These are the kinds of parents that volunteer in the schools, that schedule and keep appointments, that coach their kids sports teams. Ask yourself how hard it is to remember to complete an entire prescription once you are feeling better ? Now imagine that you are asking kids and parents to do something for years without any appreciable benefit, even though that benefit would be occurring. Fluoridating the water is an economic, safe and readily available means to supply fluoride. It also has the advantage that anyone who does not want it can opt out by simply not drinking or cooking with the city supplied water.

    Is this ideal ? No, is it one among many strategies that is associated with a drop in dental decay ? Yes.
    Is the level of fluoridation being proposed demonstrated safe ? Yes. Even in the studies, limited though they are, that are quoted as showing an adverse effect, the 0.7 ppm being proposed is touted as a safe level. Those who are worried about the additive effect from fluoridated products have the ability to chose products without added fluoride. There is no force in this proposal, only increased availability if desired.

  5. David M. Greenwald

    Medwoman:

    You’re laying out most of my concerns:

    “Our pediatricians tell me that when they prescribe drops, the follow through on subsequent prescriptions is very poor.”

    This is among my concerns.

    I’m not concerned as I said about the safety issue. But what does concern me is whether the fluoridated water is actually going to get to those kids who need it and I just wonder how much study has occurred about whether at risk kids are drinking enough tap water to have any additional fluoride impact them.

  6. B. Nice

    [quote]Some have suggested that one approach may be to go through the schools, as they have with food. Some treatment is better than no treatment, no doubt, but the key time to brush the teeth is not just after meals, but before bedtime, and no school can address that.[/quote]

    We are not talking about brushing habits we are talking about easy access to fluoride.

    [quote]Despite this, I have seen horrific stories, firsthand, of young kids six, seven years of age with large numbers of cavities because their parents did not insist on proper brushing habits and failed to take their kids to dentists.[/quote]

    Me too. It’s awful.

    [quote]Finally, yes I am concerned about the unhealthy food selections that still exist in our schools. I have put this matter to the attention of school board members and administrators, and there has been little action on that front.[/quote]

    Have they addressed you at all on this point? It’s hard to fight for fluoride for these kids then send them to school where their breakfast options include chocolate milk and fruit loops. Getting rid of these options is an issue I’d be willing to put some effort into.

  7. B. Nice

    [quote]Our pediatricians tell me that when they prescribe drops, the follow through on subsequent prescriptions is very poor. These are not typically parents without resources, access, or the ability or awareness to follow through. These are the kinds of parents that volunteer in the schools, that schedule and keep appointments, that coach their kids sports teams.[/quote]

    Guilty as charged.

  8. David M. Greenwald

    “We are not talking about brushing habits we are talking about easy access to fluoride.”

    We are really talking about both, because building good brushing habits could override some parental neglect.

    “Have they addressed you at all on this point? It’s hard to fight for fluoride for these kids then send them to school where their breakfast options include chocolate milk and fruit loops. Getting rid of these options is an issue I’d be willing to put some effort into.”

    They were sympathetic, but I didn’t see much in the way of follow through. The excuse is that they can’t get kids to eat healthy foods.

  9. B. Nice

    [quote]We are really talking about both, because building good brushing habits could override some parental neglect[/quote].

    I guess I mean to say we are talking about these things independent of one another. Adding fluoride to the drinking water is not going to change brushing habits either.

    [quote]The excuse is that they can’t get kids to eat healthy foods.[/quote]

    That’s an unfortunate response from them and a poor excuse for providing free junk food to kids. My bet is that kids would eat healthy food if unhealthy options were not available.

  10. medwoman

    [quote]It’s hard to fight for fluoride for these kids then send them to school where their breakfast options include chocolate milk and fruit loops. Getting rid of these options is an issue I’d be willing to put some effort into.[/quote]

    I do not see this as an either/or. I think both fluoridating the water and improving the dietary options in the schools are worthy goals.

    [quote]But what does concern me is whether the fluoridated water is actually going to get to those kids who need it and I just wonder how much study has occurred about whether at risk kids are drinking enough tap water to have any additional fluoride impact them.[/quote]

    I do not know how one would design a study to adequately test for the amount of water consumed by each group of children. But I do believe it would be safe to say that the families who have the most difficulty providing adequate preventive health care for their children are likely to coincide with those that would likely not have the spare money to spend on bottled water and therefore would be more likely to be consuming tap water.

  11. B. Nice

    [quote]I do not see this as an either/or. I think both fluoridating the water and improving the dietary options in the schools are worthy goals.[/quote]

    I agree. When I started thinking about alternatives ways to get fluoride to the kids who could benefit most from it, in case it doesn’t end up being added to drinking water, incorporating it into school meals came to mind. The irony of situation then struck me as I thought about the content of some of the choices being provided. (breakfast choices are particularly bad).

  12. davisite2

    IMO, Dan Wolk’s public advocacy for Davis fluoridation needs to be seen in the light of his attempt to defeat Krovoza in the upcoming primary. Davis may well split their votes between the two and the outcome, if either is indeed victorious, will most likely be determined by the votes beyond Davis. Based upon the history of the lack of political involvement of Woodland voters, one would expect that Woodland voters will follow the pro-fluoridation position of their Establishment leaders . Dan Wolk’s obvious connection with his mother’s political “camp”,from his political “get-go_”is for me, unsettling as it portends where he will be getting future political “advice”

  13. jostoich

    ISRAEL WILL END FLUORIDATION IN 2014, CITING HEALTH CONCERNS
    http://www.fluoridealert.org/articles/israel_fluoridation/

    On July 29, 2013, the Supreme Court of Israel ruled that new regulations require Israel to stop adding fluoride chemicals into public water supplies in one year, reports the Fluoride Action Network (FAN).

    Izun Hozer Association for Dissemination of Health Education and Yaacov Gurman petitioned Israel’s highest court, November 12, 2012, demanding that the Ministry of Health order the cessation of fluoridation because it presents health dangers and its benefits are no longer widely accepted.

    A 1974 regulation mandated fluoridation throughout Israel. But in April 2013, the Minister of Health,Yael German, created a new regulation removing that mandate.

    “It must be known to you that fluoridation can cause harm to the health of the chronically ill,” including “people who suffer from thyroid problems,” German wrote in a letter addressed to doctors opposed to ending fluoridation.

    The court ruled that the new regulations will not only bring an end to mandatory fluoridation in Israel in 2014 but will also put an end to any fluoridation – mandatory or voluntary. See translation of the Court’s ruling at: http://www.fluoridealert.org/uploads/israel_supreme_ct_july2013.pdf

    Paul Connett, PhD, FAN Executive Director, says, “Zealous fluoridation promoters try to convince the American public that ‘everyone drinks fluoridated water.’ But the opposite is true. An overwhelming number of countries do not fluoridate, including 97% of the European population. In fact, over half the people in the world drinking fluoridated water live in the US. We are the odd ones out.”

    “Fluoridation is an outdated, unscientific, failed public health blunder,” says Connett. ”What I find remarkable here is that Health Minister German has been able to escape the unscientific belief system on fluoridation that traps so many public health bureaucracies in fluoridated countries.”

    Many communities, over the last few years, stopped fluoridation in the US, Canada, New Zealand and Australia. Recently, both Wichita, Kansas and Portland, Oregon rejected fluoridation 60% to 40%. Hamilton, NZ, councilors voted 7-1 to stop 50 years of fluoridation after councilors listened to several days of testimony from those for and against fluoridation

    Windsor, Ontario, stopped 51 years of fluoridation. Sixteen regional councils have halted or rejected fluoridation in Queensland since mandatory fluoridation was dropped there in Nov 2012.

    Meanwhile, New York City Council Member Peter Vallone, Jr continues in his effort to halt fluoridation in NYC.

    Research published in peer-reviewed scientific journals indicates that fluoride ingestion is ineffective at reducing tooth decay and harmful to health. See http://www.FluorideAction.Net/issues/health

  14. jostoich

    Water Fluoridation Is Anything But Safe

    While naturally-occurring arsenic in groundwater is one of the most common sources of exposure, hydrofluorosilicic acid (fluoride) added to drinking water is commonly contaminated with toxic arsenic. This form of fluoride added to the water supply is actually a toxic byproduct from the fertilizer industry.

    Recent research has revealed that diluted fluorosilic acid adds, on average, about 0.08 ppb of arsenic to your drinking water. Arsenic is a known human carcinogen, for which there is no safe level. Adding this to our water supply makes absolutely no sense — especially in light of the epidemic of cancer. Hydrofluorosilicic acid greatly increases lung and bladder cancer risk.

    Low-level chronic exposure to arsenic can lead to a wide variety of health problems, including chronic fatigue, reproductive problems, reduced IQ and other neurological problems, and various cancers. It is shameful that fluoridation is allowed to continue in the face of overwhelming evidence showing the health hazards of not just fluoride itself, but also of related contaminants such as arsenic.

    Clean pure water is a prerequisite to optimal health. Industrial chemicals, drugs and other toxic additives have no place in our water supplies.

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