When I first started working with a public health unit, I remember colleagues working extremely hard on the fluoride portfolio. The fluoride lobbyists were coming to our region to convince Council to remove the substance from the water. This was an extremely stressful time for staff, they were overwhelmed with several questions from the public, council members, and lobbyists, which meant a lot of time was spent a lot of time reviewing data and the best available research evidence. Now, nearly seven years later, I see the same discussions happening around the world, between friends, colleagues and Council's both in Canada and here, in New Zealand.
The history of fluoride
The history of fluoride goes back to the early 1900s when a dentist from the east coast of america noticed brown stains on the teeth of residents in Colorado Springs (known as the Colorado Brown Stain). Though the teeth were quite discoloured, he noted that they were also resistant to tooth decay. By the 1920's, another case of brown stains were found in Oakley, Idaho. Parents stated that the brown stains appeared in their children's teeth, after a water pipeline was constructed to a springs a few miles away. Though nothing unusual was found in the drinking water, it was advised that they town discontinue the use of the pipeline. A few years later, the brown stains on teeth had disappeared. Soon after, dental professionals began to test water to help discover any relationships between water quality and the effect on teeth. In 1930 it was discovered that high concentrations of fluoride were the cause of brown stains on teeth.
Some of the first fluoride studies were carried out by Dr. H Trendley Dean, who was head of Dental Hygiene at the National Institute of Health. It was he and Dr. Elias Elvove who discovered that fluoride levels in water up to 1.0 ppm did not cause fluorosis (brown stains) in most people and only mild enamel fluorosis in a small percentage of people. However, fluoride research did not end there. In 1944, the pair of dentists tested their theory of adding fluoride to the water to prevent tooth decay, as noted from the original Colorado Brown Stain studies. In 1945, Grand Rapids, Michigan was the first city to add fluoride to their water systems. In a 15 year research study, after 11 years they found that the rates of dental caries in children decreased by 60%, making tooth decay a preventable for most people.
Fluoride today
The World Health Organization (WHO) recommends a population health approach to prevent dental caries, this can be achieved by applying constant low levels of fluoride in the oral cavity. While some areas have naturally occurring fluoride in the water, other regions may require a "top up" to the suggested range of 0.7 - 1.0 ppm to achieve optimum oral health benefit. You may have noticed that fluoride is added to various things such as water, salt, milk, mouthwash, and toothpaste. As a result, for over 60 years, people around the world have benefited from fluoride.
In recent years, fluoride lobbyists have been gaining momentum and have successfully swayed the decision of local Councils to remove fluoride from the water. This has occurred in several cities and communities around the world. Anti-fluoride lobbyists generally believe that it's not safe, it does not work, and removes the ability for individuals to make a choice about their health. For example, here is an organization in New Zealand that I came across. As with other lobbying groups, they are supported by members of the dental industry, concerned citizens and other professionals. Both sides of the debate will always include testimony from dentists and health professionals, concerned parents, politicians, and health organizations, making it confusing to know who to believe. Anecdotally, I've heard stories from friends who moved to cities that removed fluoride from the water, and have seen an increase in dental issues. Cities that have removed fluoride from the water, have seen an increase in tooth decay. Having worked in public health, I know and believe that fluoride in water is a good thing, but I know there will always be people on either side of the fence on this public health issue...
