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Don’t Drink the Water? Author Paul Connett Wants People to Take a Fresh (or First) Look at Fluoridation - Page 2 PDF Print E-mail
News/Features - Health
Written by Jeff Ignatius   
Thursday, 09 December 2010 05:16

Ringing Endorsements

The first hurdle Connett needs to overcome is the widespread and intuitive belief that fluoridation is good. The general public understands that fluoride helps reduce tooth decay, so adding fluoride to the water supply seems like a no-brainer.

That thinking is shaped by the dental and public-health establishments.

The American Dental Association (ADA), on its “Fluoride & Fluoridation” Web page, makes the following claims about fluoridation: “Community water fluoridation is the single most effective public-health measure to prevent tooth decay. ... Studies conducted throughout the past 65 years have consistently shown that fluoridation of community water supplies is safe and effective in preventing dental decay in both children and adults. ... Today, studies prove water fluoridation continues to be effective in reducing tooth decay by 20 to 40 percent, even in an era with widespread availability of fluoride from other sources, such as fluoride toothpaste.”

In 1999, the Centers for Disease Control & Prevention’s Morbidity & Mortality Weekly Report named water fluoridation one of the “10 great public-health achievements” of the 20th Century. “The effectiveness of community water fluoridation in preventing dental caries [cavities] prompted rapid adoption of this public-health measure in cities throughout the United States,” the CDC wrote. “As a result, dental caries declined precipitously during the second half of the 20th Century. For example, the mean DMFT [decayed, missing, or filled permanent teeth] among persons aged 12 years in the United States declined 68 percent, from 4.0 in 1966-1970 to 1.3 in 1988-1994.”

Add to those unequivocal pronouncements the glib dismissal of people opposed to fluoridation. A June article in on GOP U.S. Senate nominee Sharron Angle was typical in using opposition to fluoridation as political shorthand for “crazy”: “There is growing proof that she is a genuine nut, and not just a run-of-the-mill hardcore ideologue. ... [I]t’s been revealed ... that Angle is a staunch opponent of the fluoridation of our water supply.”

That broad brush, Connett argued in our interview, keeps people away from the fluoridation issue. “This I think also applies to many people in the environmental movement,” he said. “Many of them are perceived as being a little close to the edge, and they won’t touch fluoridation because they feel that that in the public’s eye will push them over the edge as being less than intelligent, less than balanced, less than whatever.”

Does Fluoridation Prevent Tooth Decay?

Yet if you read Connett’s book or peruse the Web site of the Fluoride Action Network – of which Connett is director – he seems eminently reasonable.

Take the CDC claim that DMFT declined 68 percent over two decades. That information is presented visually in the CDC article, and it’s stunning: As fluoridation rises from roughly 40 percent of the population to more than 50, tooth decay plummets.

In lauding fluoridation as one of the great public-health achievements of the 20th Century, the CDC's Morbidity & Mortality Weekly Report presented the misleading graph above.

Yet The Case Against Fluoride in Chapter 6 pairs that graph with one showing tooth decay among 12-year-olds for roughly the same period in eight countries – four with fluoridated water and four without. Every country has a roughly similar decline in tooth decay. Non-fluoridated Denmark dropped from more more than 6 DMFT near 1980 to roughly 1 in 2000.

In other words, the CDC has taken a correlation and turned it (without evidence) into causation. Tooth decay has been dropping steadily and quickly in industrialized countries around the world, whether they fluoridate their water or not.

What Connett doesn’t (and can’t) do is fully explain why there’s been such a dramatic decline in tooth decay. The widespread use of fluoride toothpaste is typically cited as one major factor, and Connett also suggested that increased income levels, better diets, decreased pollution, and antibiotics in processed food might play roles. “I don’t think it’s clear-cut,” he said. “I think there are many possible factors.”

But Connett and The Case Against Fluoride argue persuasively that studies showing the benefits of fluoridated water have grossly overstated its impact on tooth decay. The authors concede based on studies since 1980 that there might be an “extremely small” protective effect of fluoridation, “amounting on average to only a fraction of a tooth surface for the permanent teeth and not much more for the baby teeth.”

Connett added in our interview: “Let’s say for the sake of argument that there is a small benefit from ingesting fluoride. It doesn’t rise above the background noise. Certain factors do rise about the background noise ... .” In particular, the authors claim, there is a stronger relationship between higher incomes and better oral health than between fluoridation and better oral health: “According to the results of a questionnaire administered to parents in all 50 states by the Department of Health & Human Services, there is absolutely no correlation between the percentage of parents who responded that their children had very good or excellent teeth and the percentage of the population in the state drinking fluoridated water. However, there is a very strong relation in all 50 states between the percentage of parents giving that answer and their income levels.”

Connett noted that even in the literature endorsing fluoridation, there has been backtracking on the benefits of the practice. For example, the very same CDC article that lauds fluoridation as one of the 20th Century’s great public-health achievements (and presents that grossly misleading chart) includes this statement: “Fluoride’s caries-preventive properties initially were attributed to changes in enamel during tooth development because of the association between fluoride and cosmetic changes in enamel and a belief that fluoride incorporated into enamel during tooth development would result in a more acid-resistant mineral.” That was a major argument for using water as a fluoride-delivery mechanism; it was thought there was a dental-health benefit to ingesting the fluoride. The article continues: “However, laboratory and epidemiologic research suggests that fluoride prevents dental caries predominately after eruption of the tooth into the mouth, and its actions primarily are topical for both adults and children.”

Connett has seized on that statement and the research behind it to argue that if fluoride’s benefits are “primarily” topical, there’s no need to deliver it through the water.

This phenomenon – of praising fluoridation while also undermining claims about is effectiveness – is relatively common, Connett said. Studies often espouse the party pro-fluoridation line even when it’s poorly supported by the presented evidence – likely a result of researchers being afraid of having their funding cut off, he said.

Does Fluoridation Cause Health Problems?

The claim that fluoridation isn’t effective at its stated goal is just one component of The Case Against Fluoride.

The other scientific issue is whether fluoridation might cause health problems. This is a serious concern for two reasons. First, because in communities where the drinking water is fluoridated, it’s nearly impossible to avoid at home, at work, and in restaurants. Second, while the concentration of fluoride is controlled in fluoridated water, the amount one ingests will vary widely depending on one’s water intake. In other words, the dose is uncontrolled.

The Case Against Fluoride looks at many health studies related to fluoride, but a key piece of research is the 2006 National Research Council report Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. The report’s summary states: “After reviewing research on various health effects from exposure to fluoride, including studies conducted in the last 10 years, this report concludes that EPA’s drinking-water standard for fluoride does not protect against adverse health effects.” The study concluded that the drinking-water standard of 4.0 milligrams per liter should be lowered but did not recommend to what level. The EPA has not changed its standard for fluoride.

The report had consensus that fluoridation at the maximum allowed concentration of 4.0 milligrams per liter can cause several health issues: dental fluorosis, skeletal fluorosis, and increased risk of bone fractures. Further, it said more research is needed in other areas, including neurobehavioral effects, reproductive and development effects, and endocrine effects.

It’s critical to understand the difference between the charge of the National Research Council report – which only looked at the maximum contaminant level of 4.0 milligrams per liter – and typical fluoridation at 1.0 milligrams per liter. The negative health effects cited by the National Research Council might not emerge or be as serious in that normal water-fluoridation concentration. The Case Against Fluoride counters that fluoridation “is indiscriminate and offers no control over the dose received by an individual. It makes inadequate allowance for differing sensitivity to toxic effects, or for the size and body mass of recipients ... .”

Connett views the National Research Council report as a landmark review, the first thorough and balanced analysis in the United States of the literature on fluoridation health effects. “What the National Research Council report did was to say that the safe-drinking-water standard isn’t safe, that the EPA should do a new health-risk assessment,” he said.