Salt Lake Tribune - Sunday, September 30, 2001

Fluoridation Proponents Misled Utahns Before Last Year's Vote

BY KIRK MILLSON

If anyone doubts that health officials had Utah's best interests at heart when they campaigned for water fluoridation last year, the officials have only themselves to blame. Their misinformation and attempts to discredit scientists holding opposing views demonstrated an unhealthy disrespect for voters' intelligence.

By now you know that health officials misled voters about the complexity of fluoridating the Salt Lake County water supply, and you might have heard that they exaggerated the impact of fluoridation on cavity rates. These rates have been falling for years in non-fluoridated areas such as Utah, and 12-year-olds in many countries that don't fluoridate water have fewer cavities than their American counterparts. The decay rates in many non-fluoridated countries have also dropped faster than the rates in the heavily fluoridated United States (World Health Organization statistics).

 
Now a report from the Centers for Disease Control has made it clearer than ever that fluoridation proponents were also misleading about how the substance works. The CDC report reflects the view of most scientists today that while there is an excellent argument for putting fluoride in one's mouth, the same can't be said for swallowing it.

Just to be absolutely clear, the CDC report and every scientist on its fluoride review panel support water fluoridation, because they say even small amounts of fluoride splashed regularly on the teeth can prevent cavities. But the report -- as well as several of the scientists who e-mailed The Tribune last month -- confirmed what this paper pointed out in an editorial last fall: Fluoride's predominant effect is topical -- that is, "the overwhelming majority of its benefit" comes from direct contact with teeth, explained William H. Bowen, a University of Rochester researcher on the CDC panel.

The CDC report, while political enough not to explicitly rule out any benefit from swallowing fluoride, nevertheless confirmed that the amount recycled into the saliva ducts is too small to affect the three agreed-upon ways that fluoride fights cavities: impeding bacterial action, enhancing remineralization of the tooth enamel, and inhibiting demineralization of the enamel. The only thing all the CDC scientists now agree upon is that fluoridated water is effective when it is in your mouth and for a relatively short time afterward. That's why "swishing and spitting [fluoridated water] is probably just as effective as swishing and swallowing," according to University of Iowa researcher Keith Heller, another of the CDC's reviewers.

Arguing about whether fluoridated water is just million-dollar mouthwash or whether there is a benefit to consuming it might seem a pedantic exercise to some. After all, however it works, the CDC is adamant that it does. But if there is no benefit to swallowing fluoride, that leaves only risks, and even the CDC acknowledges that ingesting too much fluoridated water is not a good idea.

The CDC recommends that babies under 6 months of age ingest no more than 0.7 milligrams of fluoride per day. But since babies that age drink up to 1 1/2 liters of water-based formula every 24 hours -- according to nurses in the University Hospital maternity ward -- they could ingest twice the CDC's recommended dose in a fluoridated area. The CDC report also advises that in areas where the water has twice the fluoride that Utah health officials have considered adding, "children should use alternative sources of drinking water." So an active Utah child who drinks twice the water of the "average" sedentary kid for which the fluoridation formula was devised could conceivably ingest more fluoride than the CDC recommends.

This is an issue today only because of how proponents sold fluoridation to voters last fall. Had they been forthright with the information and still won the fluoridation election, The Tribune would not be wasting ink on the topic. But fluoridation lobbyists weren't honest. They pitched fluoride as a crucial building block in the formation of children's teeth, then seeded Northern Utah with billboards featuring smiling kids.

"Fluoride is to teeth what cement is to concrete," asserted a Deseret News editorial last fall, echoing fluoridation proponents. "Fluoride in the water is incorporated into the enamel of developing teeth in children under 16, rendering teeth more resistant to decay for a lifetime." On this point, proponents could not have been more misleading. The CDC report states that "fluoride works primarily after teeth have [formed and emerged], especially when small amounts are maintained constantly in the mouth."

Several other proponents built on the myth that fluoride is some kind of children's vitamin by framing the argument solely in terms of fluoridation vs. fluoride pills. The irony of this campaign is that it undoubtedly convinced many Utahns that merely swallowing fluoride pills is effective when, unless the pills are chewed and swished around the teeth first, they are of little (if any) benefit. Many also downplayed the benefits of brushing with fluoridated toothpaste, which one of the world's most respected pro-fluoride researchers last year told The Tribune "is as good or better than fluoride in the water."

You might wonder why, if swallowing fluoride yields no significant benefits, public health officials continue to push the idea. A few undoubtedly are still believers in the old research. But another member of the CDC review panel has a theory on the rest. "Given the turbulence that all too often accompanies local decisions on fluoridation, keeping up with changing paradigms can lag behind the political necessities," says Brian A. Burt, a University of Michigan researcher and a co-author of The Dentist, Dental Practice and the Community.

In other words, if public support for fluoridation is achieved with inaccurate information, some health officials (not Burt) believe the end justifies the means.

It doesn't. No matter how beneficial fluoridated water -- or any public health measure -- might be, people are entitled to the truth before deciding whether to implement it. Utahns weren't trusted with the whole story before they voted last fall.