To Fluoridate or Not?

Devon A. M. D’Aoust

The history of fluoride's use as an additive to municipal drinking water dates back
to 1945, when the city of Grand Rapids, Minnesota, became the first municipality to have
fluoride added to its drinking water supply. It set the precedent for municipal water
fluoridation and, by 1960, approximately 50 million Americans received fluoridated
water (Lennon. 2006:759). In 1954, the residents of Hastings were the first people in
New Zealand to receive fluoridated water and, as in the U.S.A., by the 1960s its use had
spread throughout the country (Ministry of Health. n.d.). As this process of fluoridation
is now commonplace, and accepted by most as safe and effective, there should be no
reason for debate on the subject. However, speculation and debate as to whether or not
fluoride is actually safe and effective has been going on long before fluoride was
introduced into drinking water. The debate still continues. So if the topic of water
fluoridation still provokes questions and debate, can it truly be safe? Should municipal
drinking water undergo fluoridation? This essay will describe and discuss the main views
on the topic of fluoridation (fluoride proponents, anti-fluoridationists, and alternative
means of fluoridation), and will attempt to answer the question: to fluoridate, or not?

Dentists and doctors alike support the addition of fluoride to municipal drinking
water, claiming it is safe and effective in reducing dental caries within an optimal level of
0.7 to 1.0 ppm (Greater Wellington. 2010). In fact, the Chief Dental Officer of Canada,
Dr. Peter Cooney, states in a letter to the public that fluoride's effectiveness in reducing
dental caries, in young people especially, makes water fluoridation important as a public
health measure. Cooney also describes water fluoridation as having a large advantage
(presumably over other fluoridation methods), as it “benefits all residents in a
community, regardless of age, socioeconomic status, education, or employment”
(Cooney. 2008). Furthermore, Health Canada, the health branch of Canada's federal
government, states that fluoride's use in this manner is promoted by over 90
medical/health organisations worldwide (Health Canada. 2008). Cooney states that
modern science still supports fluoride's use in water in the recommended range, and that
water with a fluoride content within the recommended range causes no negative side-
effects. Cooney's letter also makes reference to a study done by an expert panel
regarding recommendations on fluoride. The expert panel comprised scientists from
various universities, along with Health Canada, and the Environmental Protection Agency
(E.P.A.) among others. This study made three recommendations to Health Canada
regarding fluoride. First, it recommends lowering the recommended fluoride content in
drinking water. Second, it recommends making toothpaste with a lower fluoride content
available, especially for children. The last recommendation it makes is to encourage
lowering the fluoride content in baby formula (Health Canada. 2008). Cooney, however,
has found no reason for fluoride levels to be lowered, and, as in his letter, still supports
fluorides addition to drinking water at concentrations within the recommended range.

Perhaps, though, if it is recommended that fluoride content be reduced, it

shouldn't be added to drinking water at all. In a world full of people and opinions, there
exist some that say fluoride's use in drinking water should not continue because it is
harmful to human health. Alongside that are other reasons for not adding it to drinking
water, including it being an ineffective method of treating dental caries, and its use being
unfairly imposed by municipalities on people who don't want it added to their water.
These people would prefer not to have water containing added fluoride, and argue on the
basis that they should have the freedom of choice when it comes to fluoridated drinking
water (Greater Wellington. n.d.). Harmful effects of fluoride have been recorded and
documented and, in other cases, covered up or obscured. Kaj Eli Roholm, a Danish
scientist, discovered in numerous studies that fluoride exposure in various forms can
cause osteosclerosis (particularly skeletal damage, including damage to the spine, hips,
knees and enlarged craniums in men), and lung damage, of which most cases were
pulmonary fibrosis (Roholm. 1937:143, 150, 202). So thorough were his studies that he
even discovered and commented on fluoride's effects on teeth. According to his studies,
fluoride is found to be not only unbeneficial, but actually harmful to tooth enamel
(Roholm. 1937:315). So why is this scientific and medical information not considered
when fluoridating water? Perhaps it is because the studies and their discoveries are
considered too old (1937) to be relevant now. Perhaps it is because more studies have
been done more recently that come to different conclusions, such as the aforementioned
study carried out by an expert panel of scientists for Health Canada. However, the most
likely cause for ignoring Roholm's scientific studies is Edward Largent, who published a
paper in the American Journal of Roentgenology in 1951 that deliberately tried to
discredit Roholm's work by falsifying and doctoring results of separate studies (Bryson.
2004:106-107).

But whereas the United States, Canada and New Zealand, amongst other
countries, choose to fluoridate their drinking water, other countries have different
methods of fluoridation. For example, Austria, France, Germany, Romania, Slovakia,
Spain, and Switzerland allow the fluoridation of salt, much in the same way table salt
contains iodine (European Salt Producers Association. n.d.). However, recent material
has been published by the World Health Organization (WHO) that suggests that children
especially can benefit from fluoridated milk, rather than water, as both milk and fluoride
have reasonable evidence that shows they prevent tooth decay. Milk contains other
vitamins and minerals that aid in proper formation of teeth and bones. Fluoride would
work especially well alongside these other compounds. Not only does the fluoridated
milk deliver fluoride to children effectively, but in certain cases it has also increased or
even created government school milk subsidies to make milk (fluoridated) more
accessible and affordable. Countries like Bulgaria, Chile, and Russia have fluoride milk
programs aimed at children of lower income families. (World Health Organization.
2009:7-10). Among other methods of fluoridation, the fluoride tablet was and is still
commonly used, though Health Canada does not endorse or recommend its use anymore,
mainly because fluoride is most effectively used topically (Health Canada. 2008)

Enough evidence exists to support fluoride's benefits to human dental health, but
there is not enough modern research on its side effects, particularly neurological, to come
to the conclusion that it is safe for human consumption in small amounts. Fluoride is
present in food; particularly food that has been prepared with fluoridated water. This
extra dose will increase the amount of fluoride one ingests daily, potentially pushing it
over the recommended limit. And since little research exists as to fluoride's effects at
over the normal concentration, it is not possible to say that fluoride, consumed as it is, is
particularly safe. Perhaps, then, the best way to use fluoride as a dental carie preventative
is topically, as a mouth rinse or similar. But then what of Roholm's research? According
to his studies, fluoride actually weakened tooth enamel, rather than strengthen it. Is it
possible that fluoride's benefits as a carie preventative have hidden its rather frightening
side effect as an enamel weakener? More research into this topic needs to be done before
a definitive answer can be reached. That does not negate, however, the other side effects
Roholm noticed in his studies: the skeletal damage to the spine, knees and hips, and the
respiratory problems from exposure to the substance. If fluoride can cause these
problems in even moderate amounts, is it really safe to add in small quantities to drinking
water? If it is truly a poison, or has some toxic effects, it can not be safe to let it
accumulate in one's body. Furthermore, it is not ethical, or morally justifiable to expose a
population of any size to any kind of poison intentionally. This is especially true when a
government or organisation has the intent to use the poison as a mass medicine.

Therefore, based on the evidence, one must come to the conclusion that fluoride is
not as safe as it is said to be by health regulatory bodies, such as the New Zealand
Ministry of Health, Health Canada, or the World Health Organisation. Until further
scientific research has been done on the topic of fluoride's potential side effects, ingesting
fluoridated drinking water is an unnecessary risk to take. Moreover, if fluoride is used, it
should be used topically to reduce potential ingestion or exposure. However, fluoridated
milk, given especially to children in developing areas with little or no access to proper
dental care and fluoride toothpaste, would have more benefits than its water counterpart,
due to the wealth of nutrition available in milk. Fluoride is the only price to pay for
subsidised milk, but, ultimately, is it worth it? Is the fluoridation of anything worth the
risk? Given the facts, probably not.

List of References

Bryson, C. (2004). The Fluoride Deception. New York: Seven Stories Press.
Colquhoun, J. (1997). Why I Changed My Mind About Water Fluoridation. Journal of
The International Society of Fluoride Research, 31(2), 103-128.

Cooney, P. (2008). Letter from Canada's Chief Dental Officer. Retrieved May 8, 2010,
from http://www.hc-sc.gc.ca/ahc-asc/branch-dirgen/fnihb-dgspni/ocdo-bdc/
project-eng.php

European Salt Producers Association. (n.d.). Salt Fluoridation. Retrieved 17 May,

2010, from http://www.eusalt.com/salt_and_body/salt_fluoridation.html

Greater Wellington Regional Council. (2010). Fluoride. Retrieved 14 May, 2010, from
http://www.gw.govt.nz/fluoride-2/

Health Canada. (2008). Findings and Recommendations of the Fluoride Expert Panel
(January 2007). Retrieved May 11, 2010, from http://www.hc-sc.gc.ca/
ewh-semt/alt_formats/hecs-sesc/pdf/pubs/water-eau/2008-fluoride-fluorure/2008-
fluoride-fluorure-eng.pdf

Health Canada. (2008). Fluoride and Human Health – It's Your Health. Retrieved May 9,
2010, from http://www.hc-sc.gc.ca/hl-vs/alt_formats/pacrb-dgapcr/pdf/iyh-vsv/
environ/fluor-eng.pdf.

Lennon, M. A. (2006). One in a million: the first community trial of water fluoridation.
Bull World Health Organ, 84(9), 759-760.

Ministry of Health. (n.d.). Fluoridation in New Zealand. Retreived 15 May, 2010, from
http://www.moh.govt.nz/moh.nsf/pagesmh/3597

Roholm, E. K. (1937). Fluorine Intoxication. London: H. K. Lewis and Co. Ltd.

World Health Organization. (2009). Milk Fluoridation for the Prevention of Dental `
Caries. Retrieved May 9, 2010, from http://whqlibdoc.who.int/publications/
2009/9789241547758_eng.pdf.