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October 20, 2014 - Kim Moore [see other posts]

Smiling Girl

The Fight for Fluoridation

Some background from the CDC:
In the 1930s, dental scientists noticed the occurrence and severity of tooth decay was lower among people whose water supplies contained higher levels of fluoride, a naturally-occurring mineral nutrient. Extensive studies followed and discovered that fluoride, when present in the mouth, can become concentrated in plaque and saliva, helping prevent breakdown of tooth enamel. In 1945, the city of Grand Rapids, MI, added fluoride to its municipal water system. Community water fluoridation—adjusting the amount of fluoride in an area's water supply to a level that helps to prevent tooth decay and promote oral health—had begun. Since then, numerous scientific studies and comprehensive reviews have continually recognized the effectiveness and safety of fluoridation in preventing tooth decay. This method of fluoride delivery benefits all people—regardless of age, income, education, or socioeconomic status.

In 1998, I had no idea there was any issue about community water fluoridation. That was the year the Health Ministry Fund adopted a new focus for grants to improve the oral health of Kansans. Our research told us the key to improving oral health in Kansas is to adjust fluoride levels in community water to offer optimal benefits for healthy teeth. Simple and effective.

I was right about the effective part. There is not any real issue about the safety and efficacy of community water fluoridation.

I was wrong about the simple part.

Opponents to water fluoridation -- who I thought had been soundly and appropriately trounced in the anti-communist days of the 1950's and early 1960's -- emerged with a host of always questionable, often ambiguous, and sometimes downright bizarre reasons to fight fluoridation. What may have been viewed as by-gone era John Birchers and fear-mongers had morphed into a new era of paranoid and anti-government sentiment that uses social media and modern technology to intimidate and misinform -- too frequently, successfully -- on the alleged issues of community water fluoridation. In spite of community water fluoridation being one of the greatest public health achievements of all time, advocating for this proven decay prevention measure was not simple.

Today's typical, local anti group is supported by a cottage industry of national anti-fluoride groups whose leaders make money peddling their new and rehashed bad science -- usually for a price. All of this is facilitated by technology which can bring the misinformation into the average Kansan's home at virtually no cost.

After many years of work supporting improvements in oral health, water fluoridation is no longer a focus of Health Ministry Fund grants. Oral health, however, continues to be an important health concern for all Kansans. Improvements have been made and need to be protected for our future. The fight continues, not on the grounds of science (which is firmly behind community water fluoridation), but on that of politics. Opponents have seemed to me to come from far-right political roots, including what I would describe as libertarian groups.

These groups oppose professional authority, which they see as directing their lives -- doctors, dentists, public health workers, and government. They seek to create opposition on a social class basis (precincts with lower income residents frequently are the big vote sources for anti-fluoridation ballots) by not-so-veiled references to the "elites" which "are telling them what to do -- have fluoridation in their water." They raise hundreds of questions, from fluoride in water used for firefighting to Chinese studies raising IQ issues about fluoride. They don't defend much of what they say and quickly retreat from any one point when clear evidence is presented against it. You would think they would quickly use up their limited credibility, but often their rash and wrong statements are simply excused as the product of unbridled passion. They also attack fluoridation supporters with questions about their motives. For example, accusing -- without any evidence and completely wrongly -- funders like United Methodist Health Ministry Fund of having some clandestine investment motive for supporting fluoridation.

Although each and every one of their questions has been answered by years of fluoridation research and the actual experience of fluoridated communities, the issue comes to community members as startling new information. A very small group of highly motivated people, frequently supported by persons outside the community, bring this issue to the forefront. Citizens and city council members are told there is information they need to hear. Dozens, if not hundreds, of questions and studies are bandied about. Many of these studies are completely bogus; some involve fluoride levels at hundreds of times the amount used in community water fluoridation. There is real passion coming from the antis.

On the other side, busy professionals and the limited public health community attempt to rally. This issue is just one of many for them and is not their life work, even for the brief period of a campaign. They believe their credentials and detailed review of the real evidence -- if shared broadly -- will overcome the mass hysteria and weak bona fides of the anti-group. Media hypes the issue on the front page and in brief news reports giving credibility as they quote the antis and the fraudulent hucksters they bring into the community "to get the public the real information." Most editorial pages eventually come down on the side of water fluoridation. In some communities, local public officials stay "neutral" and "let the public decide," reserving their political capital for things that matter more to them. In a few cases, some public officials actively support the antis (this was the case in Wichita in 2012).

Complicating the issue can be the comedic way the ballot question is sometimes written -- requiring a "no" vote to support fluoridation. This was the case in Hutchinson and will be the situation for Salina in November.

How does it all turn out? Too often, if will end with "victory" for bad science and passionate defenders of the right to be left alone. That means more children lying awake at night, crying with decayed teeth and missing school due to unrelenting pain. That means hundreds of children under age 6 going into surgery suites to have all those little, rotten, primary teeth plucked out at considerable expense. That victory means pediatricians will need to prescribe fluoride drops to young children to help parents prevent rotten teeth in their children; some will be able to afford this and others won't. Their victory means lines will get longer at the next Kansas Mission of Mercy where persons who cannot afford dental care will have hundreds of teeth extracted. No fluoridation will assure that senior citizens develop more caries on the roots of their teeth, which become exposed due to aging. And, in nursing homes, residents will stop eating and become ill needlessly because of rotten teeth (Medicare and Medicaid don't pay for dental care for most adults!).

Healthy teeth are worth fighting for, but it is a very hard fight!