Fluoride debate rages over decades

Additive sparks concerns about personal freedoms

By Mike Lee
Sunday, February 6, 2011 at 3 p.m.

Nearly 60 years after San Diego residents barred fluoride from public pumps and pipes, the city utilities department started fluoridating the water supply on Tuesday.

The latest move highlights the long-running tug-of-war over fluoride that has been shifting from city to city for decades. No matter how many millions of people drink the stuff each day or how many health leaders tout its benefits, questions about the wisdom of putting fluoride into tap water just won’t die.

That’s partly because large doses of fluoride are dangerous and myriad studies leave something for just about everyone to cite as evidence to support their views.  But it’s also because fluoridation has come to represent larger questions that resonate through American history.

“It is central to an ongoing debate within American culture over the proper relationship between the individual and the state,” said Char Miller, an environmental historian at Pomona College in Claremont. “Fluoride is seen by some as sort of the Trojan horse of government intervention in our lives.”

Fluoridation as a political issue goes back to the 1950s when conservative groups cast it as a Communist plot. That idea gained notoriety in the satirical 1964 movie Dr. Strangelove. “A foreign substance is introduced into our precious bodily fluids without the knowledge of the individual. Certainly without any choice,” said the fictional Gen. Jack D. Ripper. “That’s the way your hard-core Commie works.”

Modern fluoride opponents don’t generally blame the Red menace for fluoride, but they do see it as evidence of an overreaching government trying to cure social ills with a once-size-fits all solution that has side effects.

That group largely has been dismissed by white-coated scientists and public health officials who give assurances the odorless and tasteless compound is safe in the doses prescribed for water supplies.

The benefits, according to federal health officials, are fewer cavities in young children and teens.  Fluoride was first added to water supplies before it was widely available in toothpaste and other dental products — a point that resistance groups raise and federal researchers recently said means the target amount in drinking water should be decreased.

“Someone who is anti-fluoride has traditionally been sort of a crackpot,” said Rick Gersberg, professor of environmental health at San Diego State University.

As San Diego ramped up its fluoridation plan in recent months, he became curious about the negative health effects of the additive, which has been linked to bone fractures, bone tenderness and teeth pitting known as fluorosis — along with long-running questions about cancer.  The more he looked, the more skeptical he became that fluoridation was worth the risks.

“Maybe (opponents) were smarter than we thought,” Gersberg said. “Usually when a medicine is given, a doctor is controlling the dose.  Here, we don’t know who is getting it and how much they are getting and we don’t know how much they are getting in food and … and topical dental treatments.”

He’s not the only mainstream scientist to raise concerns in recent years. Scientific American magazine in 2007 wrote about health risks under the headline “Second thoughts on fluoride.”

Spirited debates flare up whenever cities or counties start fluoridation, like Escondido did seven years ago and an unsuccessful lawsuit was filed to stop it. Most of the region’s water agencies started delivering fluoridated water in 2007 when the Metropolitan Water District began putting the additive in its treated supplies at the rate of about 0.8 milligrams per liter.

Since then, there has been little talk about fluoride in the Helix Water District until San Diego’s initiative revived interest, said general manager Mark Weston. Even then, he said, “we have had less than five residents complain about our fluoridation practices in the last two months.”

More than 60 percent of U.S. residents — or roughly 200 million people — drink fluoridated tap water and most of them do so without giving it a second thought.  The Centers for Disease Control and Prevention listed water fluoridation as one of the top ten public health advances in the 20th century.

“Dentists are so excited about it,” said George Stratigopoulos, a dentist in Clairemont Mesa and board member of the San Diego County Dental Society. “It’s going to save a whole lot of time in my chair for a lot of people.”

Fluoride is a common substance that shows up naturally in most water supplies but typically at levels too low to have much benefit for dental health. It’s typically added to water as fluorosilicic acid, which the CDC said is derived from the production of phosphate fertilizers.

Fluoride was first intentionally put into public water supplies in 1945 in Grand Rapids, Mich. — something it touts online — and subsequent studies showed a decline in tooth decay, so the product spread rapidly.

Nine years later, San Diego residents voted in a special election to ban treatment of city water with “any fluoride compound.” San Diego’s wording remains, but the City Attorney’s Office said it has been superseded by a 1995 state law requiring water providers with more than 10,000 connections to fluoridate water supplies. The city was exempted from state law until outside funding was found.

Money came from First 5 San Diego in 2008, when the City Council accepted $3.9 million to install fluoridation systems at the city’s three water treatment plants.  The grant, paid for with tobacco-tax revenue, also will fund operations and maintenance for two years.

Federal health agencies say several studies over the decades show fluoridation to be “safe and effective for all community residents” — but skepticism surged in January when the U.S. Department of Health and Human Services proposed changing the recommendation, established in 1962, for the optimal fluoride level in drinking water to prevent tooth decay.

The proposed level, 0.7 milligrams of fluoride per liter of water, is at the lowest end the long-standing target range.  Agency leaders said the change was because Americans have access to more sources of fluoride in toothpaste and other items than they did in the 1960s.

“The prevalence of dental fluorosis has increased since the 1980s, but mostly in the very mild or mild forms,” the secretary of Health and Human Services said in January, adding that the agency also has seen an upswing in more severe forms.

Fluoride’s complicated nature is underscored at the state’s Office of Environmental Health Hazard Assessment in Sacramento, where scientists are assessing it for possible inclusion on the Proposition 65 list of chemicals known to cause cancer.

“Many chemicals can have beneficial health effects in some circumstances and cause health hazards in other uses,” said agency spokesman Sam Delson.

The Safe Drinking Water and Toxic Enforcement Act of 1986 doesn’t permit researchers to assess benefits — only whether substances cause cancer — and the agency is reviewing more than two dozen studies to answer the question for fluoride.