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  Pockets of Anti-Fluoridation Sentiments Persist Despite Widespread Public Health Acceptance and Promotion

Despite dramatic improvements in the nation's dental health, a 50-year safety record and recognition from the U.S. Centers for Disease Control and Prevention (CDC) as one of the 10 greatest U.S. public health achievements of the 20th Century, fluoridation of public drinking water remains a contentious issue in some U.S. communities.

Several communities, including parts of western Maryland and Utah, increasingly are challenging local government decisions to add fluoride to water systems as a cost-effective means to reduce cavities among children and tooth decay among the general population. Arguments against fluoridation range from alleged adverse health effects to an infringement of free choice. Nevertheless, just more than 60 percent of Americans live in communities supplied with fluoridated water, including 43 of the country's 50 largest cities. But, widespread acceptance has not curtailed critics.

The controversy surrounding fluoridation began only a few years after Grand Rapids, MI, in 1945, became the first city to test the hypothesis that exposure to fluoride in water reduces incidence of cavities. The results were significant. In the participating communities, the reduction of cavities ranges between 40 percent and 60 percent. By 1950, however, at the height of the Cold War, fluoridation was labeled by some opponents as part of a communist plot.

Still, organizations such as the American Dental Association (ADA) endorsed (and continue to endorse) fluoridation, and the practice of adding water to public systems spread. Today, more than 90 professional health organizations support fluoridation of drinking water as a safe, inexpensive and effective public health initiative that reaches people of all ages and socioeconomic strata.

In fact, in August, CDC released its report "Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States," which credits fluoridated drinking water for dramatic reductions in tooth decay and recommends that U.S. drinking water systems include fluoride levels at roughly one part per million "as an efficient strategy to reduce dental disease among Americans." The report estimates that about one-third of the U.S. population does not currently receive adequate amounts of fluoride from public drinking water.

Fluoride is naturally present in most water sources that are used for drinking water supplies. Fluoridation merely adjusts the amount of fluoride to an optimal level to provide for protection of teeth. The American Dental Association notes, "Fluoridation is a form of nutritional supplementation that is not unlike the addition of vitamins to milk, breads and fruit drinks; iodine to table salt; and both vitamins and minerals to breakfast cereals, grains and pastas."

Fluoride is not the first substance to be added to drinking water for public health reasons. In the United States, chlorine has been added to most water supplies for nearly 100 years, resulting in the virtual elimination of waterborne diseases such as cholera, typhoid, dysentery and hepatitis A. Both the fluoridation of drinking water and the control of infectious diseases (in part, due to the chlorination of drinking water) were cited by the CDC as two of the ten greatest public health achievements of the 20th Century.

The average cost of fluoridation is about 50 cents per person per year, although costs can run higher. Proponents argue that this cost is a small price to pay for the health benefits. "In the years 1971-1974, 74 percent of children six to 17 years old had one or more cavities in their permanent teeth. By the period 1988-1994, the percentage had dropped to 46 percent." [Where the Public Good Prevailed, Stephen L. Isaacs and Steven A. Schroeder, The American Prospect Magazine, June 4, 2001.]

Scientific evidence shows no correlation between fluoridation of drinking water and adverse health outcomes. The ADA cites extensive research demonstrating that fluoridation does not increase the incidence or mortality rate of any chronic condition, including cancer, heart disease, intra-cranial lesions, nephritis, cirrhosis, and Down Syndrome.

Yet, anti-fluoridation sentiment persists. Fluoridation opponents argue that fluoridation is no longer necessary, as people now are exposed to fluoride through their diet, dietary supplements, toothpaste and other oral hygiene products. In Utah, with the least fluoridated water in the country-only two cities, Brigham City and Helper, currently fluoridate their water-opponents in several locales have successfully prevented fluoridation, charging that fluoride is a dangerous toxin that should not be forced upon water users. However, voters in Davis and Salt Lake counties in Utah recently approved adding fluoride to the public water supply.

In western Maryland, where residents suffer from the worst rates of tooth decay in the state, opponents have successfully kept fluoride out of the water for 40 years. They allege fluoride causes a variety of serious illness including brain and kidney damage, cancer and Alzheimer's disease. In response, dozens of area dentists have formed a group known as the Fluoride Dream Team, which successfully persuaded officials in Frostburg and Cumberland to fluoridate water supplies.

Interestingly, despite "anti fluoride" pockets across the nation, some bottled water producers are beginning to market the presence of fluoride in their products. For example, Danone Waters of North America, Inc. now offers "Danon Fluoride To Go," fluoridated and bottled spring water to "help [kids] build strong teeth every day."

The recent CDC report, based on a study prompted in part by the widespread availability of bottled water, recommends that the U.S. Food and Drug Administration (FDA) require bottled water products to include labels with fluoride concentrations. Current FDA regulations do not require producers to list fluoride on the label.

Though widely considered a proven public health benefit, fluoridation remains a controversial matter in parts of the country. Several factors - including potential bottled water labeling requirements, periodic ballot initiatives, and continued government oversight - indicate that fluoridation will continue to be both a timely and divisive issue.

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