Monday, January 10, 2011

The Fluoridation Controversy Revisited

On January 7, 2011, for the first time in nearly half a century, the federal government has reviewed recommended fluoride levels in drinking water, and announced that they may recommend reducing (but not eliminating) such levels.  Apparently, kids are getting too much fluoride, as evidenced by the significant increase in dental fluorosis (tooth mottling) in teens since the 1980s.  Which should come as no surprise, since fluoride is found not just in drinking water, but also in toothpaste, some vitamin supplements, tea, processed foods and soft drinks made with fluoride-containing water, some bottled waters, and even the air we breathe.

Water fluoridation began in earnest in the early 1950s, after first being tried in 1945 in Grand Rapids, Michigan.  Today, the majority of communities in the United States currently fluoridate their water.  However, most European countries currently do not, and most of those that once did have banned the practice decades ago due to safety concerns.  While it is true that tooth decay rates have declined in the US since fluoridation was adopted, similar or even faster declines have been observed in countries that do not fluoridate.  Also, declines often began before fluoridation, and continued after stopping it.  Thus, the secular decline in tooth decay was most likely due to an increase in the use of fluoride toothpaste as well as improvements in general nutrition, as opposed to water fluoridation.  Which makes perfect sense, since it is now known that the benefits of fluoride are topical rather than systemic.

As for the potential risks associated with fluoridation, the statements by proponents of the practice have not been particularly reassuring.   Fluoride has been linked to several adverse health effects, some scarier than others.  While the jury is still out on many of these effects, evidence has been mounting for quite some time, and even the relatively weak version of the precautionary principle embodied in the Rio Declaration would seem to preclude continuation of deliberate water fluoridation in any amount.

There are also ethical issues to consider.   Mass-medicating the whole population with uncontrolled doses of a potentially hazardous substance without informed consent is generally viewed as violating basic biomedical ethical principles, to say nothing of civil liberties issues.

Since our founding in 2009, the TSAP has generally been neutral on the issue of water fluoridation.   However, in light of both past and recent evidence, we now recommend that a complete moratorium on the practice be put in place as a precautionary measure while the issue is studied further.

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