Fluoride is a mineral that occurs naturally in almost all foods and water
supplies. The fluoride ion comes from the element fluorine. Fluorine, the
13th most abundant element in the earth's crust, is never encountered in
its free state in nature. It exists only in combination with other
elements as a fluoride compound.
Fluoride is effective in preventing and reversing the early signs of
tooth decay. Researchers have shown that there are several ways through
which fluoride achieves its decay-preventive effects. It makes the tooth
structure stronger, so teeth are more resistant to acid attacks. Acid is
formed when the bacteria in plaque break down sugars and carbohydrates
from the diet. Repeated acid attacks break down the tooth, which causes
cavities. Fluoride also acts to repair areas in which acid attacks have
already begun. The remineralization effect of fluoride is important
because it reverses the early decay process as well as creating a tooth
surface that is more resistant to decay.
Community water fluoridation is the adjustment of the amount of the
beneficial trace element fluoride found in water to provide for the
proper protection of teeth. Fluoridation has been widely utilized in this
country since 1945. It does not involve adding anything to the water that
is not already there, since virtually all sources of drinking water in
the United States contain some fluoride. 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.
The protection of fluoridation reaches community members in their homes,
at work and at school -- simply by drinking the water. The only
requirements for the implementation of fluoridation are the presence of a
treatable centralized water supply and approval by appropriate decision
Some people believe that there are effective alternatives to community
water fluoridation as a public health measure for the prevention of tooth
decay in the United States. The fact of the matter is that while other
community-based methods of systemic and topical fluoride delivery (i.e.
school-based fluoride mouthwash or tablet programs) have been developed
over the five decades that water fluoridation has been practiced, none is
as effective as community water fluoridation and none is free from
financial constraints or other drawbacks. Alternatives to community water
fluoridation remain useful only for populations significantly isolated
from public water systems.
Nearly 145 million Americans are currently receiving the benefits of
optimally fluoridated water. With the 1995 enactment of Assembly Bill 733
in California, ten states and territories in the United States now
mandate fluoridation through legislation. Besides California, these
include seven other states (Connecticut, Georgia, Illinois, Minnesota,
Nebraska, Ohio and South Dakota), as well as the District of Columbia and
Puerto Rico. Three states (South Dakota, Rhode Island and Kentucky), as
well as the District of Columbia, have achieved the ultimate success with
100 percent of their treatable community water systems providing the
benefits of fluoridation to their citizens.
While safety has been an issue frequently raised by those opposed to
fluoridation, scientific data from peer-reviewed clinical research
provide overwhelming evidence that the adjustment of fluoride levels in
drinking water to the optimal level is undoubtedly safe. Hundreds of
studies on fluoride metabolism have tracked the outcomes of ingested
fluoride. Ingested fluoride essentially travels three metabolic pathways.
It is either excreted by the kidneys, absorbed by the teeth or taken up
in the skeleton.
At optimal levels fluoride has never been demonstrated to cause skeletal
fluorosis or other bone problems. On the contrary, there is mounting
evidence that continued exposure of individuals to low levels of
fluoride, as in optimally fluoridated drinking water, results in a
decrease in osteoporosis and a decrease in concurrent susceptibility to
vertebral fracture. Furthermore, there is no evidence of increased
morbidity or mortality from any disorder for those with lifetime
exposures to optimally fluoridated drinking water.
Those opposed to water fluoridation claim that exposure to fluoridated
water increases an individual's risk of suffering from several forms of
cancer. Again, the overwhelming weight of scientific evidence indicates
otherwise. Over 50 studies have evaluated the potential relationship of
water fluoridation and cancer mortality. None found any credible evidence
that exposure to water fluoridation is in any way related to an increased
risk of cancer in humans. A number of national and international
scientific commissions, after reviewing all of the available scientific
literature, also concluded that water fluoridation was safe and that it
in no way related to increased risk to humans of any form of cancer.
Finally, a 1990 study of fluoridated and fluoride-deficient communities
by the U.S. National Cancer Institute revealed no link between exposure
of any populations to fluoridation and the incidence of many different
types of cancer occurring in a 14-year period.
Mottled enamel or dental fluorosis has been claimed to be an indication
of the "toxic effects of fluoridation" by those opposed to fluoridation.
Technically, dental fluorosis is a developmental defect of enamel that
can occur when a higher than optimal amount of fluoride is ingested at
the same time as the stage of tooth development when enamel is being
formed. The severity of the fluorosis is directly related to the age of
the child at exposure, the type of exposure, the level of exposure, and
the duration of exposure.
It is important to note that fluorosis can only occur during the period
when teeth are developing. Once teeth have formed, fluorosis can no
longer occur. The mildest form of dental fluorosis may appear in about 10
percent of those exposed to optimally fluoridated water. Most mild to
moderate fluorosis occurs not from the ingestion of properly fluoridated
water, but from the unnecessary and inappropriate prescribing of fluoride
supplement tablets or drops for children in fluoridated areas and the
inappropriate ingestion of large amounts of fluoride-containing
toothpaste by young children not properly supervised during
toothbrushing. The presence of dental fluorosis at any aesthetic level is
not related to any other adverse conditions in humans, nor is there any
evidence to show that dental fluorosis is a precursor to any disease or
dysfunction. Mild to moderate dental fluorosis is no more a pathological
condition than is having freckles.
There has never been a single valid, peer-reviewed laboratory, clinical
or epidemiological study that showed that drinking water with fluoride at
optimal levels caused cancer, heart disease, or any of the other
multitude of diseases proclaimed by very small groups of
antifluoridationists to be caused by fluoridation.
Because fluoride is so effective, those fortunate enough to be provided
with fluoridated water can count on an up to 40- to 50-percent reduction
in the number of dental cavities they would have experienced without
fluoridation. Fluoridation is an extremely cost-effective public health
measure because the technology is so simple and the fluoride so
inexpensive. Studies indicate that a $100,000 investment in water
fluoridation prevents 500,000 cavities. Moreover, for each dollar
invested in fluoridation, over $80 in dental treatment costs are
prevented, amounting to an 80:1 benefit-to-cost ratio. Few disease
prevention efforts, public or private, achieve that level of return on