Fluoride Spokesperson Training

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					   Fighting for Fluoride

Principles, techniques and information
   for community water fluoridation

                   Jeff Album, Vice President
                 Public & Government Affairs
        Delta Dental of California, New York, Pennsylvania & Affiliates

 MediaRelations Principles And Effective
 Presentation Techniques

 Preparing   for the Opposition

 Understanding     & Framing the Public Policy
    (Time permitting)
   Media Relations Principles &
Effective Presentation Techniques
    Staying on Message                                   Media Relations Principles,
    (Stick, Bridge, Deflect)                      Effective Presentation Techniques

   Stick to 3 or 4 talking points. Always know and
    state the one you’re speaking to.
       Fluoridation is good public policy
       Fluoridation is safe
       Fluoridation works
       Fluoridation is cost-effective
   Bridge to those points in response to all questions.
       “That question goes to the heart of why Fluoridation is safe…”
   Deflect to your points, when questions are biased
    and/or “loaded.”
       “While I can’t respond to that, what I can say is this…” or, “You’re
        question is off base to begin with. What you should ask is… and the
        answer is …”
                                                            Media Relations Principles,
Don’t Bury Your Lead                                 Effective Presentation Techniques

   In conversation, many people tend to lead with lengthy support
    statements, followed by a summary that eventually takes them to an
    actual point.

   With media and/or in most formal public settings, start succinctly
    with your point, follow briefly with your support, and if time allows,
    restate your point to close.

   The media wants short, pithy sound bytes, not facts. In public
    forums as well, simple phrases offer better traction. Anti-fluoridation
    advocates often unravel because they ramble.

        The better-spoken speaker often wins hearts and minds, regardless of
         what they said.
                                                              Media Relations Principles,
    Stay in Charge                                     Effective Presentation Techniques

   Set the agenda, don’t wait for questions or play defense; shape the

   Preempt your opponent’s arguments
        “Fluoridation opponents will tell you it’s not safe, doesn’t work, and is
         forced medication. They will cite impressive sounding scientific sources,
         neglecting to mention why the medical and scientific community regards
         those sources to be flawed, out of date or taken out of context. Don’t allow
         these tactics to divert you from your talking points.”

   Appeal to your audience’s emotion/sense of caring
        After refuting an anti-argument, come back to the unmet needs of children,
         the human cost of dental disease, or the number of missed school and
         work hours caused by a preventable disease. Too many fluoridation
         advocates present their arguments in a clinical, detached fashion, which
         comes off as arrogant and aloof.
                                                             Media Relations Principles,
    Resist News “Bias”                                Effective Presentation Techniques

   Journalists are trained to report two sides to
    every controversy
       Do not acknowledge there is a bona fide “controversy” with the
        fluoridation issue
       Coverage of “controversies” confers equal weight to each side,
        leading undecided readers/viewers to conclude both sides are
        valid, and be against fluoridation “just in case.”
         • Plays into the hands of the anti-fluoridation tack, and speaks to why
           the anti’s raise so many different lines of attack.
Preparing for the Opposition
                                            Preparing for the Opposition
Know Their Arguments

 Most recent osteosarcoma & cancer issues
 EPA scientists statement / The NRC report
 FDA’s failure to certify fluoride as safe
       Toothpaste warning label and ADA advisory on infant
 Fluoride as a waste byproduct
 Fluoride only works topically
 Fluoride causes fluorosis
 Fluoride aggregate dosage from all sources not
  considered in 1 ppm
    Coping with                  Preparing for the Opposition

    Scientific Misrepresentation
   Internet is most common source of misinformation likely to be cited
    by your opponents.

   Actual/valid scientific findings are often cited, then taken out of
    context, and/or valid studies cited that used wrong dosage, wrong
    fluoride type, faulty methodology, or were non-juried.

   Advocacy Groups like “Environmental Working Group,” or the “EPA
    Union of Scientists” are cited as scientific sources, when they in fact
    do no science and forward a political agenda.
                                                           Preparing for the Opposition
Fighting the “Credibility War”
   Opponents will cite various research articles, noted
    health experts and other “facts” gleaned from various
       Impossible to respond to every citation raised. Antis can publish any
        claim they want, while scientists and public health advocates feel bound
        to respect scientific method and juried review.
       Best not to pretend to be a scientist and point out when your foe is not
        either; find ways to question the credentials of the person presuming to
        present or relay “scientific” evidence. Defer questions of science to
        respected fluoridation experts available to field calls and inquiries.
       You can also defer to the last three U.S. Surgeon Generals, the U.S.
        Center for Disease Control, the World Health Organization and any
        other recognized, health and science authority with published
        statements in support of the efficacy and safety of community water
Understanding & Framing
   the Policy Debate
                                       Framing the Policy Debate
    Two Scenarios

   When you boil down all the arguments for and
    against community water fluoridation, the most
    reasonable assertions from either side support
    one of two possible public policy choices.
    These choices are either based on:
     1. Personal Responsibility; or
     2. Community Responsibility

   The philosophical grounds for fluoridation is
    based on the notion of community
    responsibility to mitigate the community/
    societal costs of dental disease.
Scenario 1:
Personal Responsibility and Informed Choice

Under this scenario, your town/region would opt not to fluoridate the
drinking water because those who want fluoride can get it on their own, for
example from fluoridated toothpaste, fluoride supplements and dentist
office treatments. In this scenario individuals are trusted to make use of
available information and take responsibility for their own oral health.

People who support this scenario are concerned about the potential
dangers of fluoridation. They view science and experts with a healthy
skepticism; they question the scientific evidence for fluoridation, and they
fear that adding more chemicals to the water supply may have long-term
consequences that experts do not yet understand. They believe that even
if the risks are small it is better to be safe than sorry. They feel that
people should be trusted to make their own choices, instead of having to
accept a form of involuntary medication that tampers with nature and
people’s bodies.
Arguments in Favor of Personal
Responsibility and Informed Choice
Choice and Community
    People should take responsibility for themselves and their children.
    We need to respect people’s right to opt out if they have concerns about
     fluoridation. People who want fluoride treatments can get them on their own.
    Government should not be in the business of forcing mass medication on the
Science and the Environment
    Fluoride is a poisonous chemical – we should not add it to our water supply.
    We should be wary of interfering with nature. There has been enough damage.
    Why pour fluoride onto our lawns, or use it to wash our cars?
    Some dentists and scientists do not support fluoridation. If scientists can’t all
     agree, we should not be acting until their differences are settled.
    This option costs nothing.
    The status quo works fine for most people.
Policy Implications & Facts
Useful Things to Know to Help Refute

Most area residents are exposed to small amounts of fluoride today

     Most water supplies naturally contain about 0.2 - 0.4 ppm of fluoride. (Find out what
    your levels are)
     Packaged foods and drinks processed in fluoridated areas contain some fluoride.
     Most people use fluoridated toothpaste.

Most dentists agree that fluoridated toothpaste alone won’t give people the level
of fluoride needed for optimal protection. For optimal effect, residents can use

     Fluoridated mouthwash (cost/year)
     Fluoridated bottled water (about $450/year for a family of 4 [delivered])
     Dentist office treatments (cost/year)
     Fluoride supplement tablets for children (available with a doctor’s prescription)
Policy Implications & Facts
Useful Things to Know to Help Refute

  Too much fluoride has widely acknowledged and completely controllable risks:

        Young children swallowing too much can develop enamel fluorosis, leading to
       mottling. Health experts consider this a cosmetic issue. 25% of children in the US
       have some enamel fluorosis and only 1% have visible stains on the teeth.
        Fluorosis is almost always caused by swallowing toothpaste (contains 1000 ppm
       of fluoride) or misuse of supplements.
        In U.S., fluorosis does not occur more frequently in fluoridated areas.
        Some suggest fluoridated water is associated with health problems including
       cancer, osteoporosis and kidney disease. Studies do not bear this out.

  Tooth decay has declined significantly in the U.S. over the last 50 years. Most experts
  attribute this to fluoridation in water and in toothpaste. In 2004, more than three-quarters
  of Americans (78%) said they brush their teeth twice a day, and 50% said they floss.
Arguments Against Personal
Responsibility and Informed Choice
Choice and Community
    We’ve educated people about taking care of their teeth for decades, yet tooth decay
     is still epidemic. Something must be done.
    Individual rights are important, but the greater good of the community comes first,
     especially when there is little potential harm and great potential gain.
    Most of us lead very complicated lives already – we should make things easier for
     people where we can. Making young children take fluoride supplement tablets is
     difficult – many parents would just as soon skip the aggravation.

Science and the environment
    Fluoride at the right dosage benefits our health by preventing tooth decay.
     Fluoridated drinking water comes nowhere near levels known to cause problems.
    Fluoride is already found in nature; some cities’ water are naturally fluoridated.
     There is no reason to believe it will be harmful.
    There is no evidence that fluoridated water harms the environment. Lawns,
     gardens and wildlife are fine in fluoridated communities.
    Science is almost never unanimous. There is more agreement about fluoridation in
     the scientific community than about any other public health measure.
Arguments Against Personal
Responsibility and Informed Choice
    Reducing tooth decay in our community will save us money in the long run.
     Decay drives up everyone’s dental bills, employer’s dental insurance costs, and
     drives up everyone’s taxpayer expenses for publicly supported insurance
     programs (federal Medicaid and State Children’s Health Insurance Program).
    Dental disease leads to lost productivity and reduced earning potential for many
     members of our community.
Scenario 2:
Rely on Community Responsibility and Science-Based Policies

Under this scenario, your area’s drinking water should be fluoridated so
that everyone – especially the young, the old and low-income families –
receives at least one of the basic components of good oral health. In this
scenario, your community as a whole is acting to improve oral health for
all its residents, and sparing the community as a whole the expense of
treating dental disease through government supported programs.

People who support this scenario understand that adding fluoride to the
community’s drinking water is a cost-effective, scientifically supported and
safe way of preventing tooth decay. They trust the scientific evidence in
support of fluoridation, and they feel that the community should take
advantage of a technology that has improved the lives of millions of
Americans over the last 50 years. They feel that the community has not
only the right but the responsibility to make such decisions for the greater
good, even if some people object.
Community Responsibility
and Science-Based Policies
Useful Things to Know in Support

 Most dentists and public health experts say adding fluoride to the drinking water is the
most effective way to prevent cavities because everyone – even people who don’t go to
the dentist or take good care of their teeth – gets optimal doses of fluoride throughout
the day.

     • Dental health experts say that there would be significantly fewer cavities if fluoride
     levels were raised to 0.8 ppm, which remains low enough to avoid unwanted side
     effects, even with other fluoride sources accounted for.

Fluoride is added to drinking water at the treatment plant, at the same time as chlorine
and various other additives. Adding fluoride is no different then adding these other
chemicals to promote the common good.

Water quality is monitored to make sure it meets clean water standards.

The water will look, smell and taste the same as it does now.
Community Responsibility
and Science-Based Policies
Useful Things to Know in Support

  Communities that have introduced fluoridation in recent years have
   seen a 30-60% drop in tooth decay among young children and a 15-
   35% drop in decay among teenagers and adults.

  Children and adults will still need to use fluoridated toothpaste and
   visit the dentist in order to maintain the best oral health.

  Children who currently take fluoride supplements will no longer need
   the extra fluoride. They will need to stop taking supplements in
   order to reduce their risk of developing enamel fluorosis.
Arguments in favor of Community
Responsibility and Science-Based Policies
Choice and Community
    This simple step improves everyone’s health without people having to think about it
     or change their daily lives in any way.
    The community has a responsibility to use all reasonable means to improve the
     health and well-being of its members, especially the most vulnerable.
    Under this scenario, everyone, and especially the young, the old and the medically
     underserved receive one component of good oral health: fluoride.

Science and the environment
    Water fluoridation has been in practice for over fifty years, providing plenty of time
     and opportunity to study risks to both health and environment. None observed.
    Fluoride occurs naturally in our water; community water fluoridation is only the
     slight adjustment of naturally occurring element to obtain the maximum benefit.

    Fluoridating the drinking water is most cost-effective way to reduce tooth decay –
     costing households only fifty cents a year.
    One filling costs roughly the same as fluoridating water over a lifetime for a single
     resident. Every $1 spent on fluoridated water saves almost $40 in treatment costs.