KGNU Boulder Denver asked me to interview anti-fluoridation advocate, Paul Connett, when he was invited to Lafayette, Colorado to testify in favor of removing fluoride from the city’s water. Connett is the author of The Case Against Fluoride. I invited Boulder County public health officials to be on air at the same time as Paul Connett, and they declined, basically saying they had been warned that Connett is an experienced debater, and as public health officials, they would sound silly by comparison. So I talked ahead of time with a public health dental expert to hear why he believes fluoridation is important, and then served as the Devil’s advocate, for interviewing Connett.
Just caught the last 15 mins on fluoride this morning…great show! – M
FOLLOW-UP WITH THE COLORADO HEALTH DEPARTMENT – Here is a written reply to followup questions regarding Paul Connett’s interview and key points:
SHELLEY – Are there valid studies in other countries indicating that excess fluoride can affect brain function, and have those studies been checked out in the U-S?
COLORADO HEALTH DEPARTMENT: Mr. Connett’s references are studies that were mainly conducted in China, India and Mexico. Most of the studies Mr. Connett refers to were compiled in the Harvard paper entitled Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis by Choi et al. While there was data demonstrating a 1 point IQ difference in fluoridated vs non-fluoridated areas, there are several very important factors that must also be considered: the natural fluoride content in the areas the studies were conducted was far higher than is allowed in any community water system in the United States (about 10 times higher) and even less than is maintained by communities who add fluoride for the prevention of tooth decay, researchers did not find the same differences in adult IQ in these areas, there are concerns surrounding the data collection in the studies, the studies did not account for other factors that can greatly influence IQ such as heavy metal pollution, dietary deficiencies, and poverty, and the studies were available only in Chinese making it difficult for the average researcher to evaluate the studies for reliability and validity. Other sources cited by Connett are mainly referenced in the magazine Fluoride which is not peer-reviewed, cited by Pub-Med, or referenced in medical or dental libraries. Please note as well that the Harvard Deans released a letter of support for community water fluoridation after this paper was released further demonstrating the questionable scientific validity of the study and the applicability of any findings to the United States.
Community water fluoridation has been practiced in the United States for over 65 years and studies have and continue to demonstrate the safety and efficacy of this public health practice.
SHELLEY - Is it true or not that World Health Organization (WHO) studies indicate that areas/countries that use fluoridated water and those that don’t BOTH have a reduction in cavities, with no significantly better rate of cavity reduction in areas that do use it?
COLORADO HEALTH DEPARTMENT – It should first be clarified that fluoride is a natural mineral that is present in all water sources. Some areas have too much and some have levels too low to reduce dental cavities. To imply that there are areas that do not have any fluoride is inaccurate. The very simple statement Mr. Connett selectively quoted from information provided by WHO illustrates misconceptions in oral health and access to care around the world. Please note that WHO supports community water fluoridation as a public health measure to reduce dental disease.
Community water fluoridation creates something called the halo effect which means that products made in areas with optimal fluoride levels that are consumed in areas with inadequate fluoride levels provide a benefit to the population who does not also have the benefit of optimally fluoridated water. That, in addition to fluoridated toothpaste and dental care, leads to a reduction in cavities.
There are many countries noted in the information provided by Mr. Connett that provide fluoride via salt or milk. Even more than that have universal health care which includes dental care. Access to regular preventive care is another important factor in reducing dental cavities.
It is inaccurate to state there is “no significantly better rate of cavity reduction” in areas with inadequate fluoride levels in such a broad statement. Individual countries and the other factors (such as universal dental care) should be considered when comparisons are made. If this were true, WHO likely would not recognize the effectiveness of this public health practice.
SHELLEY - What about Connett’s contention that in an age when fluoridated toothpaste is widely available, fluoridated water might be obsolete?
COLORADO HEALTH DEPARTMENT – Studies show that community water fluoridation prevents at least 25 percent of tooth decay in children and adults, even in an era with widespread availability of fluoride from other sources, such as fluoride toothpaste.
Optimal reduction in dental cavities can be reached when fluoridated water is consumed, fluoridated toothpaste is appropriately used, routine preventive dental care is provided, and dietary habits are optimal.
In addition to providing a significant reduction in cavities on top of using fluoridated toothpaste, community water fluoridation does not require any behavior change or effort on behalf of the individual. The benefits are realized simply by drinking the water. To rely solely on fluoridated toothpaste assumes that the individual will brush their teeth and use the appropriate amount of fluoridated toothpaste at least twice a day. It also provides exposure of the tooth surface to fluoride only when the teeth are brushed rather than throughout the day as drinking water does. Fluoride has been found most effective when the tooth surface receives frequent exposure to small amounts of fluoride which is what happens when drinking optimally fluoridated water.
SHELLEY - How about low income mothers using infant formula? Are they encouraged to use distilled water?
COLORADO HEALTH DEPARTMENT – No. The ADA continues to recommend that “parents and caregivers of infants who consume powdered or liquid concentrate infant formula as the main source of nutrition, they can suggest the continued use of powdered or liquid concentrate infant formulas reconstituted with optimally fluoridated drinking water while being cognizant of the potential risks of enamel fluorosis development.”
As Ms Schlender also discussed during her interview with Mr. Connett, enamel fluorosis is a cosmetic concern that may cause some slight white spots on the enamel but also presents with harder enamel that has been found to be less prone to cavities. These white spots are often not visible to the untrained eye. Severe enamel fluorosis is damaged enamel and is extremely rare in the United States and has not been found to be caused by optimal levels of water fluoridation.
If parents who are using infant formula are concerned about enamel fluorosis, they can certainly use distilled or filtered water or they can alternate between optimally fluoridated and filtered water to still provide some benefit to the developing teeth.