FREQUENTLY ASKED QUESTIONS
What is fluoride?
Does fluoride really help in preventing cavities?
Why not just go take care of your teeth and see your dentist?
Is this all about children?
So how did people discover fluoride was helpful in reducing cavities?
How does fluoride really work?
Why are some people scared of fluoride in drinking water?
How do I know fluoridated water is safe?
Who is responsible for the safety of public waterthe Federal Drug Administration or the Environmental Protection Agency?
What about arsenic? Doesnt the level of arsenic increase when fluoride is added to the water?
Can some things be both therapeutic and toxic?
What are the adverse effects of fluoride?
Who has fluoride added to the community water system?
What happens if a community stops adding fluoride to the community water system?
What can I do if I live in a community with fluoridated water but I dont want to drink it?
Isnt what I want in my water a matter of personal freedom?
Why is fluoride so controversial?
What are the alternatives to water fluoridation?
Is fluoride REALLY safe?
Why does a toddler get the same dose of fluoride as an adult in water?
Can my kids drink too much water in a dayfor example when playing soccer on a hot dayand get sick?
Why is fluoride listed as a contaminant in a City Water Report?
How am I supposed to make baby formula since youre not supposed to use fluoridated water for infants under six months of age?
Is fluoride REALLY safe?
Is fluoride REALLY cost effective?
Is fluoride REALLY equitable?
I need more fluoride in my water. What do I?
What is fluoride? (Back to Top)
Fluoride is a naturally occurring element. It is found in rocks and soil everywhere, in fresh water and ocean water. In fact, waters in and around the United States have natural fluoride levels that range from 0.1 parts per million to over 12 parts per million.
Does fluoride really help in preventing cavities? (Back to Top)
Initial studies showed a 60% reduction in caries in fluoridated communities (communities which had appropriately adjusted fluoride to the water source). More recently, the benefit appears to be 30-40%. The difference may be attributed to use of fluoridated toothpaste and the prevalence of fluoridated water in packaged foods and beverages.
Preventable oral diseases afflict the majority of Californias underserved children.
Children from low-income and minority backgrounds bear most of the unnecessary burden of pain, suffering, and compromised dental health.
Fifty-five percent of all California children have untreated tooth decay. Among racial and ethnic minorities, 66% of 6-8 year-old Hispanic children, 60% of Black children, and 71% of Asian children have untreated decay.
Twenty-seven percent of California preschool children have untreated tooth decay and 9% are in need of urgent dental treatment.
Tooth decay begins when children are less than 1 year old, and almost all of it goes untreated in this population.
In Humboldt County, the number of school days missed due to oral pain translates to four children missing an entire year.
Water Fluoridation is Cost Effective
California families can benefit from this safe and effective public health measure for less than 50 cents per person per year!
Current Costs of Oral Disease:
Cost of one filling $140
Funds lost per school day (ADA) $ 26
Yearly Cost to the State of California (Denti-Cal) $700 million
Cost of fluoridating Arcata Water
= 50 cents per year per person
Just $2 for a family of four!
The cost of prescription fluoride:
Supplemental tablets= $3-4/month or $36- $48 per year PER CHILD
Supplemental liquid drops (for children under 3)= $8-9/month or $90-$108/year
*It should be noted that the food & drug administration (FDA) approves all of these substances
Why not just go take care of your teeth and see your dentist? (Back to Top)
Thats an excellent question. Unfortunately, oral care isnt as easy as just take care of yourself and see a dentist for some people, including many children, the disabled, and the poor. Dental disease is now known to be an infectious disease- if a person has a significant amount of a specific bacteria, strep mutans, they will be at a much higher risk for developing tooth decay than someone who does not have this bacteria in their mouth. And while having this specific bacterium does not doom a person to lifelong tooth decay, they will most certainly need to have very careful oral hygiene to avoid decay. Now take this knowledge and apply it to a child; a child needs parents who diligently and actively participate in their childs oral care--- this means the parent brushing the childs teeth twice a day from when the first little tooth appears until school age... and then monitoring the child as he brushes his teeth twice a day until at least eight years old. Without this dedication to their childs oral health, some children, especially poor children, are at risk for decay. We know from national, state, and local Humboldt County studies that 80% of dental decay is in children who are poor. Unfortunately, we have a lot of poor kids in Arcata.
Now to address why not just go to your dentist. For a variety of reasons (and without pointing fingers at the dental profession) there are simply very few dentists who can take patients under the Denti-Cal program which is the dental part of Medi-Cal. The majority of dental facilities which accept Denti-Cal reimbursement are the Community Dental Clinics and they frequently are so overwhelmed with the community need that there are long waiting lists or they are may not be able to take new patients at all. For a very young child, the clinics may simply not be able to offer the services necessary to treat dental decay due to the childs age. This leaves very few local resources to treat extensive decay or oral disease in a young child.
Is this all about children? (Back to Top)
No, although children most certainly gain huge benefits from having access to fluoridated water while their teeth are developing. Teens, adults, and especially older adults continue to benefit from community water fluoridation. With neglected or poor oral health, an adult is at risk for root cavities, especially senior citizens. Water, which has appropriate levels of fluoride, decreases the risks of this specific type of cavity and thereby alleviates pain, suffering, and expensive dental treatment.
So how did people discover fluoride was helpful in reducing cavities? (Back to Top)
Prior to 1945, as series of epidemiologic and laboratory studies confirmed the association between the environment (naturally-occurring fluoride concentrations of water supplies) and the health and cosmetic appearance of the teeth. Where the fluoride level was low there was a high prevalence of dental caries, yet where the fluoride level was high there was a low prevalence of dental caries but a high prevalence of dental fluorosis/enamel mottling. This led to the concept of creating an ideal environment for optimal dental health through adjusting the naturally occurring fluoride level to about 1 part per million. Remember, fluoride is a naturally occurring element found in rocks, soil, fresh water and ocean water.
How does fluoride really work? (Back to Top)
Topical fluorides strengthen teeth already present in the mouth. Fluoride is incorporated into the surface of teeth making them more decay-resistant. Fluoridated drinking water probably has a topical effect as well as a systemic effect. Systemic fluorides can give topical protection because ingested fluoride is present in saliva, which continually bathes the teeth. Fluoride is incorporated into the tooth surface to prevent decay. Fluoride also becomes incorporated into dental plaque and facilitates further remineralization. It reduces the solubility of tooth enamel in acid. It reduces the ability of plaque organisms to produce acid. Adults may also benefit from fluoridation, particularly those with receding gums, which expose the tooth roots that are particularly susceptible to decay. In addition to reducing tooth decay, water fluoridation prevents needless infection, pain, suffering and loss of teeth; improves the quality of life; and saves vast sums of money in dental treatment costs.
The magnitude of the effect depends on a lot of factors.
A sizable population of Arcatans falls into the category of increased vulnerability with poor access to professional prevention and treatment. The poor, uninsured, the elderly and the disabled, along with children would stand to benefit especially form universal exposure to community water fluoridation.
Why are some people scared of fluoride in drinking water? (Back to Top)
Some Arcata residents have raised questions about the safety and efficacy of water fluoridation, exhibiting fear and concern. This is a legitimate question to assist a community understand the pros and cons of preventative public health measures. It may be that some people have concerns based on extrapolation of experimental data using relatively large doses of fluoride and accounts of environmental pollution from industry like steel and zinc production and uranium extraction. These are at exposures significantly greater than optimum water fluoridation. It is likely that there have been "cover ups" about worker and community adverse effects from industrial exposure from fluoride from the 1950s and 60s. There is no such "cover up" about the safety of water fluoridation, nor is one necessary. Environmental concerns about pollution are legitimate; safety concerns about drinking water are not.
The Humboldt- Del Norte Medical Society Executive Committee has reaffirmed its position in support of water fluoridation as a safe and effective measure. Many other scientifically valid organizations also recognize the importance of water fluoridation, such as the Centers for Disease Control and Prevention, American Dental Association, World Health Organization, and American Academy of Pediatrics.
Locally, the following groups have taken a stance in support of community water fluoridation:
California Conservation Corps
Humboldt Child Care Council
Humboldt Del Norte Dental Society
Open Door Health Centers
Six Rivers Dental Hygiene Component
Northcoast Children's Services
How do I know fluoridated water is safe? (Back to Top)
Over 50 years of research and experience have shown that fluoridation at optimal levels does not harm people or the environment. Leading scientists and health professionals, numerous professional organizations, and governments around the world support community water fluoridation.
Who is responsible for the safety of public waterthe Federal Drug Administration or the Environmental Protection Agency? (Back to Top)
The Clean Water Act of 1974 and subsequently amended gives the Environmental Protection Agency the authority to regulate drinking water standards, including the addition of fluoride. The FDA does not have this authority, although they have approved fluoride supplements and toothpastes as being safe and efficacious in reducing dental decay.
According to the EPA Fact Sheet Fluoride in Drinking Water, the Maximum Contaminant Level Goal (MCLG) and Maximum Contaminant Level (MLG) standards were promulgated in 1986; both limits were set at 4ppm (or 4 times the level used for drinking water). The fact sheet goes on to say that based on the NAS [National Academy of Sciences] review and other studies, there are no data available at this time to conclude that the fluoride in drinking water standards should be revised. This is bureaucratic jargon for the levels are safe for human beings.
What about arsenic? Doesnt the level of arsenic increase when fluoride is added to the water? (Back to Top)
This is a red herring. Studies done on sources of fluoride used for fluoridation show that there is NO arsenic in the vast majority of samples. In the few samples where arsenic was detected, it was found to be within the accepted limits for arsenic in water. Many sources of ground water have small amounts of naturally occurring arsenic. According to the EPA, it is neither practical nor necessary to remove every last molecule of most contaminants to ensure safe drinking water.
Can some things be both therapeutic and toxic? (Back to Top)
Yes. Health care professionals are familiar with the notion that a substance can be therapeutic at one level, yet toxic at a higher dose. This notion is key to understanding water fluoridation. Iodine is an excellent example. It is a toxic substance and can even be used to kill bacteria in higher concentrations, but it is added to table salt to prevent thyroid problems. In the case of fluoride, one would have to drink 100 liters (about 25 gallons) of water to get a toxic dose. Fluoride ingested in low doses is either used and deposited in bones and teeth, or excreted by the kidneys. It does not accumulate in the body.
What are the adverse effects of fluoride? (Back to Top)
Scientific literature does not support the claims that fluoride adversely affects the immune system, collagen, glucose metabolism, the integrity of genetic material, causes, attention deficit disorder, Alzheimer's disease, osteoporosis, cancer or AIDS, aggravates kidney disease or hypothyroidism. Anti-fluoridationists and anti-fluoride websites cite "scientific articles", most of which have methodological problems:
They are not from reputable peer-reviewed journals and are not obtainable through a medical or dental library
They do not deal with the fluoride compounds that are actually used to fluoridate water
They study exposure levels way above that possible at 1 ppm dilution of fluoridated water
They inappropriately try to extrapolate data from poorly designed animal or bench-top research with no relationship to the levels of fluoride in drinking water
Severe cosmetic or dentally injurious fluorosis of teeth or skeletal fluorosis is seen in some people growing up in areas with natural fluorides in 8 to 20 times the concentration as Arcata water. This leaves a wide safety margin for individual consumption.
Legitimate epidemiological studies have not detected health risks to water fluoridation at 1 ppm.
Since community water fluoridation was introduced in 1945, more than 50 epidemiologic studies in different populations and at different times have failed to demonstrate an association between fluoridation and the risk of cancer. Mild dental fluorosis (mottling of tooth enamel) can occur, particularly if a child also uses fluoridated toothpaste, but fluorosis does not weaken teeth. Skeletal fluorosis, which is a serious health problem, does not occur from drinking water, but can be an occupational and environmental health risk in the proximity of industries that utilize large amounts of fluoride. In contrast, the benefits of water fluoridation are great and easy to detect.
A very thorough survey of many US adults (using xrays and clinical diagnoses) found virtually no skeletal fluorosis in a population exposed for many years to natural fluoride in local water at 20 ppm (which is 20 times the recommended concentration). By comparison, in other countries there is fairly common skeletal fluorosis at concentrations half of that (but still 10 times more than in fluoridated drinking water). Clearly other factors must be operative.
Who has fluoride added to the community water system? (Back to Top)
Over 300 million people in more than 40 countries worldwide enjoy the benefits of fluoridated water. In the United States, approximately 145 million people in more than 10,000 communities benefit from drinking fluoridated water. Arcata and the Jacoby Creek area water has been fluoridated for 40 years and currently uses a granular sodium fluoride. The cities of Eureka, Scotia, and Hoopa also fluoridate their water. Water in the rest of the county is not fluoridated.
What happens if a community stops adding fluoride to the community water system? (Back to Top)
Antigo, Wisconsin, discontinued water fluoridation in 1960. By 1965, 2nd grade children had 200% more tooth decay, and 4th graders had 70% more. Antigo reinstituted fluoridation. Studies in other communities show similar results.
What can I do if I live in a community with fluoridated water but I dont want to drink it? (Back to Top)
Water filters are available whereby individuals can de-fluoridate their water, or they could drink distilled water.
The amount of fluoride your family receives depends on the type of home water treatment system used. Steam distillation systems remove 100% of fluoride content. Reverse osmosis systems remove between 65% and 95% of the fluoride. On the other hand, water softeners and charcoal/carbon filters generally do not remove fluoride. One exception: some activated carbon filters contain activated alumina that may remove over 80% of the fluoride.
Isnt what I want in my water a matter of personal freedom? (Back to Top)
Some people against water fluoridation feel fluoridating a community water supply impinges on their personal freedom. They feel they are "medicated against their will." In fact, filters are available whereby individuals can de-fluoridate their water, or they can drink distilled water. Furthermore, participation in civil society in Humboldt County involves numerous examples where public policies are initiated for the common good, considering that the risks to an individual are absent or minimal. The law requiring use of helmets by motorcyclists "infringes on personal freedom" to protect society from the burden of caring for an injured individual. Vitamin D is added to milk, iodine is added to table salt and folic acid is added to cereals to prevent diseases arising from nutrient deficiency states. Immunizations are required for children to attend school. Children who cite religious beliefs to be exempted from immunizations would not be free to attend school if they were exposed to measles, however. Fluoridation is considered by the public health community to be one of the top 10 effective public health measures of the 20th century and the courts, either in direct judgments or on appeal, has universally upheld this view.
Why is fluoride so controversial? (Back to Top)
While the opponents to community water fluoridation may be well intentioned, there is no scientific basis on which anti-fluoridationists base their claims. There is no credibility within the scientific community to support the scare tactics or faulty research used in the literature which opponents to community water fluoride use. Those who would benefit most from treating the rampant decay caused by non-fluoridated water are the biggest proponents for fluorides removal from public water. The overwhelming majority of medical and dental practitioners in our community have indicated their support of retaining fluoride in our community water supply.
What are the alternatives to water fluoridation? (Back to Top)
There is nothing that is as inexpensive, equitable, easy, and effective as water fluoridation.
Fluoride tablets - expensive, dosing everyday is a challenge for busy families, not as good as water fluoridation since topical exposure is very limited.
Fluoride toothpaste - good for topical exposure, but it does not work systemically since it is spit out.
Fluoride mouth rinse - must be prescribed by a DDS (or MD), but if you cant get access to a DDS you wont get access to mouth rinse. It has the same problems as fluoride tablets. MDs do not prescribe this.
Topically applied high dose fluoride (Fluoride varnish or a "fluoride treatment") must be applied by a dental or medical professional. Again, access to dentists is extremely limited for low-income children and even more so for preventive services.
Is fluoride REALLY safe? (Back to Top)
Fluoride has been extensively studied for many years and it is right that it is constantly being re-evaluated so we have current data and analyses. Consistently, researchers from numerous different disciplines (physiology, toxicology, medicine, dentistry, public health, nutrition) have lines of evidence and analysis that all come to the same conclusionsfluoride is safe, effective, and cost effective in communities like Arcata.
What are the effects in the Arcata Marsh with the city water being fluoridated?
A study was done to investigate whether fluoride was accumulating in the marsh and there was no sign of fluoride accumulation in the Marsh. In fact, the father of the Marsh Project, Bob Gearhart, is strongly in favor of maintaining Arcatas community water fluoridation.
Why does a toddler get the same dose of fluoride as an adult in water? (Back to Top)
The concentration of fluoride in water is the same for everyone. Concentration is not the same as dose. The dose is the concentration multiplied by the amount consumed. Clearly, a toddler does not drink the same amount of water as an adult and hence the dose that the toddler gets is far less than that for an adult. The concentration of fluoride in drinking water is carefully adjusted based on such things as climate (people in warm climates drink more than those in cold).
Can my kids drink too much water in a dayfor example when playing soccer on a hot dayand get sick? (Back to Top)
For a toddler to have a toxic acute overdose of fluoride, the child would have to ingest about 80 fluoride chewable tablets. For a similar age child to become toxic from fluoridated water ingestion, the child would have to drink about 20 gallons of water. Compare this with the toxic effects of iron where a small child would ingest 10 to 20 childrens chewable vitamins with iron or about 4 adult therapeutic iron pills to experience acute symptoms. Simply stated, any individual, child or adult, would experience severe effects from water toxicity long before having an acute toxic reaction to the fluoride in the water.
Why is fluoride listed as a contaminant in a City Water Report? (Back to Top)
Water naturally picks up minerals and other solids as it flows underground or as surface runoff. Fluoride is also added to many community water supplies. Water is thoroughly tested for many of these minerals and solids under the term "contaminants". Contaminants do not necessarily indicate a health risk. It is just a bureaucratic term used by local, state and federal agencies involved in water purity and safety.
How am I supposed to make baby formula since youre not supposed to use fluoridated water for infants under six months of age? (Back to Top)
Its always best to talk to your babys doctor about your childs health care but most pediatricians recommend using bottled or distilled water to make infant formula. Additionally, since fluoride concentration in breast milk is very low, there is also no evidence that breast feeding while drinking fluoridated water presents any problem whatsoever to the nursing infant. In fact, breastfeeding women who drink fluoridated water have children with less fluorosis than children who were formula fed.
Standard references state there are no contraindications to either pregnancy or breastfeeding while drinking water in the concentration found in community fluoridated water sources. Additionally, the only side effect of taking in too much fluoride in first three years of life is an increase of non injurious and seldom cosmetically visible dental fluorosis.
Is fluoride REALLY safe? (Back to Top)
Yes, fluoride is really safe! Fluoride has been extensively studied for many years and it is right that it is constantly being re-evaluated so we have current data and analyses. Consistently, researcher from numerous different disciplines (physiology, toxicology, medicine, dentistry, public health, nutrition) have lines of evidence and analysis who all come to the same conclusionsfluoride is safe, effective, and cost effective in communities like Arcata.
Is fluoride REALLY cost effective? (Back to Top)
Yes, fluoride is really cost effective! California families can benefit from this safe and effective public health measure for less and 50 cents per person per year!
Is fluoride REALLY equitable? (Back to Top)
Yes, a community, which provides fluoride to all its citizens, is providing one of the most equitable public health measures possible. Fluoride provides a proven detriment to dental cavities to all its citizens regardless of age, race, or socioeconomic status.
I need more fluoride in my water. What do I? (Back to Top)
Fluoride is available for people who do not have fluorinated water. People who live in homes where the water does not have fluoride added, can help keep their teeth healthy by using liquid fluoride or fluoride tablets. Fluoride is used to help resist acid, strengthen teeth, and block bacteria from causing decay.
Fluoride is generally taken medicinally twice daily as a dental health enhancer, as prescribed by a doctor. The liquid fluoride may be added to water, fruit juice, cereal or other foods. It may also be taken directly from the bottle, with the use of an oral syringe or dropper to accurately measure the dose. Fluoride tablets are used in several different ways. They may added to drinking water or fruit juice, dissolved in the mouth or chewed.
People who help improve and maintain their dental health with fluoride must always careful to follow the instructions on the label and to take this helpful medicine in strict accordance with their doctors' instructions. While fluoride promotes healthy teeth, it can take the place of flossing and brushing and must be used in combination with a complete dental routine.
“Adults miss millions of hours of work each year due to dental disease. By improving our nation’s oral health, we improve our nation’s overall health”. Vice Admiral Richard H. Carmona, M.D., M.P.H., F.A.C.S., United States Surgeon General Commander, United States Public Health Services
|Adults miss millions of hours of work each year due to dental disease. By improving our nations oral health, we improve our nations overall health. Vice Admiral Richard H. Carmona, M.D., M.P.H., F.A.C.S., United States Surgeon General Commander, United States Public Health Services