# Water fluoridation
## Introduction

The fluoridation of city water supplies has been named one of the ten great public health achievements in the 20th century according to the Centers for Disease Control and Prevention (CDC). Additionally, the American Dental Association states that “community water fluoridation is the single most effective public health measure to prevent tooth decay" (ADA, 1). Fluoride has dramatically changed the oral health of millions of people since it was first introduced into the public water supply of towns and cities across the United States in 1945. Grand Rapids, Michigan was the first to start this revolution of putting fluoride into public drinking water. This is a very important issue and citizens should not wait to fluoridate their drinking water.

## Common Misconceptions

If water fluoridation is so momentous, why does only 67% of the United States population have access to fluoridated water (CDC)? In order to explain this, it is important to explore the many misconceptions about fluoridation.
Misconception #1: Water fluoridation is merely the government’s way to medicate citizens without their permission or knowledge.
Water fluoridation is actually a safe, effective, and inexpensive way to protect the teeth of all residents in a community. Unlike many medical treatments or preventive methods, everyone (men, women, children and adults alike) will have access to the protective benefits that fluoride has to offer, with no regard to socio-economic status. Fluoridated water has been proven to protect teeth from decay or even reverse the decay process.
Misconception #2: Water fluoridation is too expensive and has little cost benefit.
Water fluoridation has been calculated by the CDC to save up to $38 in dental treatment for every $1 invested in fluoridation. Furthermore, a study completed by the CDC in 2000 states that average per person savings ranged from $15.95 in very small communities to $18.62 in large communities. It was shown that even in worst case scenarios with high levels of treatment expenses, fluoridation was still cost-effective. In fact, it is estimated that fluoridation costs merely $0.50 per person in communities >20,000 and only $3 per person in communities <5,000. Even in the smallest communities, this amounts to less than a penny a day per person, or less than a nickel a day for an average family of four!
Misconception #3: Water fluoridation causes dental fluorosis, which actually weakens the teeth.
It has been shown that communities with highly naturally fluoridated water have seen high numbers of children with dental fluorosis. Dental fluorosis only occurs during tooth formation and becomes apparent when teeth come in. It can range from symmetrical whitish areas on the teeth (very mild) to brownish discoloration with pitting of the enamel (very severe). Though dental fluorosis certainly isn’t cosmetically pleasing, it has been shown that this does not affect the teeth strength, function, or promote adverse dental health effects. Mild cases of dental fluorosis have typically been seen in communities with more than 1ppm of fluoride in the water. Typical levels in fluoridated water range from 0.7 – 1.2ppm.
Misconception #4: Water fluoridation can cause cancer, decreased IQ, decreased bone strength, impaired immune system, impair thyroid function and many other ailments.
The United States Centers for Disease Control and Prevention and the World Health Organization have not found any reason to believe that water fluoridation causes cancer, decreased IQ, decreased bone strength, impaired immune system, or impaired thyroid function. To the contrary, some studies have shown that fluoridation actually increases bone strength, though more studies are required to make a full statement regarding fluoride’s impact on bone density. Furthermore, many studies performed on mice and human subjects have shown no significant difference in cancer incidence between those with access to fluoridated water and those without.

## What is fluoride?

“Fluoride is a naturally occurring compound that can help prevent dental decay” (ADA, 10). Fluoride is an ion that comes from the element fluorine. Fluorine is a very abundant element and is found on the earth’s crust as the ion fluoride. Fluoridation of public drinking water is simply adjusting the amount of fluoride that naturally occurs in the water; for some this may mean adding fluoride and for others this is may mean decreasing the amount of fluoride. “The optimal fluoride level recommended by the U.S. Public Health Service is 0.7-1.2 parts per million for the prevention of tooth decay” (ADA, 1). As of 2002, over two-thirds of the United States population have fluoride in their public water supply. Public water supply fluoridation is a very safe and effective practice to prevent tooth decay. “Today, studies prove water fluoridation continues to be effective in reducing tooth decay by 20-40%, even in an era with widespread availability of fluoride from other sources, such as fluoride toothpaste” (ADA, 1).

## Systemically VS Topically

Fluoride helps protect teeth from decay in two ways, systemically and topically. Systemically, fluoride is ingested into the body and the fluoride becomes incorporated with the tooth structure making it stronger. When fluoride is systemically ingested, such as drinking a glass of water with fluoridated water regularly, the fluoride incorporates into the teeth better than if it were applied topically, such as fluoride in the toothpaste. Systemically, fluoride is also present in saliva, which bathes the teeth throughout the day, again allowing the teeth to become stronger, and this further prevents tooth decay.(ADA, 10)

## Economic Effectiveness

Water fluoridation is also very cost effective for small towns. It will cost approximately $3.00 per year per person to fluoridate the water. Furthermore, for every $1 spent on water fluoridation, $38 in dental treatments is saved (ADA, 1). It has been proved from data collected that the average lifetime cost per person to add fluoride to the drinking water is less than the cost of treating one dental filling (ADA, 56). To put it into economic terms, is it better for a person to pay $3.00 a year to have fluoridate their public water supply, which helps support healthy teeth without decay or is it better for a person to brush their teeth, hoping the fluoridated toothpaste will be sufficient to prevent tooth decay? Each person has to weigh the costs individually, but from the facts it seems evident that every public water supply should be fluoridated.It is quite a rare occurrence to find a public health initiative that is not only accessible by all people, but also inexpensive and cost-effective. Water fluoridation is needed in communities around the United States to protect the dental health of all people.
For more information regarding water fluoridation, please visit these websites:
http://www.cdc.gov
http://www.who.int
http://www.ada.org
Authors: Whitney Johnson, CHES and Nancy Johnson, CHES
Date: February 1, 2008
References:
(2007). Water Fluoridation. Retrieved January 16, 2008, from Centers for Disease Control and Prevention. http://www.cdc.gov/fluoridation/.
American Dental Association. Fluoridation Facts. Chicago, IL: American Dental Association, 2005. Retrieved February 07, 2008 from the American Dental Association. <http://web.archive.org/web/20090327062647/http://www.ada.org/public/topics/fluoride/facts/fluoridation_facts.pdf>