National Flouride Report Prompts Confusion Over a Top 10 Health Strategy

This guest opinion is by Gordon Empey, D.M.D, MPH, a dental health consultant to the Oregon Department of Human Services.

Photo Courtesy: City of Beaverton

(SALEM) - News stories about a new national report that recommends reduced fluoride levels in drinking water is causing confusion among people who have an interest in this issue.

As the consultant to the state's oral health program, I'd like to offer a perspective on the report and share some important facts about fluoridation.

The report, commissioned by the Environmental Protection Agency (EPA), is intended to guide the EPA in developing standards for water systems with naturally occurring fluoride concentrations that serve about one-half of one percent of the nation's population.

This report does not apply to communities that adjust the fluoride in water supplies at the lower levels effective for preventing tooth decay.

Natural fluoride, a mineral present in water, soil and air, is the focus of this report. It recommends that the maximum level of natural fluoride in drinking water be lowered from the current upper limit of 4 milligrams per liter. The report finds that children who continually drink water at these levels are not protected from a condition called severe enamel fluorosis, whose symptoms include discolored, pitted or hard-to-clean enamel. It also finds that a lifetime exposure to fluoride concentrations of 4 milligrams per liter or higher is likely to increase bone fractures.

Community water fluoridation is the adjustment of fluoride in drinking water to a level of about 1 milligram per liter. The NRC report does not evaluate the risks or benefits of these lower concentrations. Most of the expert panel members who wrote the report indicate they do not question the use of lower levels of fluoride, which have been shown to reduce tooth decay by 18 percent to 40 percent.

Over the past 60 years, extensive research has shown that fluoridating public water supplies is a safe, effective and economical way to reduce tooth decay. Fluoridation has been extensively studied and is now widely accepted--nearly 170 million Americans (68 percent of the population) drink fluoridated water.

Tooth decay causes toothaches and premature loss of teeth in children. Infections and inflammations resulting from oral disease in adults have been linked to chronic diseases such as heart disease, diabetes, HIV and even pregnancy complications. Good oral health is essential for good general health.

Following the report's release, the U.S. Centers for Disease Control and Prevention (CDC), the nation's lead agency in promoting health and quality of life, issued a statement recommending continued community water fluoridation as a safe, effective and inexpensive way to prevent tooth decay. Nearly every reputable national and international health-related organization recognizes the benefits of water fluoridation and the past five Surgeons General have supported fluoridation.

Oregon ranks 48th out of 50 states for water fluoridation. Although Salem, Hood River, Corvallis, Beaverton and other communities have chosen fluoridation, only about 19 percent of the state's residents drink fluoridated water.

I sincerely hope the NRC report does not dissuade Oregon communities from learning the facts about community water fluoridation, which has been called one of the 20th century's Top 10 public health achievements. Learn more about the report at www.nationalacademies.org and http://www.ada.org/prof/index.asp#fluoride