Fluoride

Position Statement

GREENVILLE WATER SUPPORTS FLUORIDATION

According to the Centers for Disease Control and Prevention (CDC), a division of the U.S. Department of Health and Human Services (HHS), “For 65 years, community water fluoridation has been a safe and healthy way to effectively prevent tooth decay. CDC has recognized water fluoridation as one of 10 great public health achievements of the 20th century.”

Greenville Water also acknowledges the recommendations of the World Health Organization (WHO), American Medical Association (AMA), Canadian Medical Association (CMA), Center for Disease Control (CDC), American Dental Association (ADA), Canadian Dental Association (CDA), American Water Works Association (AWWA) and other professional organizations in the medical community, for the fluoridation of public water supplies as a significant public health benefit.

Greenville Water supports the use of fluoride in a safe, effective, and reliable manner that includes adequate monitoring and control of fluoride levels within limits mandated by local, state and federal laws and that is subject to community acceptance through applicable local decision-making processes.

Greenville Water’s position in favor of fluoridation is based on the following:

     1.  Health Benefits & Social Equity

According to 2008 data from the Centers for Disease Control and Prevention, 64.3% of the U.S. population receives fluoridated water; and 72.4% of the U.S. Population is on public water systems receiving fluoridated water.

Water fluoridation prevents tooth decay mainly by providing teeth with frequent contact with low levels of fluoride throughout each day and throughout life. Even today, with other available sources of fluoride, studies show that water fluoridation reduces tooth decay by about 25 percent over a person’s lifetime.

Community water fluoridation is not only safe and effective, but it is also cost-saving and the least expensive way to deliver the benefits of fluoride to all residents of a community. For larger communities of more than 20,000 people, it costs about 50 cents per person to fluoridate the water. It is also cost-effective because every $1 invested in this preventive measure yields approximately $38 savings in dental treatment costs.

This method of fluoride delivery benefits all people―regardless of age, income, education, or socioeconomic status. A person’s income and ability to get routine dental care are not barriers since all residents of a community can enjoy fluoride’s protective benefits just by drinking tap water and consuming foods and beverages prepared with it.

Fluoride from other sources prevents tooth decay as well, whether from toothpaste, mouth rinses, professionally applied fluoride treatments, or prescription fluoride supplements. These methods of delivering fluoride, however, are more costly than water fluoridation and require a conscious decision to use them.

Source: Centers for Disease Control and Prevention

     2.  Recent Changes to Recommended Levels Reflect Ongoing Assessment and Review

On January 7, 2012, the U.S. Department of Health and Human Services (HHS) and the U.S. Environmental Protection Agency (EPA) announced steps to ensure that standards and guidelines on fluoride in drinking water continue to provide the maximum protection to the American people to support good dental health, especially in children. HHS proposed that the recommended level of fluoride in drinking water can be set at the lowest end of the current optimal range to prevent tooth decay, and EPA is initiating review of the maximum amount of fluoride allowed in drinking water.

HHS’ proposed recommendation of 0.7 milligrams of fluoride per liter of water replaces the current recommended range of 0.7 to 1.2 milligrams. This updated recommendation is based on recent EPA and HHS scientific assessments to balance the benefits of preventing tooth decay while limiting any unwanted health effects. These scientific assessments will also guide EPA in making a determination on whether to lower the maximum contaminant level (MCL) of 4 mg/L for fluoride. The secondary standard for fluoride is 2 mg/L to protect against moderate dental fluorosis.

HHS moved away from a range for fluoridation to a single number in recognition of two factors: people now get fluoride from other sources, and regional differences in water consumption have evened out in recent decades.

In February 2011, Greenville Water adopted the recommended dosage of 0.7 milligrams per liter.

Opposition to Fluoridation

It is acknowledged that there are possible negative impacts from excessive fluoride exposure. Since fluoridation of water began in the 1940s, sources of fluoride have increased. Other sources include dental products such as toothpaste and mouth rinses, prescription fluoride supplements, and professionally applied fluoride products such as varnish and gels.

The EPA’s recent assessments of fluoride were undertaken in response to findings of the National Academies of Science (NAS), which in 2006 recommended that in developing regulatory standards for high levels of fluoride in drinking water, adverse health effects warranted consideration. Such evidence is the foundation for the recommended fluoride levels for public water systems to prevent tooth decay.

Opponents frequently cite the fact that public water fluoridation is not mandated in Europe.  According to the American Dental Association (ADA), “European countries construct their own water quality regulations within the framework of the 1980 European Water Quality Directive…The Directive does not require or prohibit fluoridation, it merely requires that the fluoride concentration in water does not exceed the maximum permissible concentration.”
The ADA report goes on to state, “water fluoridation is not practical in many European countries because of complex water systems with numerous water sources. As an alternative to water fluoridation, many European countries have opted for salt fluoridation, in addition to the use of fluoride toothpaste for topical benefits, as a means of bringing the protective benefits of fluoride to the public.”

According to the American Public Health Association, “the base of scientific evidence continues to support Fluoridation as a safe and effective public health measure. Reviews of the scientific literature on the health effects of fluoride over more than 20 years have been conducted by the National Health and Medical Research Council; National Research Council (NRC), USA (1993, 2006);  World Health Organization (WHO) (1994, 1996, 2006); US Agency for Toxic Substances and Disease Registry (2003); International Programme on Chemical Safety; WHO (2002); Forum on Fluoridation, Ireland (2002); Medical Research Council, UK (2002); University of York, UK (2000); Institute of Medicine, USA (1999); Health Canada (1999)45; US Public Health Service (1991); and Kaminsky et al., New York State Department of Health (1990).   All of these reviews have found fluoride to be safe and effective.” Opponents have claimed potential toxicity from fluoridated water, but none of these claims has been supported by studies of scientific merit, which is reflected in a statement from the American Dental Association:

“The American Dental Association continues to endorse fluoridation of community water supplies as safe and effective for preventing tooth decay. This support has been the Association’s position since policy was first adopted in 1950. The ADA’s policies regarding community water fluoridation are based on the overwhelming weight of peer-reviewed, credible scientific evidence. The ADA, along with state and local dental societies, continues to work with federal, state and local agencies to increase the number of communities benefiting from water fluoridation.”

Concluding Comments

Financial considerations are a factor in many cases related to community debates about fluoridation.   Some water systems and municipalities cite prohibitive costs and a lack of funds to implement or sustain the practice.   At this time, financial considerations for fluoridation are not an issue for Greenville Water.  The associated costs are budgeted and the necessary systems are in place.

Regarding health concerns, Greenville Water believes there is a limited amount of peer-reviewed research and information to support fluoride opponents.   Many of the sources cited often distort the facts and do not accurately represent the information.

In conclusion, Greenville Water supports fluoridation due to the preponderance of evidence in favor of the practice, including recommendations set forth by leading health agencies, non-governmental organizations and industry associations based on decades of science and research.

 

Resources on Fluoridation as Noted in Greenville Water March 2012 Position Statement

 

Centers for Disease Control and Prevention  (Division of U.S. Health and Human Services)

Community Water Fluoridation – http://www.cdc.gov/fluoridation/

Fluoridation Basics – http://www.cdc.gov/fluoridation/benefits/

 

U.S. Department of Health and Human Services (HHS)

http://www.hhs.gov/news/

 

National Academies of Sciences

Fluoride in Drinking Water: A Scientific Review of EPAs Standards (2006) http://dels.nas.edu/Report/Fluoride-Drinking-Water-Scientific/11571

 

Environmental Protection Agency (EPA)

Fluoride in Drinking Water – http://water.epa.gov/drink/contaminants/basicinformation/fluoride.cfm

Press Release on New Fluoride Level Recommendation: http://yosemite.epa.gov/opa/admpress.nsf/3881d73f4d4aaa0b85257359003f5348/86964af577c37ab285257811005a8417!OpenDocument

 

American Dental Association

Fluoridation Facts, 2005:

http://www.ada.org/sections/professionalResources/pdfs/fluoridation_facts.pdf

 

Policy Statement on Fluoridation:

http://www.ada.org/4045.aspx

 

World Health Organization (WHO)

http://www.who.int/water_sanitation_health/publications/fluoride_drinking_water/en/

 

American Medical Association (AMA)

http://www.ama-assn.org/

https://ssl3.ama-assn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=%2fresources%2fdoc%2fPolicyFinder%2fpolicyfiles%2fHnE%2fH-440.972.HTM
Canadian Medical Association (CMA)

http://www.cma.ca/

 

Ministry of Health and Long-Term Care
http://www.mhp.gov.on.ca/en/healthy-communities/dental/CMOH-on-Fluoridation.pdf

 

Canadian Dental Association (CDA)
http://www.cda-adc.ca/_files/position_statements/Fluorides-English-2010-06-08.pdf
American Water Works Association (AWWA)

http://www.awwa.org/Publications/StreamlinesArticle.cfm?ItemNumber=55064

 

American Public Health Association
Policy Statement on Community Water Fluoridation in the United States, 2008
http://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/24/13/36/community-water-fluoridation-in-the-united-states

 

CBC News
Dentist says cavities in kids on the rise 3 years after Calgary stopped adding fluoride to drinking water
http://www.cbc.ca/m/news/canada/calgary/dental-decay-rampant-in-calgary-children-pediatric-dentist-says-1.2864413