By Sarah Eilers
Fluoride, a pedestrian topic? You may not think of it as an agitating one, or a source of community division and debate. Your tap water likely includes fluoride, as does your toothpaste. Your dentist may rub it onto your teeth after a cleaning. But the introduction of fluoride into public water supplies in the 1940s and ‘50s was not universally welcomed, and some question it today.
Whether or not to fluoridate the water supply was a local decision, and a contentious one. Dentists, doctors, and state and federal public health authorities considered it a simple, inexpensive preventative for tooth decay and loss. These conditions were practically inevitable before the introduction of artificially fluoridated water, and often led to more-serious health problems, as well as cosmetic concerns. Authorities argued that research conducted in the 1930s had shown that residents of areas where water contained a natural concentration of fluoride had healthier teeth. Cities that were early adopters of artificial fluoridation, such as Grand Rapids, Michigan, profiled in the film Fluoridation, reported clearly positive data. The Centers for Disease Control calls mass fluoridation one of the greatest public health achievements of the 20th century.
And yet. Many citizens and local leaders needed convincing back then, and the city of Portland, Oregon, is still not convinced today. Fluoridation of the public water supply was labeled by some as mass-medication without consent, a potential driver of heart and bone problems in older people, and even a Communist conspiracy.
Four films held at the National Library of Medicine illustrate the debate and the efforts of respected public figures such as Dr. Benjamin Spock, Chicago Mayor Richard Daley, and Paul Dudley White, called the father of American cardiology, to make the argument in favor of fluoridation 50 to 60 years ago. The tone of the films ranges from kindly to confrontational—an intriguing glimpse into the early days of the discussion.
February is National Children’s Dental Health Month, so the look back is timely. In addition to Fluoridation, a data-driven, bar-chart-heavy production, NLM holds A Drop in the Bucket (1952), For Children Because We Care (1965), and One in a Million (1962). One in a Million takes an aggressive stance, referring to “strong pressure groups, professional hate-mongers” and “fanatic objections.” Opponents are caricatured as uninformed, even a little unhinged. A Drop in the Bucket, directed by Joseph Henabery (who played Abraham Lincoln in the infamous film Birth of a Nation, and later directed Rudolph Valentino in 1925’s Cobra) takes a folksy look at fluoridation. The friendly Doc Jenkins explains what fluoride is and why it’s needed.
Finally, the filmograph For Children… is gently persuasive, featuring images of children and a soothing voiceover by Dr. Spock. “Whether the fluoride is added in by nature or by engineers in precise amounts under controlled conditions, the fluoride is always the same,” he reassures us.
In modern times, we know more than ever about fluoride, and Dr. Spock may not be entirely correct. Though no research has claimed direct causality, a 2016 study found an association between diabetes and fluoride that is ingested (as opposed to directly applied to the teeth). A 2015 article in the journal Environmental Health concluded that, “State prevalence of artificial water fluoridation in 1992 significantly positively predicted state prevalence of ADHD in 2003, 2007 and 2011, even after controlling for socioeconomic status.” Other studies suggest a dangerous association between oral bacteria and heart disease, so controlling that bacteria—one way or another—is considered medically essential. Dentists and oral surgeons often prescribe antibiotics before dental surgery for this reason.
While continuing to strongly support the fluoridation of public water supplies, the U.S. Department of Health and Human Services also issued a recommendation in 2015 that revised downward the 1962 guidelines for optimal fluoride concentration in drinking water. The new recommendation is set at 0.7 milligrams of fluoride per liter of water, while the 1962 standards called for a range of 0.7 to 1.2 milligrams per liter. The government seems to agree that lowering the dose is good public health policy.
In 2013, the last time a referendum was held, Portland still said no.
Sarah Eilers is the Manager of Historical Audiovisuals in the History of Medicine Division at the National Library of Medicine.
Sarah Eilers – You completely misrepresented the study by Kyle Fluegge. Instead of reading and understanding the actual paper, you apparently relied on an anti-F interpretation from a news release from Case Western Reserve University, and completely ignored two significant findings of the study:
1) Natural fluoride in drinking water “is significantly protective” of diabetes
2) “Among the three fluoridation chemicals used in this data set (sodium fluoride, fluorosilicic acid, or sodium fluorosilicate), only fluorosilicic acid was significantly and robustly associated with decreases in incidence and prevalence of diabetes.” and “Sodium fluoride produced significantly positive associations with incidence (β= 0.93, P< 0.001) and prevalence (β= 0.76, P< 0.001), whereas fluorosilicic acid and sodium fluorosilicate produced significantly negative associations respectively (fluorosilicic acid: β= –0.72, P< 0.001 and β= –0.54, P= 0.002; sodium fluorosilicate: β= – 0.55, P= 0.05 and β= –0.49, P= 0.02)."
So, the actual conclusions of Fluegge’s study would appear to be that the most commonly added fluoridation chemical, fluorosilicic acid (used in 75% of water treatment plants), seems to significantly protect against diabetes. Only 7% of treatment plants use sodium fluoride (the only additive linked to an increase in diabetes). NaF is generally only used in smaller treatment plants, so most individuals will drink water protected with fluorosilicic acid.
Actually, there are so many flaws and inconsistencies with the study that it really proves nothing.
Regarding the ADHD claims. No one has “proven” any association of optimally fluoridated water with ADHD. The Malin study you cite has been thoroughly discredited in the scientific literature for its poor methodology, inadequate control for variables, and reaching a conclusion not supported by the peer-reviewed science.
The inadequacy of controls by Malin was clearly demonstrated in a 2015 study by Huber, et al. which, using the exact data as did Malin, determined that the reported cases of ADHD were attributable to the elevation level at which the children resided, not to fluoridated water.
Mr. Johnson–Thanks for your comments. I agree that those two studies prove nothing. I’m not aware of the Case Western news release. My chief focus is the historical films, and the way they approach and depict the controversy at the time fluoride was first introduced into public water supplies. I was surprised to learn that the efficacy and safety of fluoridated water is still questioned in some quarters, so thought it worthwhile to mention in the post.