Doctors and scientists have called water fluoridation one of the biggest public health successes of the past century, contributing to the more than 40% drop in adult tooth loss since 1945.
Yet for as long as there has been fluoridation, there have been those who reject the scientific consensus and believe fluoride is, at best, an unnatural additive and, at worst, a neurotoxin. A plot point of the 1964 Cold War satire “Dr. Strangelove” revolves around a deranged general who believes fluoridation is a Communist conspiracy.
Now, social media has given new life to anti-fluoridation forces, just as it did for debunked theories about vaccines that public health authorities partially blame for the worst U.S. measles epidemic in 25 years. The percentage of people receiving fluoridated water in the U.S., while still rising nationwide, declined in 20 states between 2006 and 2014, with nine states seeing declines of two percentage points or more, according to a Bloomberg Environment analysis of Centers for Disease Control and Prevention data.
Anti-fluoride activists are also taking their fight from the internet and town halls into the courtroom, suing the Environmental Protection Agency to try to force it to ban the fluoridation of water nationwide. The case is heading for a trial early next year in a San Francisco federal court.
William Maas, the CDC’s former head of oral health, said public health officials like his former colleagues need to be more aggressive in promoting the benefits of fluoride.
“We know from a political standpoint, at a city council or a referendum, it’s not always science that prevails,” Maas said. “So I think CDC is sort of outgunned on that.”
The question occasionally comes up in Congress. Over the last five years, Reps. Mike Simpson (R-Idaho), a former dentist, and Rosa DeLauro (D-Conn.) have raised concerns during hearings that the executive branch isn’t doing enough to promote fluoridation.
Utilities in cities as far-flung as Brooksville, Fla., Johnstown, Pa., Lawton, Okla., Montrose, Colo., and Greenfield, Mass., all decided to stop fluoridating their water within the last five years, according to research from the Association of State & Territorial Dental Directors.
Nicole Johnson, an associate director in the CDC’s Oral Health Division, said there could be a number of reasons for declines across several states, such as population growth in non-fluoridated towns or water utilities stopping fluoridation due to the costs. But she acknowledged that anti-fluoride activists are playing a significant role.
“If you go on social media, it’s really easy to find anti-fluoridation information,” she said.
Stopping fluoridation can most harm the people who have the least ability to get routine dental care, she said. “It benefits the entire community regardless of age or access to health care,” she said.
Maas added that, while one can choose to drink non-fluorinated bottled water, “a person can’t choose to drink fluoridated water unless it’s made available to them.”
A epidemiological study of what happened in Juneau, Alaska, after residents voted in 2007 to stop fluoridating water put a finer point on the practice’s benefits.
Children on Medicaid in Alaska’s capital had 16% more cavity procedures and incurred an average of $161.84 more in dental costs per child after the city stopped fluoridating its water, according to an analysis of Medicaid data that was published earlier this year.
Jennifer Meyer, a public health professor at the University of Alaska Anchorage and one of the authors of that analysis, said the uniqueness of Juneau—a remote, isolated city with very little population turnover—mean these results are the starkest and most definitive evidence yet of the consequences of stopping water fluoridation.
Despite these findings, Mayor Beth Weldon said Juneau doesn’t expect to resume fluoridation any time soon. She said residents overwhelmingly voted in favor of a referendum to stop it.
“I don’t think public opinion is going to change,” she said. She added that Alaskans “like things to be pristine and keep things pretty pure,” and that, after stopping fluoridation, Juneau adds nothing to its water other than some light chlorination to “keep the bugs out.”
Juneau’s desire for unadulterated water belies the fact that regulators at the EPA, which is responsible for drinking water quality across the country, have examined the safety of fluoride multiple times in the past several decades and determined that adding it to water in safe amounts produces, at worst, minor cosmetic tooth blemishes.
Despite the EPA’s reviews, activists have been able to continue their lawsuit that seeks to force the EPA to declare fluoride a toxic substance. Edward Chen, the federal judge hearing the case, declined to dismiss it in late 2017, saying he wasn’t sure the plaintiffs could produce enough scientific evidence to win but that “they are at least entitled to attempt to make that showing.”
The EPA wouldn’t provide one of its water regulators for an interview and didn’t respond to written questions in time for this story.
In Juneau, and in many other towns across the country, opponents of fluoride had some help.
The group Fluoride Action Network, one of the lead plaintiffs in the lawsuit, provides assistance to those lobbying town councils to stop fluoridation by supplying information and in some cases, organization.
Chris Neurath, the group’s research director, said the group was involved in the Juneau referendum as well as votes in Portland, Ore., and Wichita, Kan. He said there is no typical profile or demographic characteristic of a city that is more or less receptive to the network’s message.
“It often can be just chance,” he said. “Maybe one or two people, say a newspaper editor or a mayor of a city who is opposed, and that can start it.”
Neurath added that there can be a snowball effect, from one community to another.
“Most of this is at the local level and they’re pretty isolated,” he said. “But if they find out if someone across the country has done this, they can gain inspiration.”
The Fluoride Action Network was founded in 2000 by Paul Connett, a retired toxicology professor who has appeared on Alex Jones’ InfoWars talk show and questioned whether there was a cover-up of the true origins of the 9/11 attacks. Jones is the radio host who has said the 2012 Sandy Hook school shooting was a hoax staged by gun-control advocates, an assertion he later attributed in a sworn deposition to “a form of psychosis.”
Connett told Bloomberg Environment that he appeared on Jones’ show to reach as wide an audience as possible and that he doesn’t subscribe to Jones’ "extreme views.” As for his comments about the 9/11 attacks, Connett said they were partly in jest and that he was trying to make the point that “we should not be frightened off from looking at the evidence in any controversial issue.”
Neurath said his group opposes fluoridation because, among many other reasons, the “rapidly emerging science” showing that fluoride has harmful neurological effects on children and fetuses. Much of this evidence centers on studies out of China, Mexico, and Canada that look at IQ differences between mothers and children who were exposed to different levels of fluoride.
However, these studies, and the broader body of literature on fluoride’s neurological effects, aren’t accepted by the CDC, the National Institutes of Health, the American Dental Association, the American Academy of Family Physicians, and numerous other medical and scientific organizations. In fact, the CDC lists water fluoridation as one of the top 10 public health achievements of the 20th century.
Maas compares vaccination opponents to the peddlers of dubious dietary supplements. “In the 1800’s, we’d call them snake oil salesmen,” he said.
But those who reject mainstream science can no longer be ignored. The CDC says misinformation about vaccines is a significant factor in the ongoing measles outbreak that is now that largest in the U.S. since 1994.
When it comes to fluoride, Maas said the CDC’s desire to appear unbiased and apolitical means fluoride opponents can crowd the agency out of the marketplace of ideas.
“I think they would say their job isn’t to tell people how to vote,” Maas said. “Their job is to give people information.”
Johnson cited the CDC’s numerous initiatives to encourage fluoridation—from creating fact sheets that municipal leaders can cite in debates, to spearheading the development of ultra-low-cost dissolvable fluoride tablets for rural communities. She said the CDC is continually looking for ways to reduce the costs of fluoridation and give scientific information to those fighting anti-fluoride activists.
“It’s a local decision,” Johnson said. But “we can always do more.”
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