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Fluoride or not, it comes down to parent responsibility

Barring a successful citizens referendum on the matter, Portland has decided to add flouride to much of the region’s drinking water, which leads us to consider the benefits of flouridating the public water system.

Unquestionably, public health officials, including those at the U.S. Center for Disease Control and Prevention and the U.S. Department of Health and Human Services, champion fluoridation as a colossal achievement. The CDC, for example, named water fluoridation as one of the 10 greatest public health achievements of the 20th century.

But there also are many people who continue to question the effects of water fluoridation on the community. Among other things, they point to relatively recent decisions by the U.S. Department of Health and Human Services and the U.S. Environmental Protection Agency to decrease the recommended dosage of fluoride in public drinking water, from a recommended range of 0.7 to 1.2 milligrams per liter of water to the lower value in that range, 0.7 milligrams.

Fluoride, once less common when the practice of fluoridating water supplies in the 1940s was introduced, is now found in multiple products. Fluoride toothpaste, mouth rinses and fluoride treatments applied by dental professionals are some sources. Other sources include water used for manufactured or processed food and beverages. Juice, beer, wine, tea, infant formula and soda all commonly include fluoride at varying levels. As the federal agencies have recognized, there is less of a need for fluoride as a drinking water additive today than there once was.

When it comes to fluoridating public water supplies, the question the community needs to ask is whether fluoridation’s health benefits far outweigh any risks. The city of Beaverton has been fluoridating water for its customers for several years. Portland made the decision to add fluoride to its water supply. That decision forces several Washington County water providers, which rely on water from Portland, to swallow that decision without having any say in the matter. Among the 13 suburbs and water districts affected are the Tualatin Valley Water District, West Slope Water District and the Tigard Water Service Area.

Fluoride is a necessary component for achieving dental health, and as such public health campaigns should be undertaken to inform parents of fluoride’s benefits and risks. It is primarily the parent’s responsibility to ensure his or her children practice good dental hygiene. This includes making sure kids brush their teeth morning and night, don’t overindulge in sugary foods, visit the dentist regularly and receive the appropriate amount of fluoride.

Unfortunately, however, this is not always the case. Many parents are either uneducated about fluoride treatment, don’t have the money to take their children to see the dentist or are simply irresponsible when it comes to ensuring their children practice good dental health. Fluoride treatments are readily and easily available to parents who live in areas without fluoridated water systems, but it is up to the parents to leverage those services for their children’s benefit.

The underlying premise of government officials who promote water fluoridation is that we, as a society, have an obligation to care for children who are left in the dark regarding dental health. There is a financial incentive as well: The CDC estimates every $1 invested in a fluoridated water system yields as much as $38 in dental treatment cost savings.

A 1994 comprehensive World Health Organization report titled “Fluoride in drinking water” clearly explains the benefits of fluoride for dental health. In fact, the occurrence of cavities decreases significantly at fluoride levels 1 milligram per liter and continues to decline up to 2.6 milligram per liter,though at a less pronounced rate.

The same report, however, makes it clear that fluoridated water has different effects based on the person. Young children are logically going to receive a higher dose per body weight versus an adult should they drink the same volume of water. Fluoride is retained in higher concentrations in infants and children, as well.

Critics of fluoridation — and there are many, including those with backgrounds in science — argue fluoride’s introduction as a dietary supplement on a mass scale is harmful considering the wide variety of consumption habits within the expansive population it serves. Though it is extremely unlikely fluoride consumption in our community could reach levels associated with dangerous skeletal fluorosis, there is a legitimate risk of dental fluorosis in children’s developing enamel in the event fluoride ingestion surpasses recommended levels.

In the WHO report, 20 percent of children served by drinking water with a fluoride level of 1 milligram per liter of water evidence a very mild form of fluorosis, a type of discoloration of the teeth. At this level, however, the fluorosis is of such a mild degree it is not cosmetically apparent to the children or their parents, according to the WHO report. What is apparent, however, is the benefit of reduced tooth decay.

Ultimately it is the responsibility of parents who live in areas served or not served by a fluoridated water supply to monitor their children’s fluoride consumption. Do your research, talk to your dentists and physicians and explore fluoride filtration systems if you believe the risk of fluorosis is too great, or if the science is too inexact for you to accept.

It’s your drinking water. You should have a say about what goes into it — or should come out of it.



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