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History on the side of fluoride opponents

Portland is one of two U.S. cities that have resisted fluoridation


by: TRIBUNE PHOTO: CHRISTOPHER ONSTOTT - Reservoirs at Mount Tabor, such as this one, are among many hot-button issues for Portland's water supply, but none are as controversial as fluoridation. If fluoridating Portland’s water supply is such a bad idea, then why is almost every other large U.S. city doing it?

But if it’s such a good idea, why hasn’t the rest of the world followed suit?

Both questions could dog critics and supporters alike as Portlanders ponder whether to fluoridate the city’s Bull Run water supply in a May 21 referendum.

Portland and Honolulu are the lone holdouts among the nation’s 50 largest cities. Tucson, El Paso, Colorado Springs and Jacksonville rely on naturally occurring fluoride in their water; the rest of the cities add it to the water, according to the British Fluoridation Society.

Two other cities that long resisted fluoridation — San Diego and San Jose — agreed to fluoridate their water supplies in 2011. The Portland City Council joined them last September, but critics gathered signatures to force the May vote. The project is on hold at least until then, says David Shaff, Portland Water Bureau administrator.

Fluoridation is not new in Oregon. Beaverton, Forest Grove and part of the Tualatin Valley Water District do it, as does Salem and several other Oregon cities.

But Oregon, like Portland, is bucking the national trend. Only 23 percent of Oregonians get fluoride added to their water supply, the third-lowest level among the states. The only states with lower rates are Hawaii, at 11 percent, and New Jersey at 14 percent, according to the British Fluoridation Society.

Fluoridation supporters used a stealth lobbying campaign last year to press the issue among Portland city commissioners, because local voters have been skeptical in the past.

City voters rejected fluoridation in 1956 and again in 1962. The third time was a charm when the City Council put a measure on the ballot in 1978, but critics qualified a repeal measure for the May 1980 ballot and voters turned down fluoridation a third time. Fluoridation doesn’t divide voters on the left and right as in typical elections, says Howard Pollick, a leading fluoridation advocate who teaches at the School of Dentistry at the University of California at San Francisco.

“The people promoting it primarily have been the medical and dental professions, because they see the devastation from teeth decay,” says Pollick, who also conducts research on the issue.

In the 1950s, he recalls, opposition was led by the right-wing John Birch Society, which called fluoridation a “Communist plot.” Present-day opponents include a mix of libertarians, conservatives, environmentalists and alternative health proponents.

Portlanders, at least up to now, haven’t been a “bunch of sheep” like voters elsewhere in the United States, says Paul Connett, a retired Lawrence University chemistry professor and a leading fluoride critic.

Portland is “in the mainstream of the world,” says Connett, executive director of the Fluoride Action Network. “It’s not in the mainstream of the U.S.”

The British Fluoridation Society calculates that 204 million U.S. residents get fluoride from their water supply, or 74 percent of the population, all but 10 million of them because it’s added to the water supply.

That’s more than half the 378 million people worldwide that drink fluoride added to their water, the society estimates.

Two dozen other countries add fluoride to their water. In Great Britain, about 10 percent of the population, or 5.8 million, get fluoridated water. In Australia, 80 percent of the population, or 17.6 million, get fluoridated water. In Canada, it’s 14.3 million, or 44 percent. In British Columbia, the province closest geographically and culturally to Oregon, only 4 percent drink fluoridated water.

Other significant users of fluoridated water are Ireland, Singapore, Hong Kong, Israel, Chile, Brazil and Malaysia.

Factors vary on why fluoride has or hasn’t been adopted from city to city and country to country, Pollick says.

In Italy, for instance, so many people drink bottled water that fluoridating the public water supply wasn’t seen as useful.

Local critics, like former state director of the American Cancer Society Rick North, says Europeans have opposed fluoridation partly out of concern that it’s administering a “drug” to people without their informed consent.

Limited use in Europe

Critics like to point out that only a tiny portion of Europeans get fluoride added to their water: just 14 million people, mostly in the United Kingdom, Ireland and Spain.

While more U.S. cities are jumping on the water fluoridation bandwagon, several prominent nations have jumped off. The list of countries that once fluoridated their water supply but stopped doing so includes the Soviet Union, Japan, the German Federal Republic (West Germany); Sweden, the Netherlands, the German Democratic Republic (East Germany): Czechoslovakia and Finland.

“It’s been an absolute dismal failure outside of the U.S., outside of a handful of countries, mostly English-speaking,” Connett says.

One reason for the disparity is that fluoridation got its start in the United States. Grand Rapids, Mich., became the world’s first community to add it to the water supply in 1945. (See sidebar). The movement has spread slowly but surely across the nation since then.

“There’s nothing specific to Europe that makes them wiser or less wise than here in the U.S.,” Pollick says.

Several European nations prefer other methods. Germany, France, Austria and Switzerland put fluoride in salt, much like the U.S. puts iodine in salt. European nations also promote the use of fluoride in toothpaste and applications directly to the teeth.

Salt has been shown to effectively reduce dental decay, Pollick says, though it has some disadvantages. “For very young children, they don’t have much salt in their diet, so they’re not going to get the early effects of fluoride in their baby teeth,” he says.

There also are concerns that people can get too much fluoride, he says, when people live in a community with both fluoridated water and fluoridated salt.

Some nations put fluoride in the milk supply, much like Americans add Vitamin D to milk. That’s being used in parts of Bulgaria, Chile, Peru, Russia, Thailand and the United Kingdom.

A variety of studies have shown that many nations have reduced dental decay, as has the U.S., but without fluoridating their water.

The United States, including local public schools, also has tried giving children fluoride tablets to chew in class. One problem with that is that compliance is uneven, especially among low-income children, Pollick says, and it’s very expensive.

He says fluoridated water remains the most reliable and cost-effective system.


Fluoride's history began with a brown stain

Back in 1901, East Coast dental school graduate Frederick McKay moved to Colorado Springs, and began noticing grotesque brown stains on his patients’ teeth.

They called it Colorado Brown Stain.

In the ensuing years, Dr. McKay and dental researcher Dr. G.V. Black realized that local folks' teeth may be discolored, but they also were surprisingly resistant to cavities.

McKay wondered if it was something in the water.

He was summoned to Oakley, Idaho, in 1923 to meet with parents there about brown stains on their children’s teeth. McKay advised town leaders to find a new source of drinking water. That did the trick, though he didn’t know why.

Later, McKay and Dr. Grover Kempf of the United States Public Health Service went to another place where people were suffering from brown teeth: Bauxite, Ark., an Alcoa company town.

Alcoa chemist H.V. Churchill, who had spent years fending off claims that aluminum cookware was poisonous, wanted to protect his company’s reputation. His assistant, using a more sophisticated technology than McKay possessed, found that the Bauxite water supply had high levels of fluoride.

In 1931, Churchill advised McKay to test the water in other towns, using the same test. Within months, his 30-year quest to discover the cause of the brown stains was over.

By the late 1930s, federal researchers developed a way to measure fluoride down to 0.1 parts per million. National Institute of Health researcher Dr. H. Trendley Dean and his assistants discovered the brown stains wouldn’t occur with fluoride levels of less than 1 part per million.

In 1944, Dean wanted to test whether adding that amount of fluoride to the water would prevent teeth decay without causing brown stains.

In 1945, Grand Rapids, Mich., agreed to become the first city in the world to add fluoride to its water system. Eleven years into a 15-year study, Dean announced there was a 60 percent drop in cavities among Grand Rapids children.

(This account is based on material from the National Institute of Dental and Craniofacial Research.)