Originally published in Governing, July 2019.
In 1901, a Colorado Springs dentist named Frederick McKay noticed many of his patients had peculiarly mottled brown teeth — but far fewer cavities than the norm. The cause, Dr. McKay determined after years of investigation, was high levels of natural fluoride in the town’s water. His discovery eventually led to the widespread fluoridation of public water systems across America and a dramatic decline in tooth decay over the past 70 years.
Numerous studies have shown the protective effects of adding fluoride to water, especially for kids, and the Centers for Disease Control and Prevention hails community water fluoridation as one of the 20th century’s top 10 public health achievements. State and local budgets have benefited too, thanks to lower public expenditures for dental care.
Unfortunately, a significant number of localities are now undoing their investments in fluoridation, thanks to a small but vocal minority of anti-fluoride activists using pseudo-science to trump data. The result has been the spread of misinformation about fluoride’s benefits, as well as higher costs for both taxpayers and families.
According to the anti-fluoridation Fluoride Action Network (FAN), more than 200 communities in the United States and Canada have rejected public water fluoridation since 2010, from small towns such as Sheridan, Wyo., to bigger jurisdictions such as Bucks County, Pa. In Portland, Ore., residents have voted down fluoridation four times since 1956, most recently in 2013. In 2018, at least 13 communities put water fluoridation on the ballot, while many other localities debated the issue at the city council level without a public vote.
Like anti-vaccinators, anti-fluoride activists rely on spurious medical research to argue fluoridation’s hazards. FAN, for instance, blames fluoride in water for everything from cancer to diabetes to low IQ to, ironically enough, tooth decay. “I’ve got a list as long as your arm of different claims,” says dentist Johnny Johnson, president of the pro-fluoride American Fluoridation Society. None of these claims, however, is backed up by valid science or facts.
One thing that is backed up by facts? Fluoridation saves money — for consumers as well as governments. A 2016 Health Affairs study estimated the nation’s net savings from fluoridation to be nearly $6.5 billion a year from avoided dental costs. Conversely, ending fluoridation can be costly. One study in New York found that residents in non-fluoridated counties were 33 percent more likely to undergo dental procedures, while a Louisiana study found that Medicaid-eligible kids in non-fluoridated communities were three times more likely to get dental treatment than kids in fluoridated areas and at twice the cost.
Dentist David Logan witnessed these impacts firsthand in Juneau, Alaska, where voters ended fluoridation in 2006. The immediate effect, he says, was an increase in cavities among his adult patients, “specifically in older adults where the root surface gets exposed.” Today, his colleagues are seeing many more cavities in kids and at “levels they haven’t seen before in their practicing career.”
All of this is expensive. Logan, now executive director of the Alaska Dental Society, notes that simple fillings cost about $175 in his community, while crowns cost upward of $500. “It’s a very significant amount,” he says, “especially when that cost is disproportionately borne by the public through Medicaid.”
A 2018 study of Juneau’s Medicaid records found that since the end of fluoridation, Juneau’s kids undergo one more cavity-related dental treatment per year than before, at a cost of $300 per child on average. The study also found the highest costs among children under 7, who’ve had no exposure to fluoridated water.
Logan is hopeful this study will help bring fluoride back to Juneau. But he admits he was badly outgunned 12 years ago by the opposition. “You don’t have to have facts. All you need is something sexy to say,” he says. “We had people with lots of letters after their names, but we didn’t put a face on it and got crushed.”
Next time, he says, he’ll be ready, as should all localities where anti-fluoride activists have made a stand. At stake is not just the integrity of science but public budgets and public health.
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