“Too good to be true,” is an idea that, according to most oral health professionals, does not apply to fluoridated water. The practice, common across the United States and in some other nations, is not practiced in Moab, but local oral health specialists say it would be a great boon to residents – particularly young children.
After a recent summit of oral health specialists in Moab, where the topic of fluoridating water was discussed as one among many ideas for the area, one of Utah’s top dental specialists said of community water fluoridation that it is a part of an American “tradition of fortifying foods and beverages to prevent disease,” like iodizing salt or putting vitamin D in milk.
“Few topics have been as thoroughly studied as fluoride and fluoridation,” said Michelle Martin, an oral health specialist with the Utah Department of Health.
According to the U.S. Centers for Disease Control, community water fluoridation is an “effective,” “cost-saving” and “safe” strategy for reducing cavities. In 1999, the CDC named community water fluoridation as one of the nation’s “Ten Great Public Health Achievements” of the 20th century. Among the other achievements on the list: Recognition of tobacco use as a public health hazard, vaccinations, family planning and motor vehicle safety improvements.
Although government agencies and numerous associations of health professionals from across the U.S. have endorsed the practice, and although more than two in three Americans live in areas with fluoridated water, a small contingent of dentists and others remain skeptical.
Dubious criticisms, clear benefits
While fervent opponents of water fluoridation claim it yields dire health risks (including debunked myths of water fluoridation decreasing IQ), more mild opponents of the practice say that its safety and efficacy have not been proven with sufficient rigor. Others criticize community water fluoridation as medical treatment given without consent.
Regardless of the costs – imagined or actual – fluoridating water is a clear oral health benefit to children, according to multiple studies and meta-analyses, which are systematic reviews that summarize the consensus in scientific literature on a given topic.
The findings on how fluoridated water affects adults’ oral health are more contested; a 2007 meta-analysis by the CDC suggests that fluoridating water can reduce cavities in adults by 27 percent. A 2011 review by the European Commission, the executive branch of the European Union, found that the effects were limited.
According to Moab’s dentists, oral health among young people, even among babies whose teeth have not yet erupted, is a major concern, and they are looking to promote oral health among children and infants of all ages. For them, community water fluoridation would significantly help the oral health of Moab’s children and adults.
“I heard a strong consensus from both of the local dentists that, in their experience, fluoridation of the water significantly improves oral health,” said Jennifer Sadoff, CEO of Moab Regional Hospital and organizer of the recent summit. “Just as with vaccinations, an ounce of prevention is worth a pound of cure.”
Sadoff told The Times-Independent that there has been an uptick in emergency room visits at Moab Regional Hospital due to preventable oral health issues, which is one reason she organized the summit.
Strong support for fluoride from health officials
A clear consensus regarding the benefit of water fluoridation exists in the community of medical health professionals. Every U.S. surgeon general since the 1950s has expressed support for community water fluoridation, and the CDC has long recommended the practice. Many professional associations of dentists and doctors, from the American Dental Association to the American Association of Pediatrics, take the same stance.
“Community water fluoridation is the single most effective public health measure to prevent tooth decay,” the American Dental Association said in a statement in 2017. Worldwide, the prevalence of community water fluoridation is highly variable. Much of Australia’s water is artificially fluoridated; a small minority of Asian and African countries practice community water fluoridation. In Europe, roughly 2 percent of people received artificially fluoridated water in 2012, according to a British study from that year.
Rural Utah’s water mostly not fluoridated
In a statement on community water fluoridation in 2016, former U.S. Surgeon General Vivek H. Murthy said that “much of our health is determined by zip code rather than genetic code,” referring to inequities in wealth and health care prevalent along urban-rural divides.
Indeed, Moab is no outlier as a small city without community water fluoridation. Rural Utahns, including everyone in Grand County and nearly all San Juan County residents, have no access to artificially fluoridated community water. This is the case for most of Utah’s rural communities; some have access to naturally fluoridated water, as fluoride occurs in higher concentrations in some places around the world.
On the other hand, the millions of people who live in the urban counties of Davis and Salt Lake passively reap the benefits of fluoridated water each time they drink locally sourced water. Municipalities there decided to start the practice years ago, as is the case with residents of many major cities around the United States.
Side effects may include tooth whitening
One well-understood and universally accepted side effect of fluoridating community water sources is fluorosis, i.e. excessive intake of fluoride. The condition does not exclusively impact people in areas with artificially fluoridated water; some groundwater naturally has high fluoride levels, sometimes to the point of containing more than the recommended dose.
Most often, fluorosis manifests in only an aesthetic way as white mottling (or blotting) on teeth. In its mild form, fluorosis indicates a heightened resistance to cavities, and in extreme cases, it can weaken and disfigure teeth.
Fluorosis can also be caused by the over-application of toothpaste that contains fluoride, which is one reason oral health experts advise parents to keep an eye on their children’s toothpaste usage.