Flush with some recent spare time, I read a Commentary in the Lincoln Journal on March 7 that proposed we “reexamine” the “fluoride question” in Lincoln and proposed we vote to remove fluoride from our water at the upcoming Lincoln Town Meeting on March 23. What “question” exactly were we talking about? This proposal was so contrary to over six decades of excellent science and well-documented experience that I decided I had to respond. I wrote to the Journal and my commentary was published on March 14:
To the Editor of the Lincoln Journal:
In her guest commentary “Fluoride question needs examination,” Moira Donnell conveys her worries that “fluoride affects the thyroid gland, the heart, the collagen in the body….” and many other organs in addition to the structure of your teeth. She refers back to a study by Bassin in 2001 that suggested a link between fluoride and osteosarcoma, a truly rare cancer of the bones in children. She wants a wide-ranging review by our town of the rationale for fluoride supplementation in our water supply, with the clear implication she thinks fluoride is dangerous and that there is a safer and equally effective alternative to prevent wide-spread childhood tooth decay through oral and applied fluoride supplementation but without fluoride in our water.
As a long-time local practicing primary care physician and Lincoln resident, I strongly differ with her. Fluoride in the water, starting back in Newburg, NY in 1945, has ended the scourge of rampant childhood tooth decay which in turn leads to loss of dentition, severe chronic gum disease, extraordinary dental reconstructive expenses, and seriously increased risk for heart disease in large populations because of chronic periodontal inflammation. Younger patients, by this time meaning most people under 50, have few amalgams. They don’t have many crowns or bridges. They have a good chance of having all their own teeth intact. By contrast, when I examine my older patients, with their mouths full of amalgams, crowns, and dental implants, I jokingly refer to them as “pre-fluoride teeth.”
Don’t Touch Our Fluoride
Town meeting can vote to study the issue, if it wants, so long as no one really proposes to remove the fluoride from our water. The facts are clear now and have been for decades. Fluoride in our water supply reliably works to stop childhood tooth decay. Other methods of supplementation are second best, less effective, and require highly motivated families and otherwise fail their children. The reduction in tooth disease is not just an important social benefit for cosmetic purposes, not just an economic benefit by avoiding massive amounts of reconstructive dental expenses, but also an important general health benefit by reducing chronic periodontal disease. Reduction in gum disease has clearly been shown to substantially reduce mortality from heart disease in the general population and especially in diabetics. (See “Periodontal disease and mortality in type 2 diabetes,” Diabetes Care. 2005 Jan;28(1):27-32, where severe periodontal disease tripled the risk of death from cardiovascular disease in diabetic populations.)
The alleged cancer link to osteosarcoma dates back to animal studies two decades ago. Osteosarcoma, by the way, which is a serious cancer that Ms. Donnell doesn’t want to expose her son to (and nor do I, neither her son, my sons, nor anyone’s) is a truly rare cancer of the bone that afflicts about 400 children annually in the entire country. Epidemiological studies by Dr. Bassin suggested that it might be increased by fluoridation. Her most recent study in 2006 (Cancer Causes Control. 2006 May;17(4):421-8), a case control study that looks for associations, not causation, now limited the issue to “an association between fluoride exposure in drinking water during childhood and the incidence of osteosarcoma among males but not consistently among females.”
Rare Osteosarcoma Unrelated to Fluoride
In a much more recent and more extensive analysis, another research team, looking at national data for the same issue of fluoridation and osteosarcoma (Cancer Epidemiol. 2012 Apr;36(2):e83-8. doi: 10.1016/j.canep.2011.11.008. Epub 2011 Dec 19), concluded that not only is there no gender difference, but also that fluoridation has no impact at all on this cancer: “Our ecological analysis suggests that the water fluoridation status in the continental U.S. has no influence on osteosarcoma incidence rates during childhood and adolescence.”
Ms. Donnell is not unbiased about fluoride. As she said toward the end of her article, “I know we have been led to believe that fluoride is the best thing ever, but after it touches your teeth, it is not.”
Fluoride Is Safe and Effective and Well-Proven
I suggest a much better summary is that fluoride, added in well-researched and carefully controlled amounts to our drinking water beginning almost 70 years ago, has dramatically improved the dental health of our country, with important population benefits for proper nutrition, vastly reduced expenses for dental prosthetics, and, by reducing inflammation from chronic gum disease that is rampant with carious teeth, provided substantial reduction of heart disease that saves many thousands of lives a year. The American Medical Association, the American Dental Association, the American Cancer Society and essentially every substantive medical professional organization support this position.
Those of you who want to restudy this issue yet again should do so. But current data, as I cited, continues to strongly support fluoridation as effective and safe. I am confident you will come to the same conclusion if you participate in the proposed study.