1. Fluoridation: Is It Safe? (Coronet, October, 1955)

By James Rorty

To fluoridate or not to fluoridate our water supply systems? That is the question hundreds of American communities will have to answer in the next year or two. And much depends upon coming up with the right answer.

According to supporters of the plan, the fluoridation of municipal water supplies is a public health measure of proven safety which greatly reduces tooth decay in both young children and adults.

This has simply not been proven, says the opposition. Moreover, 40,000,000 Americans in over 500 cities have either rejected the program or, having tried it, have abandoned it and jumked their equipment. Furthermore, the program has failed to gain approval by France's famed Pasteur Institute, has been rejected by a national convention of French dentists, been voted down by Sweden, and is looked upon with great scepticism by leading English and Swiss scientists.

Why? Because, answers the opposition, fluoridation is dangerous!

What is the case, then , for fluoridation?

Its proponents claim that our water supply systems should be fluoridated because fluoridation reduces tooth decay in growing children and this beneficial result continues into adulthood. And they also say that fluoride in the water supply system of a community has no adverse effects upon the health of the community if the concentration of fluorine in the water remains at a safe level--and this safe level is easy to control. Sufficient scientific evedence has been accumulated to prove both these foregoing statements beyond the shadow of a doubt, they state.

The case for fluoridation is based, first, on observations in communities where the water is naturally fluoridated; and second, on studies in communities where the water has been artificially fluoridated up to what is considered the "optimum," or safe, level of one part per million.

The beneficial effects of naturally fluoridated water on the teeth of young children were reported by investigators of the United States Public Health Service during the early 1940s. And it was decided to find out if a similar reduction of tooth decay would occur when fluorine was added to city water artificially.

In 1945, experiments were launched in a number of cities including Grand Rapids, Michigan; Newburgh, New York; and Brantford, Ontario, Canada. In the next few years, others began in Evanston, Illinois, and Sheboygan, Wisconsin. Before the experiments began, dental examiners ascertained the number of decayed, missing and filled teeth among the school children of these artificially fluoridated cities, and also in "control cities" where the water contained little or no fluorine.

The experiments were to continue for not less than ten years. But after five years, the progress reports of the dental examiners were so enthusiastic--six-year-old children who had drunk fluoridated water while their teeth were forming had only about one third as much tooth decay as the children in the fluorine-free cities--that the examiners felt that they had hit a public health jackpot.

On the strength of this, the American Dental Association recommended the general fluoridation of municipal water supplies. Fluoridation was also endorsed by pulic and private agencies concerned with public health, and several months later, by the U.S. Public Health Service. The American Medical Association endorsed the plan "in principle."

Meanwhile, opposition to this rapid approval of fluoridation began to solidify. In 1952, prominent scientists of unimpeachable reputation appeared before Congress' Delaney Committee on Chemicals in Food. They voiced concern before the Committee over what they considered the premature adoption of fluoridation. And they asked several questions which, they claimed, the experiments don't answer.

The "anti's" claim that these questions still have not been answered--and give their reasons for so believing.

1. Has it really been scientifically established that fluoridated water prevents tooth decay in children and adults?

The anti's say, "No."

Because judgment varies, no two dental examiners are likely to come up with the same count of decayed teeth. In fact, the margin of error is so great, say the opponents, that it is nonsense to claim a 65 per cent reduction of decay in fluoridated cities.

And what is more, say the critics, fluorine only postpones the onset of tooth decay in young children. They cite as proof the later reports of the U.S. Public Health Service's examiners which show a rapid increase of decay in children from ten years of age, on. As for the effect of fluorine on adult teeth, Drs. Margaret Cammack Smith and Howard V. Smith of the University of Arizona, co-discoverers of the relationship between fluorine and "mottled teeth," have shown that in some naturally fluoridated areas tooth decay is more severe than in non-fluoridated areas, in the later years, and more difficult to repair.

2. Is it scientifically valid to use "nature's experiment"--the naturally fluoridated areas--as a basis for conclusions about artificial fluoridation?

Again the anti-fluoridators say, "No."

They characterize as "worthless" a series of studies made by the U.S. Public Health Service of tooth decay in 21 cities whose water supplies contain natural fluorine.

The anti-flouridators point out that in most naturally fluoridated water the fluorine occurs in association with other chemicals, especially calcium, which affect the absorption and toxicity (poisonousness) of the fluorine. Opponents of the program consider it especially hazardous to fluoridate "soft" water containing little calcium.

Among the cities whose water supplies contain relatively small amounts of calcium are: new York; Seattle, Washington; Charleston, South Carolina; Baton Rouge, Louisiana; Pensacola, Florida; Augusta, Georgia; Portland, Maine; Bethlehem, Pennsylvania; and there are many, many others.

3. Is there really no evidence of health damage caused by either naturally or artificially fluoridated water?

Opponents cite two reports of actual deaths by poisoning caused by drinking naturally fluoridated water with relatively small concentrations of fluorine.

One of these deaths was that of a 22-year-old American soldier who had lived in naturally fluoridated areas where the water contained respectively 1.2, 5.7, and 4.4 parts, per million, of fluorine. The other is the case of a 23-year-old native of Argentina who lived in an area where the concentration of fluorine was 2 parts per million. In both cases, fluorine poisoning was a contributing cause of death.

In both naturally and artificially fluoridated areas, many children and adults have dental fluorosis, otherwise known as "mottled teeth" or "Texas teeth." This takes the initial form of opaque white flecks on the surface of the teeth.

These flecks are considered "unobjectionable" by the proponents of fluoridation. Opponents, however, point out that they become darker with age, to the point where they might be considered seriously disfiguring.

4. Can the concentration of fluorine in water supply systems be safely controlled?

Proponents of fluoridation claim that the "optimum" concentration of fluorine in water is 1 part per million. They hold that this is perfectly safe for the individual and effective in preventing dental decay. Their claim is based on the estimate that the average daily consumption of water is about a quart per individual.

But critics point out that any given person may drink up to ten times that amount of water daily, depending upon his occupation, the weather and the state of his health. This excessive intake of water clearly would result in a concentration of fluorine in the human system above the "safe" limit.

The same problem is presented by certain foods. A check made on the Island of Tristan da Cunha, for example, indicated that 30 per cent of the natives there have the "mottled teeth" characteristic of an excess of fluorine in the diet. However, the water on this island contains only .2 parts, per million, of fluorine. The "overdose" comes from the fluorine-containing sea food which is eaten there.

Citing these uncontrollable variables, Dr. George L. Waldbott, well-known Detroit allergist, has asked: "How can it be argued that fluoridated drinking water is safe for every person in the community, for the entire life span, when, at 1.5 parts per million, danger begins, and near 2 parts per million it can cause permanent disfigurement and even death?"

These, then, are the unanswered questions of the anti-fluoridators. And until these questions are answered they will not concede that either the safety or the effectiveness of fluoridation has been convincingly established.

Several substitutes for water fluoridation have been suggested. Local application by a dentist for example, has no deleterious effects. Neither does the use of toothpaste with a fluoride in it. In New York City the water department has presented a "pill" program and a similar plan is also being considered in St. Louis. This would permit parents and school nurses to administer accurately controlled doses of fluoride to young children, and would avoid any risk whatever to the general population.

The pill program, it has been estimated, would cost only a fraction of the amount necessary to fluoridate a city's water supply.

For many cities, 1955 and 1956 will be the years of decision on the issue of fluoridation. New York City's final vote (fluoridation has been twice recommended by the Health Department and twice successfully opposed by the Water Department) will have an important effect on the future of fluoridation both in this country and elsewhere.

The tide seems to be swinging toward the opponents of the program. The position of the anti-fluoridators is clear and effective. They hold that, far from being a public health boon of demonstrated safety and value, fluoridation is a dubious and inadequately tested venture into mass medicine. They argue that it is without precedent in public health history to apply such a whole-health program on the basis of such meager investigations of its safety and effectiveness.

Fluoridation, they further say, makes of the public a vast collection of guinea pigs who must, willy nilly, submit to the experiment.

It is possible that opponents of fluoridation are right and the U.S. Public Health Service is wrong. It was wrong 30 years ago when its experts were equally enthusiastic about iodizing all drinking water as a means of preventing goiter. Their own research resulted in calling off the program just in time; at the last moment it was established that iodization would have caused serious side effects in many people.

The position of the anti-fluoridators is that there is no great urgency about the matter. Until all the evidence is in and has been evaluated they simply warn: "Let's go slow on fluoridation."

Whether we do or not will, in the end, depend upon how much you know about the matter and how you cast your vote.

(James Rorty is a distinguished American journalist whose searching articles on the health problems of this country have been appearing in leading magazines for over 30 years. He is also the author of several books on social, political and economic problems. --The Editors.)

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