Fluorides Revisited

By proclamation of the American Dental Association, February began with Children's Dental Health Week. It was the 25th anniversary of the world's first test, in Grand Rapids, of an attempt to fluoridate water supplies so that children would need fewer fillings--and fewer extractions. The Grand Rapids program was soon followed by a similar test in Newburgh, N.Y. The results were checked against the dental decay rate of children in comparable cities without fluoridation: Muskegon, Mich., and Kingston, N.Y.

Originally, a mere few hundred scattered U.S. communities had fluorides in their water supplies, deposited by nature in the soils through which the waters flow. The value of man's imitating nature was soon apparent in the Grand Rapids experiment, which showed a dramatic reduction in the number of children's cavities (see chart). With that and similar proof from Newburgh, the campaign for nationwide fluoridation began. Despite diehard opposition, it has now progressed to the point where 43% of the total U.S. population has this anticavity protection.

Evidence in Bones. As long ago as 1916, Dentist Fredrick S. McKay of Colorado Springs noted that many of his patients had curiously mottled teeth, but that they had developed few or no cavities. He later suggested the reason: the city's water contained more than two parts per million of fluorine salts. It was a logical if slow progression from that to the carefully controlled studies of the 1940s and the continuing campaign since then.

The ideal amount of fluorine salts in public water has been established as one part per million. Less than that gives inadequate protection against decay; double that, or more, causes mottling. The question that has agitated hundreds of U.S. communities is whether fluorides,-even in a dilution of one part per million, are safe. The answer, from scientifically controlled studies in many countries, is an unequivocal yes on the basis of the evidence. But strident opposition has come from Christian Scientists, the Ku Klux Klan, the John Birch Society and a handful of physiologists and dentists. They assert that fluorides (among other effects) increase the incidence of mongolism, cancer, allergies, and sterility, and even make the teeth fall out.

The facts are clear from studies of inhabitants of such places as Colorado Springs who were conceived and lived all their lives there. These people have no higher incidence of disease of the heart, arteries, kidneys, liver or lungs than people who have lived the same sort of life in, say, Boulder, Colo., which lacks natural fluoridation. The same is true also of the townspeople of Lubbock or Bartlett, Texas, where the natural fluorides are too highly concentrated, as high as four and eight parts per million. (Some of these towns are now "defluoridating" down to the optimum 1 p.p.m.) Oldtimers there are found to have harder bones, with more fluorides in them, than their kin in non-fluoridated areas. At East Carolina University, Dr. Hal J. Daniel III has studied the stapes bones (in the middle ear, and essential to hearing) of residents in high-and low-fluoride areas. He finds evidence of much more deafness from stapes disease in low-fluoride areas.

Drinking a Tubful. Opponents point out that fluorides can be poisonous, and indeed are used in some pesticides. True, but the determining factor is the concentration. A 150-lb. man will get sick if he ingests .25 gm. of fluoride in one day, very sick on 1 gm., and will die with 4 to 8 gm. To ingest even that first .25 gm., he would have to drink more than half a bathtubful of water (42 gal.) containing 1 p.p.m., or, for 1 gm., more than three bathtubfuls (or 276 gal.). Long before he could become ill from the fluoride, he would be dead from water intoxication.

Admittedly, fluoridation of water is not the whole answer to dental health. The fluorides protect the sides of the teeth more than the grinding surfaces of molars, which have tiny fissures in them where decay often begins, especially in adolescents. For these surfaces, Dr. Michael Buonocore of the Eastman Dental Center in Rochester has devised a technique of coating with plastic film. Fluoridated toothpastes have won the approval of the American Dental Association (though not of all individual dentists) as a useful adjunct to water fluoridation. Another possibility, on which the National Institute of Dental Research is working, is the development of an antibiotic that would selectively keep down the bacteria known to be a major factor in the beginning of decay. Such a discovery may be years away. Meanwhile, water fluoridation remains the most effective, safest and cheapest shield against cavities. At 10$ psr person a year, it would cost $13 million to fluoridate all remaining public water supplies, the institute estimates. And that would save $700 million a year in dentists' fees for fillings, aside from millions of toothaches.

-The element fluorine (chemical symbol: F) is added to water in the form of several compounds, notably fluosilicic acid, sodium fluosilicate and sodium fluoride. For convenience, all are described simply as fluorides.

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