How Fear Has Conquered Facts in the Debate about Water Fluoridation

By Jennifer Sykes
HCF Communications Officer

I grew up in a small town in Southeast Kansas without fluoridated water. I do not need statistics to tell me the benefits of fluoridated water. Despite being the model patient and doing everything I was told by my dentist, I still heard those dreaded words: you have a cavity.
Statistics tell us:

  • Water fluoridation is estimated to reduce tooth decay by up to 40%
  • Every dollar spent on water fluoridation saves $38 in dental costs.
  • The American Dental Association (ADA), the United States Public Health Service (USPHS), the American Academy of Pediatrics (AAP), and the World Health Organization (WHO), among many other national and international organizations, endorse community water fluoridation.
  • The Centers for Disease Control and Prevention (CDC) recognized water fluoridation as one of the 10 greatest public health achievements of the 20th century.

Yet despite this information, voters in some states and municipalities have voted against adding fluoride to their water. Some have even attempted to repeal existing laws that requires water fluoridation. Why? Blame the power of fear and effective messaging.

Anti-fluoridation activists have done a masterful job of reframing the debate with inaccurate and misleading information that questions the safety and effectiveness of water fluoridation, despite little evidence to support their claims.

As the opposition becomes more organized, better funded and increasingly energized, the movement toward water fluoridation is losing momentum. Health groups are lagging in their support of water fluoridation, elected officials have labeled it too controversial, and there is no strong national coalition of advocates.

At last week’s Grantmakers in Health conference, I attended a workshop, “Can Reason Win? A New Campaign in Defense of Oral Health,” that discussed the current state of the anti-fluoridation movement. My biggest takeaway was that as advocates of oral health ignore the battle of water fluoridation, opponents are framing the debate and defining the discussion.

Headlines such as “This isn’t about Fighting. It’s about Facts. Let’s Discuss Fluoridation Based on Science, Not Science Fiction,” have shown to be effective, we just aren’t using them.

So let’s try a new strategy. Let’s talk about the truth. Let’s talk about how many teeth have been lost due to lack of water fluoridation. Let’s explain that any risks have been thoroughly investigated, and it’s evident that none really exist. Let’s talk about how ending fluoridation hurts kids. Let’s refocus this debate on our teeth.

A new campaign has been created to help advocates spread these messages. The Coalition in Defense of Oral Health was created to ensure every American has access to the most inexpensive, effective and basic oral health intervention – fluoridation. Their new campaign, Life is Better with Teeth, focuses on promoting oral health and the truth about fluoridation. The campaign website has educational materials such as fact sheets and power points, and advocacy items including t-shirts and bumper stickers, all based around a simple message that no one can disagree with – Life is Better with Teeth.

Comments

Part of the reason people aren't getting the fluoride they need is because kids don't drink enough water to begin with. My kids are always wanting a pop or juice box. Part of the problem lies with the parents. If more moms and dads have decent refrigerator water filters installed, then there would be more water consumed and less sugary drinks consumed (which also eat away teeth!)

I seem to have seen most of this before.

First the anecdote: no fluoride in SE Kansas and I had cavities. Well, I grew up somewhere else without fluoride and I didn't have a cavity until I was 30. What does that prove? Nothing.

Then the usual half-truths and worse:
- 40% reduction in cavities. Did you ever wonder what the actual reduction in the number of decayed tooth surfaces was? The biggest survey ever done in the USA (Brunelle & Carlos 1990) showed a reduction of 0.6 of a tooth surface, out of a total of 128 tooth surfaces in a child's mouth. That was listed as 18%, but big deal. Percents don't mean anything if you are dealing with small numbers. Comparable studies in Australia have shown an even smaller effect. A recent investigation “The Iowa Study” questions whether ingesting fluoride is useful for caries prevention (Warren et al 2009).

- $38 save in dental costs. Just take a critical look at how that figure was arrived at. And it ignored the massive cost of dental veneers for the unlucky minority who get moderate-severe fluorosis.

- Endorsements. Yes, USPHS endorsed fluoridation in 1950 before any of the trials intended to demonstrate efficacy had been completed. All the others just followed in short order.

- One of the greatest public health achievements... Congratulations!! You are the millionth person to quote this statement by the CDC. Apply now for a special CDC commemorative medal. Did you ever look at the basis for this claim? Take a look, and then look up WHO data for non-fluoridated countries. You might get a surprise.

- "Let's discuss fluoridation based on science, not science fiction". If fluoridationists are not using this slogan, that is wise of them. They may be beginning to realise who has the science and who has the fiction (alias a bunch of repetitive and largely baseless endorsements).

- "The 'truth'...how many teeth have been lost to lack of fluoridation"? In truth, not many. See above, and compare the US with non-fluoridated Europe.

- "any risks have been thoroughly investigated". What risks are you talking about? Please name one that has been thoroughly investigated, let alone proved to be baseless.

- "Let's refocus the debate on our teeth". So what's new? Fluoridationists have always talked as if the body consisted of nothing but teeth!

- "Life is better with teeth" - and better still with an optimally functioning brain, endocrine system, skeleton etc.

I hope this helps

H

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HCF's Local Health Buzz Blog aims to discuss health and health policy issues that impact the uninsured and underserved in our service area. To submit a blog, please contact HCF Communications Officers, Jennifer Sykes, at jsykes@hcfgkc.org.

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