Water Fluoridation 2015

Ronald S. Wilson, DMD

140 Mall Connector Rd

Greenville, SC

Seventy years ago, Grand Rapids, Michigan became the world’s first city to adjust the level of fluoride in its water supply. Since that time, fluoridation has dramatically improved the oral health of tens of millions of Americans. Community water fluoridation is the single most effective public health measure to prevent tooth decay. Additionally, the Center for Disease Control and Prevention

proclaimed community water fluoridation as one of 10 great public health achievements of the 20th century. Fluoridation of community water supplies is simply the precise adjustment of the existing naturally occurring fluoride levels in drinking water to an optimal fluoride level recommended by the U.S. Public Health Service (0.7 per million) for the prevention of dental decay. The EPA has deemed that 4ppm (roughly 6x more) as the maximum contaminant level of F in NATURALLY-OCCURRING water.

Fluoride Fluorine is a chemical element (symbol F) and atomic number 9. Fluoride is the negative ion of the element fluorine. Any compound, whether it is organic or inorganic, that contains the fluoride ion is also known as a fluoride. Examples include CaF2 (calcium fluoride) and NaF (sodium fluoride). Ions containing the fluoride ion are similarly called fluorides (e.g., bifluoride, HF2−).

To say that an inhaled anesthetic is a fluoridated compound and thereby any form of fluoride is a sedative is categorically untrue.

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Did you see the period on the last page? Rest assured it is there. What we are discussing here is essentially the same size as that period in a field of green. Not even one full part per million parts water. Is that too much to ask to protect the dental health of our most precious commodities, our children and our elderly?

Fluorosilicic acid: a water-based solution used by most water systems in the United States. Fluorosilicic acid is also referred to as hydrofluorosilicate, FSA, or HFS. When added to water this simply breaks down to fluoride, hydrogen, and silica (sand).

The U.S. Food and Drug Administration (FDA) does not regulate additives used for community drinking water (i.e., tap water), because its regulatory reach concerns the safety and efficacy of food, drugs, or cosmetic-related products.

Some consumers have questioned whether fluoride from natural groundwater sources, such as calcium fluoride, is better than fluorides added "artificially," such as FSA or sodium fluoride. Two recent scientific studies, listed below, demonstrate that the same fluoride ion is present in naturally occurring fluoride or in fluoride drinking water additives and that no intermediates or other products were observed at pH levels as low as 3.5. In addition, the metabolism of fluoride does not differ depending on the chemical compound used or whether the fluoride is present naturally or added to the water supply.

• Finney WF, Wilson E, Callender A, Morris MD, Beck LW. Re-examination of hexafluorosilicate hydrolysis by fluoride NMR and pH measurement. Environ Sci Technol 2006; 40:8:2572.

• G.M. Whitford, F.C. Sampaio, C.S. Pinto, A.G. Maria, V.E.S. Cardoso, M.A.R. Buzalaf. Pharmacokinetics of ingested fluoride: Lack of effect of chemical compound., Archives of Oral Biology, 53 (2008) 1037–1041

You Aren’t Drinking Toxic Waste

Regulatory Scope on Additives

Since the early 1950s, FSA has been the main additive used for water fluoridation in the United States. The favorable cost and high purity of FSA make it a popular additive.

Consumers may raise concerns about arsenic in drinking water and that fluoride additives may contain some arsenic. The EPA allowable amount for arsenic in drinking water is 10 parts per billion. NSF quality testing has found that most fluoride additive samples do not have detectable levels of arsenic. For those samples that do have some amount of arsenic, the arsenic level that an average consumer would experience over an entire year of drinking water at a concentration of 1.2 mg/L fluoride is extremely small -- only about 1.2% of the EPA allowable amount.

The U.S. Environmental Protection Agency (EPA) has authority over safe community drinking water, as specified in the Safe Drinking Water Act. On the basis of the scientific study of potential harmful health effects from contaminated water, the EPA sets a Maximum Contaminant Level (MCL) concentration allowed for various organisms or substances.

http://www.cdc.gov/fluoridation/factsheets/engineering/wfadditives.htm

How Does Fluoride Work?

For the best prevention of cavities: Both Systemic and Topical fluoride exposure are important:

Fluoride becomes incorporated into developing permanent teeth of children while still under gums-more resistant to cavities (systemic effect)

Frequent exposure to low concentrations of fluoride: saliva, release from plaque-reducing acid attack leading to cavities (topical effect via systemic

CWF)

Water fluoridation and dentifrices (toothpaste), fluoride mouthrinses, and professionally applied varnishes (topical and systemic effects from CWF and fluoride containing products)

Only Topical Claim Is False

To say that fluoride only works as a TOPICAL agent is false. Systemic fluorides are those ingested into the body. During tooth formation, ingested fluorides become incorporated into tooth structures. Fluorides ingested regularly during the time when teeth are developing (preeruptively) are deposited throughout the entire tooth surface and provide longer-lasting protection than those applied topically. It is a fact that fluorosed teeth are more caries resistant.

In addition to this, systemic fluorides can also give topical protection because ingested fluoride is present in saliva, which continually bathes the teeth providing a reservoir of fluoride that can be incorporated into the tooth surface to prevent decay.

A Public Health Problem

Tooth decay has decreased overall, however but this has been uneven across the general population.

Populations with increased risk:

1. Children

2. Elderly

3. Low socioeconomic status

4. Low level of parental education

5. Little if any access to dental care 6. Combinations of any of the above

Nearly 80% of cavities occur in 20% of the population

The poor bear a disproportionate burden of cavities

CAVITIES: Disproportionately Distributed

Newburgh/Kingston Controversy

In 1994, a study of 7- 14 year-old children in Newburgh and non-fluoridated Kingston school districts was undertaken to determine changes in dental fluorosis and dental caries. These cities were chosen in 1945 for a community clinical trial of water fluoridation because of their similarities. Since 1945, however, the availability of fluoride from sources other than water in Kingston has increased, and the communities have become less similar in their population characteristics. Census data reveal that, in comparison with Kingston, Newburgh has a higher level of poverty (26% vs. 12%), a lower percentage of persons with a college-level education (29% vs. 43%), a lower percentage of whites in the population ( 5 1% vs. 87%), and a higher rate of unemployment (12% vs. 6%). Based on this to draw conclusions of CWF today are pointless and inaccurate.

The original study from 1950 even shows that the DMF rate (decayed, missing, filled)in first molars in Newburgh was 18% better than its non-fluoridated counterpart after only three years. The rates did stay the same after the first year but after years two and three there was noted marked changes in rates, further proof that a systemic effect was taking place.

The Newburgh-Kingston Caries Fluorine Study. I. Dental Findings after Three Years of Water Fluoridation* David B. Ast, Sidney B. Finn, and Isabel McCaffrey

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1528792/?page=4

• Infection

• Extreme pain

• Difficulty in chewing

• Poor weight gain

• Difficulty concentrating

• Missed school hours

• Predictor of cavities in later life

• Costly treatment

• LIFE THREATENING

• DEATH

Deamonte Driver, 12, died February 25, 2007, after an infection from a molar spread to his brain

Why Do Cavities Matter?

Key Issues For Vulnerable Children

Race- Black children are more likely than white children to have untreated cavities

Free/Reduced Lunch- Children and teens in this program are more likely to have decay than those that do not participate

Rural/Urban Environment- Rural children are more likely to have more untreated decay than urban children

According to high-schools.com the percentage of Greer High School students on free and reduced lunch assistance (51.4%) is slightly higher than the state average of 51.1%. This may indicate that the area has a higher level of poverty than the state average. This number has increased sharply from 33.6% in 2005.

To extrapolate this one can assume that slightly over half of the children in Greer area schools are below the poverty level and are at an increased risk for dental disease with these numbers increasing every year.

Studies conducted throughout the past 70 years have consistently indicated that fluoridation of community water supplies is safe and effective in preventing dental decay in both children and adults. It is the most efficient way to prevent one of the most common childhood diseases – tooth decay (5 times as common as asthma and 7 times as common as hay fever in 5- to17-year-olds). Early studies, such as those conducted in Grand Rapids, showed that water fluoridation reduced the amount of cavities children get in their baby teeth by as much as 60% and reduced tooth decay in permanent adult teeth nearly 35%. Today, studies prove water fluoridation continues to be effective in reducing tooth decay by 20-40%, even in an era with widespread availability of fluoride from other sources, such as fluoride toothpaste.

The average cost for a community to fluoridate its water is estimated to range from approximately $0.50 a year per person in large communities to approximately $3.00 a year per person in small communities. For most cities, every $1 invested in water fluoridation saves $43 in dental treatment costs.

As a dentist it would self-serving for me to stand before you and ask for you not to fluoridate the water supply as it would be a benefit to my practice. Research shows in communities where they remove Fluoride the decay index increases. But as a health care provider it is my mandate to do whatever is in my power to improve the health of my patients and those in my community.

There have been multiple studies in communities worldwide where fluoride has been removed. They all show an increase in decay in both children and the adult population. (1979- For example in Wick, Scotland F levels were allowed to return to the natural level of .2ppm and five years later resulted in increase of decay of 27% and 40% in adult and baby teeth respectively)

This is what we must contend with

Dental Disease Not Just A Childhood Issue

Aging Population + Socioeconomic Constraints= Medical and Dental Crisis

Let’s Look At Real Numbers

In the past fifteen years (2000 through 2014), more than 449 U.S. communities in 42 states have voted to adopt or retain successful fluoridation programs.    In just the past month both Austin, TX and Denver, CO.  Decided to retain the practice. Denver alone provides fluoridated water to over 1.3 million people in the Denver area, and Austin supplies approximately another million.

U.S. Communities Voting to Adopt Fluoridation* Updated June 2015. Current through calendar year 2014.

AlabamaMadison (To retain) 2012 Russellville (To retain) 2008 North Baldwin Utilities (To retain) 2007

AlaskaAnchorage (To retain) 2013 Bethel (To retain) 2011 Kotlik 2011 Nome (To retain) 2011 Seward 2009 Fairbanks (To retain) 2008 Port Lyons 2004

Arkansas DeQueen 2012 Dumas 2012 Southside Public Water Authority 2012 Warren 2012 Yorktown 2012 Carroll-Boone Water District 2011 Fort Smith 2011 El Dorado 2010 Conway (To retain) 2008 Prescott 2003 Monticello (To retain) 2003 Dardanelle 2002 Rector 2002Kimsy East 2002 Little River 2002 Berryville 2000 Benton-Washington County Water Assoc. 1999 Gentry 1999 Grand Prairie Water District 1999 Siloam Springs 1999 ArizonaPhoenix (To retain) 2012 Y uma 2001 Gilbert 2000 Mesa 2000 El Mirage 1999 Mesa 1998

CaliforniaHealdsburg (To retain) 2014 Olivehurst Public Utility (To retain) 2012 County of Sacramento 2011 City of Sacramento (To retain) 2011 Santa Clara Valley Water District 2011 Yuba City (To retain) 2011 Crescent City (To retain) 2010 Watsonville 2010 Helix Water District (To retain) 2009 San Diego 2008 Arcata (To retain) 2006 West Sacramento 2006 Inglewood 2005 Santa Maria (To retain) 2004 Stockton 2003 Salinas 2003 Metropolitan Water Dist. of Southern CA 2003 Palo Alto (To retain) 2003 Mammoth 2002 Santa Maria 2002 Escondido 2001 Santa Monica 2001 San Francisco Public Utilities Commission 2001 Watsonville 2001 Sacramento County 2000 San Diego 2000 Sunnyvale 2000 Los Angeles 1999 Sacramento 1999 Yuba City 1999 Mountain View 1998

Colorado Loveland (To retain) 2014 Meeker (To retain) 2014 Aspen (To retain) 2012 Arvada (To retain) 2011 Denver (To retain) 2011 Durango (To retain) 2009 Project 7 Water Treatment Plan (To retain) 2009 Aspen (To retain) 2008 Erie 2008 Boulder (To retain) 2006 Fort Collins (To retain) 2005 Glenwood Springs (To retain) 2005 Fort Collins (To retain) 2003 Superior 2000 Colorado Springs 1999 Fort Morgan 1999 Canon City 1998

Connecticut East Lyme Water & Sewer Commission 2011

(To retain) Florida

Brooksville (To retain) 2013 Auburndale (To retain) 2012 Naples (To retain) 2012 Ormond Beach (To retain) 2012 Pinellas County 2012 Pinellas Park 2012 Tarpon Springs 2012 Collier County (To retain) 2011 Dunedin (To retain) 2011 Great Pine Island 2011 Holly Hill (To retain) 2011 Stuart (To retain) 2011 Plant City 2010 Deland (To retain) 2009 Fellsmere 2009 Gainesville (To retain) 2009 Port Orange (To retain) 2009 Brooksville (To retain) 2008 Stuart (To retain) 2008 Daytona Beach (To retain) 2007 Palm Beach (To retain) 2006 Eustis (To retain) 2005 Stuart 2005 Pinellas County Utilities 2003 Palm Beach County Water Utilities 2003 Jefferson Communities 2002 Martin County 2002

Bartow 2001 Chattahoochee 2001 Orange County 2001 Boynton Beach 2000 Fellsmere 2000 Flagler County 2000 Ocean Ridge 2000 Wellington 2000 Eatonville 1999 North Brevard County 1999 Wellington 1999 Bradenton 1998 Escamiba County (Pensacola) 1998 Pompano Beach 1998

GeorgiaRichland 2014 Big Canoe 2009 Jeffersonville 2001 Manor Water Authority 2001 Odom 2001 Senoia 2001

Hawaii

Lanai 2001 Idaho

Lewiston (To retain) 2011

Sandpoint (To retain) 2009 Indiana

Valparaiso (To retain) 2014 Huntingburg (to retain) 2012 Greensburg 2009 Rockville 2001 Seelyville 2001 Connersville 2000 Carlisle 1998

IowaTama (To retain) 2014 Van Meter (To retain) 2014 Storm Lake (To retain) 2014 Davenport (To retain) 2013 Des Moines (To retain) 2013 Hampton (To retain) 2013 Storm Lake 2013 Maquoketa (To retain) 2012 Davenport (To retain) 2011 Des Moines (To retain) 2011 DeSoto (To retain) 2011 Dubuque (To retain) 2011 Iowa City (To retain) 2011 Monona (To retain) 2011 Stantin (To retain) 2011 Treynor (To retain) 2011 Vinton (To retain) 2011 Waterloo (To retain) 2011 Dubuque (To retain) 2010 Iowa City (To retain) 2010 Vinton City (To retain) 2009 Hampton (To retain) 2006 Rock Valley 2000

Kansas Salina (To retain) 2014 Cheney City (To retain) 2011 Parsons City 2008 Garden City 2005 Leavenworth 2000 Hesston 1999 Kanopolis 1999 Newton 1999 Abilene 1998

Kentucky Arlington 2003

LouisianaCrowley (To retain) 2009 Walker 2007 Crowley 2004 Plaquemines Parish 1998

MaineGreat Salt Bay Sanitary District (To retain) 2011 Island Falls 2009 Vinalhaven 2008 Bangor (To retain) 2007 Jackman (To retain) 2006 Moose River (To retain) 2006 Arundel 2002 Berwick 2002 Biddeford 2002 Boothbay 2002 Boothbay Harbor 2002 Kennebunk 2002 Kennebunkport 2002 Ogunquit 2002 Southport 2002 Wells 2002 York 2002 Monmouth 2001 Dover-Foxcroft 2000 Freeport 1999 South Freeport 1999

Maryland Northeast 2009 Cumberland 2000 Frostburg 2000 Loch Lynn 2000 Mountain Lake 2000 Boonesboro 1999 Keedysville 1999 Middletown 1999

Massachusetts Duxbury (To retain) 2013 Templeton (To retain) 2013 Woodland (To retain) 2013. Groveland (To retain) 2011 Templeton (To retain) 2011 Athol (To retain) 2009 North Attleboro (To retain) 2007 Long Meadow (To retain) 2007 New Bedford 2006 North Attleboro (To retain) 2005 Woburn 2002 North Attleboro 2000 Rowley 1998 Wayland 1998

Michigan Bronson (To retain) 2014 Boyne City (To retain) 2014 Cassopolis (To retain) 2014 East Jordan (To retain) 2014 Traverse City (To retain) 2014 Marine City (To retain) 2010 Pinckney 2010 Dexter 2009 Port Huron (To retain) 2008 New Baltimore (To retain) 2008 Grand Ledge 2006 Mt. Pleasant 2005 St. Ignace (To retain) 2005 Grayling 2004 Union City 2004

MississippiLena Water Association 2014 Hancock County Utility Authority 2014 City of Grenada 2014 Central Rankin Water Association 2012 City of Winnoa

Town of Vaiden 2012 City of Pass Christian 2011 Crooked Creek Water Association 2011 East Leflore County Water & Sewer 2011 Ellisville 2011 Grenada 2011 Hiwannee Water Association 2011 Lampton Water Association 2011 Mt Comfort Water Association 2011 Smithville 2011 City of Bay St. Louis 2010 City of Bruce 2010 City of Waveland 2010 D’Iberville Water and Sewer 2010 Hancock Water and Sewer 2010 Harmony Water Association 2010 Hotophia Water Association 2010 Improve Water Association 2010 Kiln Water and Fire 2010 Leesburg Water Association 2010 Naval Construction Battal 2010 New Hope Water Association 2010 Northeast Copiah Water Association 2010 Pearlington Water Association 2010 Rose Hill Water Association 2010 Sparta Water Association 2010 Town of Derma 2010 Kossuth Water Association 2009 Fisher Ferry Water System 2009 Alcorn State University 2009 Beat III Water Association 2007 Central Yazoo Water Association 2007 City of Itta Bena 2007 City of Nettletown 2007 City of Pascagoula 2007 Diamondhead Utilities 2007 Double Ponds Water Association 2007 Glendale Utility District 2007 Hilton Heights Water Association 2007 Hopewell Water Association 2007 Marydell Water Association 2007 Smith’s Crossing Water Association 2007 Southwest Leake Water Association 2007 Sunrise Utilities 2007 Town of Ackerman 2007 Town of Baldwyn 2007 Town of Wesson 2007 Westwick Utilities 2007 Guntown 2006 Lebanon Water Association 2006 Puckett 2006 Quincy Water Association 2006 University of MS at Oxford 2005 Collinsville 2005 Pontotoc 2005 Maben 2005 Ashland 2005 Prairie Land Water Assoc. 2005 Alcorn Water Association 2004 Buffalo (To retain) 2004 Cason Water Association 2004 Combined Utilities 2004 Farmington Water Association 2004 Freeny Water Association 2004 Greenfield Water Association 2004 City of Iuka 2004 City of McComb 2004 Okatoma Water Association 2004 City of Petal 2004 City of Picayune 2004 Town of Port Gibson 2004 City of Richland 2004 North Lauderdale Water Association 2004 Town of Summitt 2004 Town of Tchula 2004 Topisaw Creek 2004 West Lamar Water Association 2004

MissouriColumbia (To retain) 2013 Forsyth (To retain) 2013 St. Joseph (to retain) 2012 Bolivar (To retain) 2011 Liberty (To retain) 2011 Bolivar (To retain) 2010 St. Roberts (To retain) 2009 Keytesville 2006 Stockton (To retain) 2006 Carl Junction 2005 Jefferson City (To retain) 2005 Joplin 2004 Webb City 2004 Osage Beach 2001 Buffalo 2000 Monett 2000

MontanaBozeman (To retain) 2012 Two Medicine Water Project 2008 Chester 2001

NebraskaGretna 2011 Alma 2008 Ashland 2008 Crete 2008 Dakota City 2008 Franklin 2008 North Bend 2008 Seward 2008 Wahoo 2008 Wisner 2008 Wakefield 2008 Y utan 2008 York 2002 Waterloo 1999 Waverly 1998

NevadaClark County/Las Vegas (To retain) 2000 Clark County/Las Vegas (state law passed) 1999

New HampshireBedford (To retain) 2004 Goffstown (To retain) 2004 Hooksett (To retain) 2004 Londonderry (To retain) 2004 Manchester (To retain) 2004 Manchester 1999

New Jersey Hightstown 2012 Atlantic City 2008 Jersey City 2002 South Brunswick 1999

New Mexico Santa Fe (To retain) 2013

New YorkDelhi Village (To retain) 2013 Lydonville Village (To retain) 2013 Springville Village (To retain) 2013 Walden Village (To retain) 2013 Yorktown Village (To retain) 2013 Messena (To retain) 2011 Walden (To retain) 2010 Cobleskill 2009 Plattsburg (To retain) 2009 Poughkeepsie Joint Water Board 2007 Corning 2006 Middletown 2003 Dansville 2000

North CarolinaDurham (To retain) 2013 Graham Mebane Water System (To retain) 2013 Orange Water and Sewer Authority

(To retain) 2013 Raleigh (To retain) 2013 Broad River Water Authority (To retain) 2009 Nano-Filtration Plant,

Cape Fear Public Utility Authority 2009 Asheville (To retain) 2008 Hendersonville (To retain) 2008 Franklinton 1998 MOASA/Vass 1998 Richmond County 1998

North DakotaGlen Ullin 1998 Hebron 1998 Hettinger 1998 Jud 1998 Monango 1998 New England 1998 Northwood 1998 Reeder 1998

OhioLebanon 2012 Northern Area Water Authority 2007 Delaware 2000

OklahomaStigler 2009 Pawhuska (To retain) 2009 Haskell County 2005 Coalgate 2001 Pittsburg 2001 Pittsburg County Rural Water District 2001 City of Woodward 2000 Pittsburg County Public Works Authority 2000 Okemah 1999 Pittsburg County Water Authority 1999

Oregon Sweet Home (To retain) 2014 Scappoose (To retain) 2013 The Dalles (To retain) 2013 Philomath 2012 Portland (City Council vote) 2012

(Public Vote 2013 reversed 2012 vote) Keizer (To retain) 2010 McMinnville (To retain) 2010 Beaverton 2002 Lebanon 2000

10

PennsylvaniaTyrone (To retain) 2013 Shippensburg (To retain) 2012 West Mannheim (to retain) 2012 Pottstown (To retain) 2009 Erie 2001 Allentown 1999 Allentown 1998

South CarolinaAiken (To retain) 2011 Dillion (To retain) 2007

TennesseeSouth Blount County Utilities District

(To retain) 2013 Selmer (To retain) 2009 Shelbyville City (To retain) 2009 Union City (To retain) 2009 South Blount County 2008

Texas Austin (To retain) 2011 Sequin 2009 Sulphur Springs (To retain) 2008 Elgin 2007 Del Rio (To retain) 2006 Alamo Heights 2004 Abilene 2000 San Antonio 2000

UtahDavis County (Layton) (To retain) 2004 Salt Lake County (Salt Lake City) 2000 Davis County (Layton) 2000

V ermontBradford 2013 Proctor (To retain) 2010 Newbury (To retain) 2009 Bradford (To retain) 2008 Randolph (To retain) 2008 Rutland (To retain) 2008 Bellows Falls (To retain) 2006 Montpelier (To retain) 2006 Burlington (To retain) 2005 Pownal 2000 Hinesburg 1999 Randolph 1998

VirginiaAlbemarle County (To retain) 2012 City of Charlottesville (To retain) 2012 Blacksburg-Christiansburg-VPI Water

11

Authority (To retain) 2011 Nelson County Service Authority 2011 Staunton (To retain) 2009 Timberville (To retain) 2009 Brookneal 2007 Cumberland County 2007

Washington Fircrest (To retain) 2014 Kalama (To retain) 2014 Pasco 2009 Skagit County 2006 Lakewood 2004 Sultan 2003 Port Angeles 2003 Pierce County 2002 Puyallup 2002 Aberdeen 1998 Pasco 1998 Yakima County 1999

West Virginia Clarksburg (To retain) 2013 Keyser (To retain) 2013 Martinsburg (To retain) 2013 Clarksburg (To retain) 2009 Clay Municipal Water Works 2007

North DakotaGlen Ullin 1998 Hebron 1998 Hettinger 1998 Jud 1998 Monango 1998 New England 1998 Northwood 1998 Reeder 1998

OhioLebanon 2012 Northern Area Water Authority 2007 Delaware 2000

OklahomaStigler 2009 Pawhuska (To retain) 2009 Haskell County 2005 Coalgate 2001 Pittsburg 2001 Pittsburg County Rural Water District 2001 City of Woodward 2000 Pittsburg County Public Works Authority 2000 Okemah 1999 Pittsburg County Water Authority 1999

Oregon Sweet Home (To retain) 2014 Scappoose (To retain) 2013 The Dalles (To retain) 2013 Philomath 2012 Portland (City Council vote) 2012

(Public Vote 2013 reversed 2012 vote) Keizer (To retain) 2010 McMinnville (To retain) 2010 Beaverton 2002 Lebanon 2000

PennsylvaniaTyrone (To retain) 2013 Shippensburg (To retain) 2012 West Mannheim (to retain) 2012 Pottstown (To retain) 2009 Erie 2001 Allentown 1999 Allentown 1998

South CarolinaAiken (To retain) 2011 Dillion (To retain) 2007

TennesseeSouth Blount County Utilities District

(To retain) 2013 Selmer (To retain) 2009 Shelbyville City (To retain) 2009 Union City (To retain) 2009 South Blount County 2008

Texas Austin (To retain) 2011 Sequin 2009 Sulphur Springs (To retain) 2008 Elgin 2007 Del Rio (To retain) 2006 Alamo Heights 2004 Abilene 2000 San Antonio 2000

UtahDavis County (Layton) (To retain) 2004 Salt Lake County (Salt Lake City) 2000 Davis County (Layton) 2000

V ermontBradford 2013 Proctor (To retain) 2010 Newbury (To retain) 2009 Bradford (To retain) 2008 Randolph (To retain) 2008 Rutland (To retain) 2008 Bellows Falls (To retain) 2006 Montpelier (To retain) 2006 Burlington (To retain) 2005 Pownal 2000 Hinesburg 1999 Randolph 1998

VirginiaAlbemarle County (To retain) 2012 City of Charlottesville (To retain) 2012 Blacksburg-Christiansburg-VPI Water

Authority (To retain) 2011 Nelson County Service Authority 2011 Staunton (To retain) 2009 Timberville (To retain) 2009 Brookneal 2007 Cumberland County 2007

Washington Fircrest (To retain) 2014 Kalama (To retain) 2014 Pasco 2009 Skagit County 2006 Lakewood 2004 Sultan 2003 Port Angeles 2003 Pierce County 2002 Puyallup 2002 Aberdeen 1998 Pasco 1998 Yakima County 1999

West Virginia Clarksburg (To retain) 2013 Keyser (To retain) 2013 Martinsburg (To retain) 2013 Clarksburg (To retain) 2009 Clay Municipal Water Works 2007

Wisconsin Albany (To retain) 2014 Madison (To retain) 2014 Holmen (To retain) 2013 St. Croix Falls (To retain) 2013 Waupaca (To retain) 2013 Milwaukee (To retain) 2012 Sun Prairie 2012 Alma (To retain) 2011 Avoca (To retain) 2011 Mt. Horeb (To retain) 2011 Amery (To retain) 2010 Poynette 2009 Elroy (To retain) 2008 Fond du Lac (To retain) 2008 Holmen 2008 Antigo (To retain) 2006 Mellen 2002 Arena 2001 Horicon (To retain) 2001 Lake Delton 2001 Hurley 1999 LaValle 1998 Merrimac 1998 Rock Springs 1998

Current Research Supporting CWF

American Public Health Association. Policy Statement Data Base. Policy #20087 Community Water Fluoridation in the United States. Adopted 2008. Available at: http://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/24/13/36/community-water-fluoridation-in-the-united-states. Armfield JM. Community effectiveness of public water fluoridation in reducing children's dental disease. Public Health Rep 2010 September-October;125:655-64. Blakey K, et al. Is fluoride a risk factor for bone cancer? Small area analysis of osteosarcoma and Ewing sarcoma diagnosed among 0–49-year-olds in Great Britain, 1980–2005. Int J Epidemiol 2014;43(1):224-34. Broadbent JM, et al. Community Water Fluoridation and Intelligence: Prospective Study in New Zealand. Am J Public Health 2014 May 15. Cho HJ, et al. Systemic effect of water fluoridation on dental caries prevalence. Community Dent Oral Epidemiol. 2014 Jan 16. Do LG, et al. Oral health-related quality of life of children by dental caries and fluorosis experience. J Public Health Dent 2007 Summer;67(3):132-9. Griffin SO, et al. Effectiveness of fluoride in preventing caries in adults. J Dent Res 2007;86(5):410-5. Iida H, et al. The association between enamel fluorosis and dental caries in U.S. schoolchildren. J Am Dent Assoc 2009 Jul;140(7):855-62. Jones S, et al. The effective use of fluorides in public health. Bulletin of the World Health Organization September 2005;83(9):670-76. Kim FM, et al. An Assessment of Bone Fluoride and Osteosarcoma. J Dent Res 2011;90(10):1171-76. Kumar JV, et al. Geographic variation in Medicaid claims for dental procedures in New York State: Role of fluoridation under contemporary conditions. Public Health Rep 2010 September-October;125:647-54. Kumar JV. Is water fluoridation still necessary? Adv Dent Res 2008 Jul 1;20(1):8-12. Levy SM, et al. Effects of Life-long Fluoride Intake on Bone Measures of Adolescents A Prospective Cohort Study. J Dent Res 2014;93(4):353-9. Murthy, VH. Surgeon General’s Perspective - Community Water Fluoridation: One of CDC’S “10 Great Public Health Achievements of the 20th Century." Public Health Reports. 2015;130(4):296-8. Näsman P, et al. Estimated Drinking Water Fluoride Exposure and Risk of Hip Fracture: A Cohort Study. J Dent Res 2013;92(11):1029-34.

Public Health Rep. 2010 Sep-Oct;125(5):655-64. Community effectiveness of public water fluoridation in reducing children's dental disease. Armfield JM1. Author information

Abstract OBJECTIVES: Water fluoridation is one of the most effective public health programs of the past century. However, efforts to extend water fluoridation into currently non-fluoridated areas are often thwarted. Despite considerable evidence regarding the effectiveness of water fluoridation at an individual level, published national community-based studies are rare. This study compared children's decay experience and prevalence between areas with and without water fluoridation in Australia. METHODS: Oral health data were obtained from clinical examinations of 128, 990 5- to 15-year-old children attending for a regular visit with their respective Australian state or territory School Dental Service in 2002. Water fluoridation status, residence remoteness, and socioeconomic status (SES) were obtained for each child's recorded residential postcode area. RESULTS: Children from every age group had greater caries prevalence and more caries experience in areas with negligible fluoride concentrations in the water (<0.3 parts per million [ppm]) than in optimally fluoridated areas (> or = 0.7 ppm). Controlling for child age, residential location, and SES, deciduous and permanent caries experience was 28.7% and 31.6% higher, respectively, in low-fluoride areas compared with optimally fluoridated areas. The odds ratios for higher caries prevalence in areas with negligible fluoride compared with optimal fluoride were 1.34 (95% confidence interval [CI] 1.29, 1.39) and 1.24 (95% CI 1.21, 1.28) in the deciduous and permanent dentitions, respectively. CONCLUSIONS: This study demonstrates the continued community effectiveness of water fluoridation and provides support for the extension of this important oral health intervention to populations currently without access to fluoridated water.

Arguments Against

And Data For

Systemic Health Effects

Following an in-depth review of existing research on the health effects of community water fluoridation, Ireland's Health Research Board released a report, "Health Effects of Water Fluoridation," and concluded that the literature found no strong evidence that community water fluoridation is definitively associated with negative health effects. The review was not designed to make any conclusions on the impact of community water fluoridation on dental health. The Ireland Department of Health asked the Health Research Board in 2014 to determine the positive or negative impact on the systemic health, including oral health but excluding dental health, of the population for those exposed to artificially fluoridated water between 0.4 and 1.5 parts per million (ppm). http://www.hrb.ie/publications/hrb-publication/publications//674/  

Thyroid ??

The British Thyroid Association confirmed in 2006 that there was no association between fluoride levels in water and thyroid disease. In an effort to determine if fluoride in drinking water affects the function, shape and size of the thyroid gland, researchers conducted a study comparing one group of people who consumed water that contained natural fluoride levels of 3.48 ppm and one group who consumed water with extremely low fluoride levels of 0.09 ppm.  The researchers noted that all study participants had been residents of their respective communities for more than 10 years.  The researchers concluded that prolonged ingestion of fluoride at levels above optimal to prevent dental decay had no effect on thyroid gland size or function. This conclusion was consistent with earlier animal studies.

It was used in one small trial in the 1950’s to see if it’s use could help in patients with hyperthyroidism. In this study 15 patients who had hyperthyroidism (an over active thyroid) were given relative large amounts of sodium fluoride orally or by injection in an effort to inhibit the thyroid’s function.  The researchers concluded that efforts to treat hyperthyroidism with fluoride was successful only occasionally among persons subjected to massive doses of fluoride.  This study does not support claims that low fluoride levels in drinking water would cause hypothyroidism (an under active thyroid).

In Feb of 2015 there was one article that shows a small link between fluoride and hypothyroidism. It should be noted, however, that it did not undergo typical peer review prior to being published and it was written by Professor Stephen Peckham, a leading anti-fluoridationist in England.

“The authors’ provide an unbalanced assessment of the effects of fluoridation on hypothyroidism in their “introduction”, “discussion” and “interpretation” sections. They reference the National Research Council (U.S), 2006 (Fluoride in Drinking Water: A Scientific Review of EPA’s Standards) as evidence for a link between fluoride exposure and hypothyroidism. Their assessment is misleading for three reasons:

1. The authors’ of the NRC report explicitly state that "this report does not evaluate nor make judgments about the benefits, safety, or efficacy of artificial water fluoridation" (National Research Council, 2006, p. 16) and also that "committee's conclusions regarding the potential for adverse effects from fluoride at 2 to 4 mg/L in drinking water do not address the lower exposures commonly experienced by most U.S. citizens" (National Research Council, 2006, p. 11).

2. They fail to mention that most of the included studies in the NRC report showed no association between fluoride exposure and thyroid function.

3. They also fail to report three scientific reviews that have concluded insufficient evidence of association between exposure to fluoride in drinking water and adverse thyroid effects.”

Peel Public Health Feb 26, 2015

Has No Affect On Adult Teeth

J Dent Res. 2007 May;86(5):410-5. Effectiveness of fluoride in preventing caries in adults. Griffin SO1, Regnier E, Griffin PM, Huntley V. Author information

Abstract To date, no systematic reviews have found fluoride to be effective in preventing dental caries in adults. The objective of this meta-analysis was to examine the effectiveness of self- and professionally applied fluoride and water fluoridation among adults. We used a random-effects model to estimate the effect size of fluoride (absolute difference in annual caries increment or relative risk ratio) for all adults aged 20+ years and for adults aged 40+ years. Twenty studies were included in the final body of evidence. Among studies published after/during 1980, any fluoride (self- and professionally applied or water fluoridation) annually averted 0.29 (95%CI: 0.16-0.42) carious coronal and 0.22 (95%CI: 0.08-0.37) carious root surfaces. The prevented fraction for water fluoridation was 27% (95%CI: 19%-34%). These findings suggest that fluoride prevents caries among adults of all ages. Comment in Fluoride prevents caries among adults of all ages. [Evid Based Dent. 2007]

Lower IQ MythThose opposed to fluoridation continue to compile and circulate studies reportedly supporting the theory that fluoridation causes lower IQ in children.  The studies often cited are from China, India, Iran and Mexico where social and environmental conditions are not similar to those in the US.  The vast majority of the studies have never been published in peer-reviewed, English language journals.  Those opposed to fluoridation in the U.S. paid to have the foreign studies, which supported their antifluoridation position, translated from Chinese to English.  The quality of these studies does not stand up to scientific scrutiny.

In 2014, a scientific review1 commissioned by the New Zealand Prime Minister’s Chief Science Advisor and the President of the Royal Society of New Zealand concluded: “There is no convincing evidence of neurological effects at fluoride concentrations achieved by CWF.”  In addition to citing numerous weaknesses of the studies from China and other countries, the review noted a 2014 New Zealand study2 that followed a group of people born in the early 1970s and measured childhood IQ at the ages of 7, 9, 11 and 13 years and adult IQ at the age of 38 years.  Early-life exposure to fluoride from a variety of sources was recorded, and adjustments were made for factors potentially influencing IQ.  This extensive study revealed no evidence that exposure to water fluoridation in New Zealand affects neurological development or IQ.

Am J Public Health. 2015 Jan;105(1):72-76. Community Water Fluoridation and Intelligence: Prospective Study in New Zealand. Broadbent JM1, Thomson WM, Ramrakha S, Moffitt TE, Zeng J, Foster Page LA, Poulton R. Author information

Abstract Objectives. This study aimed to clarify the relationship between community water fluoridation (CWF) and IQ. Methods. We conducted a prospective study of a general population sample of those born in Dunedin, New Zealand, between April 1, 1972, and March 30, 1973 (95.4% retention of cohort after 38 years of prospective follow-up). Residence in a CWF area, use of fluoride dentifrice and intake of 0.5-milligram fluoride tablets were assessed in early life (prior to age 5 years); we assessed IQ repeatedly between ages 7 to 13 years and at age 38 years. Results. No clear differences in IQ because of fluoride exposure were noted. These findings held after adjusting for potential confounding variables, including sex, socioeconomic status, breastfeeding, and birth weight (as well as educational attainment for adult IQ outcomes). Conclusions. These findings do not support the assertion that fluoride in the context of CWF programs is neurotoxic. Associations between very high fluoride exposure and low IQ reported in previous studies may have been affected by confounding, particularly by urban or rural status. PMID: 24832151 [PubMed - as supplied by publisher] PMCID: PMC4265943 [Available on 2016-01-01]

Osteosarcoma

A study published in 2011 found that bone fluoride levels are not associated with osteosarcoma. A team of researchers from Harvard University, the Medical College of Georgia and the National Cancer Institute analyzed hundreds of bone samples from 137 patients with osteosarcoma and a control group (N=51) to measure fluoride levels in the bone.  The study from nine U.S. hospitals over an eight-year period was considered the most extensive to date that examined a potential association between fluoride levels in bone and osteosarcoma; the results indicated no correlation. The study was the second of a two-part study implemented through a 15-year collaboration between the Harvard School of Dental Medicine and the three branches of the National Institutes of Health.  The National Cancer Institute (NCI) approved the design of the study, and the NCI, the National Institute of Environmental Health Sciences (NIEHS), and the National Institute of Dental and Craniofacial Research (NIDCR) provided funding for the research.  The cases for this study were recruited from existing cases between 1993 and 2000.

J Dent Res. 2011 Oct;90(10):1171-6. doi: 10.1177/0022034511418828. Epub 2011 Jul 28. An assessment of bone fluoride and osteosarcoma. Kim FM1, Hayes C, Williams PL, Whitford GM, Joshipura KJ, Hoover RN, Douglass CW; National Osteosarcoma Etiology Group. Collaborators (9)

Author information

Abstract The association between fluoride and risk for osteosarcoma is controversial. The purpose of this study was to determine if bone fluoride levels are higher in individuals with osteosarcoma. Incident cases of osteosarcoma (N = 137) and tumor controls (N = 51) were identified by orthopedic physicians, and segments of tumor-adjacent bone and iliac crest bone were analyzed for fluoride content. Logistic regression adjusted for age and sex and potential confounders of osteosarcoma was used to estimate odds ratios (OR) and 95% confidence intervals (CI). There was no significant difference in bone fluoride levels between cases and controls. The OR adjusted for age, gender, and a history of broken bones was 1.33 (95% CI: 0.56-3.15). No significant association between bone fluoride levels and osteosarcoma risk was detected in our case-control study, based on controls with other tumor diagnoses. PMID: 21799046 [PubMed - indexed for MEDLINE] PMCID: PMC3173011 Free PMC Article

Water Fluoride Levels Do Not Increase Risk Of

Bone Cancer

Fluoride levels in drinking water do not lead to a greater risk of primary bone cancer, a

new study has found.

Researchers at Newcastle University found that higher levels of natural or artificial

fluoride in drinking water in the UK had no impact on the incidence of either osteosarcoma

or Ewing’s sarcoma in people aged 0-49.

The study, funded by charity Bone Cancer Research Trust (BCRT), analysed 2,566

osteosarcoma and 1,650 Ewing’s sarcoma cases during 1980 and 2005.

1-22-14 Press release courtesy of Bone Cancer Research Trust

Early Onset Puberty?

“ The onset of menstruation in girls was selected as an index of the rate of sexual maturation, since the menarche is an event which is readily dated. The average age of the menarche was 12 years among the girls studied in Newburgh and 12 years 5 months in Kingston. No statistical significance could be demonstrated in this difference, nor in the difference between the two cities in proportion of girls who had passed the menarche. “ Newburgh-Kingston Caries-Fluorine Study XII. Pediatric Findings After Ten Years

E. Schlesinger M.D. , D. Overton M.D. , H. Chase M.Sc. , and K. Cantwell B.A.

DENTAL FLUOROSIS Dental fluorosis is a change in the appearance of the tooth enamel that only occurs when younger children consume too much fluoride, from any source, over long periods when teeth are developing under the gums.    The crown of the tooth (the part covered in enamel) is formed under the gums before the teeth erupt.  Enamel formation of permanent teeth, other than third molars (wisdom teeth), occurs from about the time of birth until approximately eight years of age.  Because dental fluorosis occurs only while teeth are forming under the gums, teeth that have erupted are not at risk for dental fluorosis; therefore, older children and adults are not at risk for the development of dental fluorosis. The vast majority of fluorosis in the United States is the very mild or mild type.

Very mild to mild fluorosis has no effect on tooth function and may make the tooth enamel more resistant to decay.  A study published in 2009 investigated the relationship between dental fluorosis and tooth decay in U.S. schoolchildren.  The study concluded that teeth with fluorosis were more resistant to tooth decay than were teeth without fluorosis.  Not only should the cavity preventive benefits of fluoridation be considered when considering policy to introduce or retain water fluoridation, but also the cavity preventive benefits of mild dental fluorosis. 

WHICH WOULD BE YOUR CHOICE???

Tooth Decay or Mild Dental Fluorosis

STATUS OF FLUORIDATION OUTSIDE THE UNITED STATES  

The value of water fluoridation is recognized internationally.  Countries and geographic regions with extensive water fluoridation include the U.S., Australia, Brazil, Canada, Chile, Columbia, Ireland, Israel, Malaysia, New Zealand, People’s Republic of China (Hong Kong only), Singapore and the United Kingdom.   For many countries, it has simply not been implemented for a variety of technical, legal, financial or political reasons.  For example, when East Germany joined West Germany, the East German government was fluoridating their half of the county.  When they reunited, fluoridation was stopped due to other financial needs.   Up until 2014, no country had imposed a “ban” on water fluoridation in its 70 year history.   On August 17, 2014, Israel’s new Health Minister Yael German issued a decision to prohibit the fluoridation of the nation's drinking water. It should be noted that the newest Health Minister has begun the process of reinstating this practice.

Responsible Parenting!!

It would take a 20kg child (~4 year old) ingesting 2 full tubes of Adult sized toothpaste at one setting to reach a lethal dose of fluoride The sudsing agent and abrasive components of toothpaste would cause anyone ingesting excess toothpaste to throw up.

“To this day, according to the American Association of Poison Control Centers, there have not been any deaths or serious adverse reactions from ingestion of fluoride toothpastes” -Clifford W. Whall, Jr., PhD Director of Acceptance Program ADA Council on Scientific Affairs April 2, 2012, email to Dr. Johnny Johnson

It’s A Poison That Is Why It Is Labeled

On Toothpaste

European Research

Eur Arch Paediatr Dent. 2009 Sep;10(3):141-8. Water fluoridation. Parnell C1, Whelton H, O'Mullane D. Author information

Abstract AIM: This was to present a summary of the evidence from systematic reviews of the effectiveness and safety of water fluoridation. METHODS: A search for relevant systematic reviews was conducted using the terms Fluoridation [Mesh] OR "water fluoridation" OR fluoridation OR (water AND fluoride) and was run from 01/01/2000 to 17/10/2008 in Pubmed, Embase, the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects in the Cochrane Library. The quality of the systematic reviews was assessed using Scottish Intercollegiate Guideline Network (SIGN) methodology checklists for systematic reviews. Websites of guideline organisations were also searched for relevant evidence-based guidelines, which were appraised using the AGREE instrument. RESULTS: Of the 59 publications identified, 3 systematic reviews and 3 guidelines were included in this review. While the reviews themselves were of good methodological quality, the studies included in the reviews were generally of moderate to low quality. The results of the three reviews showed that water fluoridation is effective at reducing caries in children and adults. With the exception of dental fluorosis, no association between adverse effects and water fluoridation has been established. Water fluoridation reduces caries for all social classes, and there is some evidence that it may reduce the oral health gap between social classes. CONCLUSION: Water fluoridation, where technically feasible and culturally acceptable, remains a relevant and valid choice as a population measure for the prevention of dental caries. PMID: 19772843 [PubMed - indexed for MEDLINE]

Added note- It is true. Much of Europe is not fluoridated. What the opposition fails to realize or admit is that it is mostly an infrastructure issue. They are not blessed with water systems as advanced as ours.

Nazi Myth

“We have done our level best to discourage opponents of fluoridation from using this emotive argument,” said Paul Connett, a chemist who directs the anti-fluoridation group Fluoride Action Network and recently co-authored a book called The Case Against Fluoride. “The historical evidence for this assertion is extremely weak. It is sad that the U.S. media has done such a bad job of educating the public on this issue that it is so easy for crazy ideas to fill the vacuum.”

Andy Hollinger of the U.S. Holocaust Museum also discredits this as does the leading expert on Nazi medical experimentation, Patricia Heberer.

Tampa Bay Times October 6, 2011

Report issued in March 2006 Focused on naturally occurring high levels of fluoride in drinking water. (~200,000 people, ~$4 million dollars spent on study)

Reviewed studies: •Effects of Fluoride on Teeth

•Musculoskeletal Effects-NO! •Reproductive and Developmental Effects-NO! •Neurotoxicity and Neurobehavioral Effects-NO! •Effects on the Endocrine System-NO! •Effects on the Gastrointestinal, Renal, Hepatic,

and Immune Systems-NO! •Genotoxicity and Carcinogenicity-NO!

States with high levels of fluoride naturally occurring: ➢ S. Carolina 5.9 mg/L ➢ Virginia 6.3 mg/L ➢ Texas 8.8 mg/L ➢ Colorado 11.2 mg/L ➢ Oklahoma 12.0 mg/L ➢ New Mexico 13.0 mg/L ➢ Idaho 15.9 mg/L

Report issued in March 2006:

1. No Health Effects from fluoride in water at 2mg/L (2ppm)

2. Severe fluorosis is virtually zero at 2mg/L fluoride in water

IMPORTANT NOTE: Community water fluoridation = 0.7ppm (mg/L) • 1/3rd level at which severe fluorosis is virtually zero

The Weight of Science

No widely respected medical and health

organizations opposes fluoridation

2. No adverse health effects from drinking fluoridated water (CWF)

“Fluoridation is the single most important commitment a community can make to the oral

health of its children and to future generations.” Dr. C. Everett Koop

Surgeon General (1982-1989)

“Fluoridation is the single most effective public health measure to prevent tooth decay and improve oral

health over a lifetime, for both children and adults.” David Satcher, MD, PhD

Surgeon General (1998-2002)

“Community water fluoridation is one of the most practical, cost-effective, equitable, and safe measures

communities can take to prevent tooth decay and improve oral health. [E]ach generation born since the

implementation of water fluoridation has enjoyed better dental health than the preceding generation.”

Dr. Vivek H. Murthy, MD, MPH Surgeon General (2014-current)

A Public Health Achievement

Thank You