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A Wake Up Call for the City of Sandpoint?

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A Wake Up Call for the City of Sandpoint?

A look at the fluoridation of city drinking water

Editor’s Note: I’m a bit of a public health nut, so when Scott Clawson told me he was writing his humor column in our last issue on fluoridating water, I was surprised. Scott, you see, is a very smart man and I thought opponents to fluoridation didn’t deserve that adjective. I believed that the public health use of fluoride was better than sliced bread. Scott’s concerns got me doing some research, which resulted in this article. Just following links from the websites of the Centers for Disease Control and the World Health Organization (both of which endorse water fluoridation) led me to studies that raised some serious questions. Upon conclusion of my research, I believe that water fluoridation no longer presents benefits that outweigh the risks, and should no longer be undertaken by our communities. There’s my editorial disclosure—count me in with the kooks. TG

I could hear the buzzing of the black helicopters outside my window and, peeking through the curtains, I swear that Elvis was peeking back from the other side. I knew the next knock on my door would have to be from the Men in Black as I sat down at my computer to write about water fluoridation. After all, isn’t that the prevailing view of anyone who doesn’t buy the story that fluoridating water is the next best thing to winning the lottery? They’re crazy, right?

The chief toxicologist for the Environmental Protection Agency’s department of drinking water, Dr. William Marcus, would agree. Not that water fluoridation opponents are crazy, mind you, but that they’re marginalized by being considered so. That’s because Marcus was fired by the EPA after he refused to remain silent on the risk of young men developing cancer from fluoride-treated water. Marcus took the EPA to court for the firing, and then-Secretary of Labor Robert Reich ordered his reinstatement to the job, finding he’d been fired in retaliation for his views. (See here for links to the case files)

What does Marcus have to say about why the EPA fired him? “Well, as you well know fluoride is still recommended as a treatment for prevention of dental caries— tooth decay—and has been touted as such by the Public Health Service since 1953-54 and they ha[ve] a reputation to protect. It wouldn’t do for them to have been making this strong recommendation over the years and now to find out that they have been exposing the general public to a material known, now known, to be potentially carcinogenic in humans.” (See here for the complete interview.)

Marcus isn’t the only EPA employee with concerns about water fluoridation. Chapter 280 of the National Treasury Employees Union, representing approximately 1,500 scientists, lawyers, engineers and other professional employees at EPA Headquarters in Washington, D.C, stated “Recent, peer-reviewed toxicity data, when applied to EPA’s standard method for controlling risks from toxic chemicals, require an immediate halt to the use of the nation’s drinking water reservoirs as disposal sites for the toxic waste of the phosphate fertilizer industry.” (See here for video of testimony before Congress. See here for their position statement.)

An immediate halt. Dr. Joey Hensley agrees. Hensley is a practicing physician and a U.S. Representative from the state of Tennessee. In December of 2006 he sent a letter to all Tennessee water districts recommending that fluoride should no longer be added to the water. (See upper right box for a PDF of his letter.)

Even the National Academy of Sciences  has weighed in, at least partially, on the side of the “kooks.” In 2006 they released a report finding that fluoride is less safe than previously thought, and that the federal Environmental Protection Agency’s safety limit on fluoride in water should be lowered.

The report found that the maximum contaminant level goal and the secondary maximum contaminant level goal of fluoride in drinking water currently allowed under federal water-safety rules can cause a harmful variety of dental fluorosis, a mottling of the tooth that in its more severe form might actually cause cavities. It also found persuasive evidence that fluoride in water increases bone fractures as well as stiffness in the joints of the elderly, and in addition it may be related to Alzheimer’s disease, marginally reduce IQ in children and alter the endocrine and hormonal levels that control most of the functions of the human body with unknown effects.

Robert Issacson, a professor of neurobehavioral science at the University of New York, Binghampton, and a member of the NAS panel, said possible effects on endocrines and hormones from water-fluoridation are “something that I wouldn’t want to happen to me if I had any say in the matter.” He also said the report “should be a wake-up call.”

If that’s the case, then the city of Sandpoint could be said to be sound asleep—not out of negligence, however, but because they haven’t heard an alarm clock ringing. “You know, things change over time, and if this is one of those things, and (fluoride) is something we need to get rid of, I’m all for it,” said councilman Michael Boge. “So far, however, I haven’t seen a concern in my community.”

Currently Sandpoint, one of the only municipalities in Bonner and Boundary counties to add fluoride to its water supplies, fluoridates to the level of 1.00mg/L (according to the CDC) at its Sand Creek water plant eight months out of the year. (The lake water treatment plant is not currently set up to fluoridate water.) Although long considered an ‘optimal’ level, the World Health Organization now seems to be calling that into question. They state, “The U.S. standard, adopted in 1962, is not appropriate for all parts of the world and is based on assumptions that have become obsolete with the rise of air conditioning and increased use of soft drinks, processed food, and other sources of fluorides.” In 1994 a World Health Organization expert committee on fluoride use stated that 1.0 mg/L should be an “absolute upper bound, even in cold climates, and that 0.5 mg/L may be an appropriate lower limit.” (Emphasis mine.) (See here for a PDF of the report)

Mary Baenen, a resident of Sandpoint, asked the Sandpoint City Council this February to drop the practice of fluoridating water. Official minutes from the meeting state “Councilman [Michael] Boge prefers to take no action and feels the city is going in the right direction with fluoridation.” The minutes also show “Councilman Reuter said his personal stance is there is no need to stop what the city is doing now, but feels the city should not spend money to include fluoridation at the LWTP [where they currently do not add fluoridation] at a cost of $10,000.” No action was taken, but Reuter recommended the city “provide the information presented... in the Public Works office.” (See upper right box for the minutes from the Feb. 4 meeting)

Boge explains his current position as one not just based on a lifetime of hearing of the benefits of fluoride, but on local support for it as well. “For example, I read in the Spokesman (Review) that it’s a ‘travesty’ that Spokane is not fluoridating their water. And local dentists support the process here.” Boge concurs with Reuter, however, in that they are both “open to considering new information.”

Kody Van Dyk, director of the city’s Public Works department, which administrates the water department, says “If the city requires fluoride, the water department will add it to the water based on the requirements of Idaho DEQ.”

With a growing body of evidence suggesting potential harm, why do communities continue to fluoridate their water supplies? In part, it’s because the CDC calls water fluoridation “one of the ten great public health achievements of the 20th century,” and states it “prevents tooth decay safely and effectively.” The American Dental Association states “[We have] endorsed fluoridation of community water supplies as safe and effective for preventing tooth decay for more than 40 years. Fluoride is nature’s cavity fighter...”.  And the U.S. Public Health Service says, “Community water fluoridation continues to be the most cost-effective, equitable and safe means to provide protection from tooth decay in a community.”

In addition, there are studies that show a decrease in dental caries (cavities) of 10- to 40 percent in communities where naturally low-fluoridated water has been supplemented with artificial fluoride.

Dental caries (cavities) are not just a cosmetic problem—untreated cavities can lead to severe dental problems, up to and including death if a cavity becomes abscessed and goes untreated.

Can those organizations be wrong in their support of water fluoridation? The CDC also admits “[L]aboratory and epidemiologic research suggests that fluoride prevents dental caries predominately after eruption of the tooth into the mouth, and its actions primarily are topical for both adults and children.” The Journal of the American Dental Association has reported, “Fluoride incorporated during tooth development is insufficient to play a significant role in caries protection.” They also recommend that parents prepare baby formula with water that is not fluoridated, primarily because of a rapidly growing national problem with dental fluorosis. And it should be noted that the American Dental Association also stated in California Superior Court (The Superior Court of the State of California, Case No. 718228), regarding the potentially harmful use of mercury in amalgam fillings, “The American Dental Association owes no legal duty of care to protect the public...” The Journal of Public Health Dentistry reported, “The case is essentially a risk/benefit issue—fluoride has little pre-eruptive impact on caries prevention, but presents a clear risk of fluorosis.” The growing body of literature shows that fluoride benefits, if they exist, come from topical applications, not from ingestion. And some disturbing trends suggest that fluoride, even in the case of dental cavities, might now do more harm than good.

A national survey of children in 1986-’87 showed “little or no differences in tooth decay rates between fluoridated and non fluoridated places throughout America.” (Yiamouyiannis, J "Water Fluoridation and Tooth Decay: Results from the 1986-1987 National Survey of U.S. Schoolchildren" Fluoride, Journal of the International Society for Fluoride Research (Vol. 23, No. 2, April 1990, pp 55-67)

And more worrisome, a study in Tuscon, Ariz. of 26,000 schoolchildren found, “When we plotted the incidence of tooth decay versus fluoride content in a child’s neighborhood drinking water, a positive correlation was revealed. In other words, the more fluoride a child drank, the more cavities appeared in the teeth.”  (Steelik C., Fowler M, Osborn M et al. Findings and recommendations of subcommittee on fluoridation. City of Tuscon, AZ)

But what about all those studies that show fewer cavities after fluoride is added to the water? The mystery is that similar declines in childhood cavities have been shown through much of Western Europe, where few communities fluoridate water. The British Medical Journal reported “Although the prevalence of caries varies between countries, levels everywhere have fallen greatly in the past three decades, and national rates of caries are now universally low. This trend has occurred regardless of the concentration of fluoride in water or the use of fluoridated salt...”

How could this be? Fluoride occurs naturally in water, in levels that vary throughout the world and even within communities. Back in the 1930s, studies undertaken in areas with higher, naturally-fluoridated water and lower incidence of dental caries highlighted fluoride as a wonder-drug in the control of cavities.

Fast forward 80 years and it’s a new world. In addition to fluoridating water, zealous cavity fighters have seen fluoride added to toothpaste, the massive growth of a new health aide, fluoride rinses, and a growing dental practice of applying fluoride directly to children’s teeth. The result? According to a report in Clinical Oral Investigations, “... caries reduction directly attributable to water fluoridation has declined in the last decades as the use of topical fluoride had become more widespread, whereas enamel fluorosis has been reported as an emerging problem in fluoridated areas.”

Indeed, even the CDC acknowledges “Much of the research on the efficacy and effectiveness of individual fluoride modalities in preventing and controlling dental caries was conducted before 1980, when dental caries was more common and more severe.”

Fluoride is a drug, and as such is regulated by the FDA. They state on their website, “FDA regulates toothpastes as drugs or cosmetics, depending on their ingredients and purpose. Toothpastes are drugs if they contain fluoride, are intended to prevent or lessen diseases like tooth decay, or affect the structure of the body or how it functions.” In the case of topical fluoride treatments, as an over-the-counter drug it’s regulated under the auspices of a final monograph (Anti-Caries Drug Products for Over-the-Counter Use, published in the Federal Register 6 October 1995). In that report, The FDA accepts the requested findings from “two [toothpaste] manufacturing associations” regarding growing concerns with dental fluorosis. The report states that in a review of “relevant clinical and epidemiological literature” there was no ‘cause and effect’ relationship between toothpaste and fluorosis, and that fluoridated toothpaste is what should be credited as the “principal contributor to caries decline over the past 20 years.”

Toothpaste, not fluoridated water. And it’s not toothpaste, they say, that’s to blame for increasing rates of dental fluorosis, now said to be present in one out of three American children.

The FDA has never conducted clinical trials for fluoride as a drug. In 2006, however, in approving the claims on fluoridated bottled water that “Drinking fluoridated water may reduce the risk of [dental caries or tooth decay],” FDA cited the CDC, the U.S. Dept. of Public Health and the U.S. Surgeon General’s support of water fluoridation as adequate to support the claim of safe and efficacious caries reduction. That’s a concern for some who believe citizens have a right to ‘informed consent’ when being prescribed medication, including notification of potential risks. There’s also concern for those with existing conditions that make them, according to the U.S. Dept. of Health and Human Services, “unusually susceptible” to the “toxic effects” of fluoride. These include the elderly, people with deficiencies of calcium, magnesium, and/or vitamin C, and people with cardiovascular and kidney problems, including diabetes.

“No physician in his right senses would prescribe for a person he has never met, whose medical history he does not know, a substance which is intended to create bodily change, with the advice: ‘Take as much as you like, but you will take it for the rest of your life because some children suffer from tooth decay.‘ It is a preposterous notion.”

That’s the opinion of Dr. Peter Mansfield, a physician from the UK and advisory board member of the 2000 UK government review of fluoridation.

Still, isn’t the chance that water fluoridation will improve the dental health of children worth a relatively small risk of side effects? The most widespread side-effect of water fluoridation appears to be dental fluorosis... an unsightly discoloring of the teeth that, in those concerned, “can be treated with [admittedly expensive] porcelain veneers.” Other risks, though rare, include allergies, bone cancer in young men, hip fractures in the elderly, and reduced brain function in children, among others.

Kody Van Dyk warns, “When the issue [of water fluoridation] comes up, local dentists want it to continue.”

Except for one, that is. Though not local anymore, Dr. Bill Osmunson (father of Kristy, the singing phenom who wowed Festival at Sandpoint attendees last year as part of Bomshel) practiced in Sandpoint for 18 years, even serving on the local school board. He introduced major dentistry advances, like laser dentistry, to the area, and holds a master’s degree in Public Health. And, currently based in Oregon, he has also become a major opponent of water fluoridation.

“We are already getting too much fluoride and higher concentrations are coming in foods,” he warns. “If you personally want more fluoride: get a prescription, eat foods high in fluoride, but please do not swallow toothpaste or fluoridated water.” To his fellow dental practitioners, he asks in a popular YouTube video. “Look once again at the science on fluoridation.”

It was looking at the science that changed Osmunson’s mind. For example, he said, “I can only find one published study comparing dental expenses, actual measured dental expenses, not estimates based on assumptions, in fluoridated versus non fluoridated communities and it found overall less than a half a percent cost reduction [for dental caries] and an actual increase in cost [for other] dental expenses for children.”

But it wasn’t just the money that concerned this dentist. “My biggest concern is the more than 20 published studies showing brain damage with the ingestion of fluoride. Tang, in a meta analysis, reviewed 16 studies and found a five-fold increase in mental retardation in areas of dental fluorosis. Dental fluorosis has increased by 50 percent in the U.S. over a recent 10-year period. When comparing states which predominantly fluoridate with those which do not we find a doubling of mental retardation.”

And Osmunson, very familiar with fluoride-enriched toothpastes and mouth rinses, points out, “The warning on fluoridated toothpaste not to swallow refers to a quarter milligram of fluoride, the same as one glass of Sandpoint water. If the FDA says, “do not swallow” more than used for brushing, a pea size, and if you do to “contact the poison control center,” then why should the city force everyone to swallow more than what the FDA says you should not swallow?”

It would appear the question today isn’t whether fluoride is a benefit to dental health, but whether we’ve succeeded all too well. Yes, water fluoridation was a major public health accomplishment—so was the smallpox vaccine and the successful effort using it to eradicate smallpox (arguably the greatest public health achievement of all time). But do we still say today that everyone should get vaccinated for smallpox? 

Or as the journal Clinical Oral Investigations writes, “Several studies conducted in fluoridated and non fluoridated communities suggested that this method of delivering fluoride may be unnecessary for caries prevention, particularly in the industrialized countries where the caries level has became low.”

Now is the time for individual communities, like Sandpoint, to develop the cost/benefit analyses that determine whether their water should be artificially fluoridated—the same types of analyses recommended by the World Health Organization, which include data on a community’s rate of dental caries, rates of dental fluorosis, and information on other potential risk factors. They must include in those analyses the risks of severe consequences of fluoridation, from an increased risk of osteosarcoma to young men, to the agonies suffered by that small percentage of the population who are strongly allergic to the product, along with the community’s willingness to pay the costs incurred, via lawsuit if necessary, should the odds come to naught and the worst occurs to a resident who has been medicated without choice.

If you are concerned about water fluoridation in the city of Sandpoint (and by the way, you don’t have to be a resident—anyone who eats in Sandpoint restaurants is also exposed to the city’s fluoridation policy), get in touch with the Sandpoint City Council at 208-263-3317, or email them at the addresses located on the city’s website. Let them know how you feel.

The U.S. Department of Agriculture lists the fluoride content of many foods here. If you are the parent of an infant, please follow recommended guidelines and do NOT use fluoridated tap water to prepare infant formula.

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Landon Otis

Tagged as:

Environment, public health, Sandpoint city council, water, fluoride, cavities, Dr. William Marcus, Michael Boge, Mary Baenen, John Reuter, Kody Van Dyk, public works, Dr. Bill Osmunson

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