Fluoride Debate Hits Several Major U.S. Cities

The largest U.S. city without fluoridated water takes a step toward getting it.

Among a certain subset of the population, apprehension about fluoride in public drinking water supplies is always present. But, like seasonal allergies or interest in baseball, the intensity of the debate waxes and wanes.

Just now though, fluoride, which protects against tooth decay, is ascendant.

This week two large U.S. cities considered whether to start fluoridating their water or to stop the practice altogether. A third will put the issue to the voters in November.

Portland, Oregon (pop. 593,000) is the largest city in the nation not to add fluoride to its drinking water. On Wednesday, the city council decided to change that, voting 5-0 to start fluoridation in 2014. It will affect some 900,000 residents in the metropolitan area.

It is possible, however, that voters will have a say before then. Opponents of the measure, who claimed that it amounts to forced medication, said they will gather signatures for a ballot referendum, the Oregonian reports:

A referendum — which would directly challenge the city’s plan rather than seek a general ban on fluoride — needs about 20,000 valid signatures in 30 days to go forward.

But if anti-fluoride activists gather those signatures, the city’s ordinance will be suspended pending a public vote in May 2014, the earliest possible date under election rules.

Portlanders have voted against fluoridation three times, most recently in 1980. This time, opponents said they have 125 volunteers and expect to have 25 paid signature-gatherers.

Debates Elsewhere
In Phoenix, that same day, a city council subcommittee decided to let its fluoridation policy stand and continue the practice.

In Wichita, Kansas, which does not fluoridate, voters will have the last word. This year, citizens gathered enough signatures to force the city council to consider the issue. The council could have taken action itself, but pushed the decision onto the public as part of the November 6 ballot.

Last year, the U.S. Department of Health and Human Services issued new guidelines for fluoride. The department said that fluoride concentrations should be 0.7 milligrams per liter, replacing a range of 0.7 to 1.2 milligrams per liter that the U.S. Public Health Service had recommended.

In lowering the recommended levels, the HHS said that Americans are now exposed to fluoride in more products than just drinking water.

American Dental Association has supported fluoridation since 1950, just after cities began adding it to drinking water. In 1997, the association put forward a more comprehensive, seven-point policy. According to the ADA:

Throughout more than 65 years of research and practical experience, the overwhelming weight of credible scientific evidence has consistently indicated that fluoridation of community water supplies is safe. The possibility of any adverse health effects from continuous low-level consumption of fluoride has been and continues to be extensively studied. Of the hundreds of credible scientific studies on fluoridation, none has shown health problems associated with the consumption of optimally fluoridated water.

The Centers for Disease Control has called fluoridation one of the ten greatest public health achievements in the U.S. in the 20th century.

Note: I’m surprised the fluoride coverage doesn’t have more cheeky allusions to Dr. Strangelove and our “precious bodily fluids.”

Brett Walton
Circle of Blue reporter

3 replies
  1. jwillie6 says:

    If you like fluoride, it is legal and available, help yourself. Otherwise, don’t add it to drinking water and force everyone to consume a poisonous drug.

    Citizens already pay for their drinking water. They should not have to pay again for botttled water or the expensive filters to remove fluoride.

    1. Take the toxic waste fluoride chemical out of the drinking water.
    2. It is still legal and available, so those who wish to take it can then put fluoride tablets in their glass of water.
    3. Leave the rest of us out of it, giving everyone the freedom of choice.

  2. Billy Budd says:

    The most compelling data of community water fluoridation’s (CWF) effectiveness is the huge Louisiana Medicaid study which found 2/3rds of the operations for terrible cavities in kids are avoided with CWF. (See: Water Fluoridation & Costs of Medicaid Treatment for Dental Decay. MMWR. CDC 09/03/1999)

    In the Louisiana study, 50% of the dental bills for the kids who were studied were avoided. If this were the only benefit, 150% CWF returns in lower dental bills. (See: Prev Chronic Dis. 2012 Mar;9: A simulation model for designing effective interventions in early childhood caries. Hirsch GB, et al)

    Anesthesia procedures — including extractions, root canals, and stainless steel crowns — cost up to $15,000 and happen more often in cities without CWF. Data presented to the Portland City Council showed 75% prevention of these operations in since fluoridation in 1956. In a comparison between fluoridated Florence and Oakridge, severe dental emergencies were completely avoided with fluoridation. Portland’s council was lobbied by a number of civil rights organizations which believe CWF is an important Social Justice issue. Mayor Sam Adams yesterday issued a very clear explanation of his support for CWF. He’s got it completely right. (See: http://tinyurl.com/94hsws3)

    Few programs that cities have undertaken have a return on investment of 150%. That number doesn’t include the savings for dental care of permanent teeth, estimated by the CDC to be $38 for every $1 invested.

    Save for those blinded by the passion of their opposing beliefs, this is sort of a no-brainer.

  3. lou forte says:

    Water Fluoridation – “No Evidence of Beneficial Effect” (5 Year Study of 51,683 in Portland)

    Watch Video: http://youtu.be/gGLPEJTYS70

    The Study says, “…the effects were generally small”. “In Portland metro, there was no evidence of a beneficial effect of fluoridation on total costs; in fact, costs were generally higher among members living in the community water fluoridated (CWF) than in the (NF) nonfluoridated districts of the metropolitan area.”

    (note: A complete copy of this and other studies can be downloaded for free through your local medical library)

    Citation: “A comparison of dental treatment utilization and costs by HMO members living in fluoridated and nonfluoridated areas” (J Public Health Dent. 2007 Fall;67(4):224-33)


    Data from Kaiser Permanente

    The study also says, “…Community Water Fluoridation (CWF) cost-effectiveness analyses have not typically included reduced caries treatment costs, thereby overestimating the marginal change in health care costs attributable to CWF…”


    Citation: “Fluoride content of solid foods impacts daily intake” (Journal of Public Health Dentistry 72 (2012) 128–134)


    “the basis for the so-called “optimal” fluoride intake. It is unclear exactly how the upper limit of that range came into existence. This range has since been designated or stated as the optimal level for fluoride intake by many researchers, although there has been no scientific validation of this range for being considered “optimal.” There has never been a clear definition as to what the range is optimal for; is it for caries prevention or is it for the prevention of fluorosis? This “optimal” range was estimated before the widespread use of topical fluorides and other fluoride exposures, and prior to the generalized, widespread distribution of beverages…It is important to look at many of these different sources of fluoride intake in light of the increasing prevalence of dental fluorosis and greater emphasis on esthetic perceptions currently being seen in the United States and other developed nations…”

    “about 25 percent of children at 6 months of age ingested amounts
    greater than the tolerable upper intake level (UL) of 0.7 mg/ l day”

    Compare this level to .01, which is often referred to as an adequate intake for children 6 months old. Mother’s milk is .004 mg/l (ppm).

    Citation: “Patterns of dental caries following the cessation of water fluoridation” says, “The prevalence of caries (assessed in 5927 children, grades 2, 3, 8, 9) DECREASED over time in the fluoridation ENDED community while remaining unchanged in the fluoridated community.”

    Patterns of dental caries following the cessation of water fluoridation.



    Other studies by Gerardo Maupomé, lead author of the Portland study above:



    “No significant relationship was found between fluoride exposure and dental caries in permanent dentition.”


    “Fluoride exposure does not appear to be reducing the caries prevalence or caries severity in these high-altitude communities.”


    “We were also unable to identify any significant reductions in caries-related procedures for individuals receiving a fluoride intervention, compared with those who did not, when stratified by risk level.”


    At-home or in-office fluoride application does not significantly reduce subsequent caries-related procedures in ambulatory adults of any caries-risk level.


    “…a minority of Indiana health professionals (17 percent) correctly identified that remineralization was fluoride’s predominant mode of action”

    “The majority of dental professionals surveyed were unaware of the current understanding of fluoride’s predominant posteruptive mode of action through remineralization of incipient carious lesions… Educational efforts are needed to promote the appropriate use of fluoride.”

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