Water fluoridation in the United States

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U.S. residents served with community water fluoridation, 1992 and 2006. The percentages are the proportions of the resident population served by public water supplies who are receiving fluoridated water. US-fluoridation-1992-2006.jpeg
U.S. residents served with community water fluoridation, 1992 and 2006. The percentages are the proportions of the resident population served by public water supplies who are receiving fluoridated water.

Water fluoridation in the United States is common amongst most states. As of May 2000, 42 of the 50 largest U.S. cities had water fluoridation. On January 25, 1945, Grand Rapids, Michigan, became the first community in the United States to fluoridate its drinking water for the intended purpose of helping to prevent tooth decay.

Contents

Fluoridation became an official policy of the U.S. Public Health Service by 1951, and by 1960 water fluoridation had become widely used in the U.S., reaching about 50 million people. [2] By 2006, 69.2% of the U.S. population on public water systems were receiving fluoridated water, amounting to 61.5% of the total U.S. population. [3] Near the end of 2012, 67.1% of the U.S. population were getting water from community water systems (CWS) supplying water that had fluoride at or above recommended levels. Those included the 3.5% of the population that were on CWS with naturally occurring fluoride at or above recommended levels. 74.6% of those on CWS were receiving water with fluoride at or above recommended levels. [4]

U.S. regulations for bottled water do not require disclosing fluoride content. [5] A survey of bottled water in Cleveland and in Iowa, published in 2000, found that most had fluoride levels well below the 1 mg/L level common in tap waters. [6] [7]

History

1909 photograph by Frederick McKay of Greene Vardiman Black (left) and Isaac Burton and F.Y. Wilson, studying the Colorado Brown Stain. McKayandBlackCDC01.jpg
1909 photograph by Frederick McKay of Greene Vardiman Black (left) and Isaac Burton and F.Y. Wilson, studying the Colorado Brown Stain.

Community water fluoridation in the United States is partly due to the research of Dr. Frederick McKay, who pressed the dental community for an investigation into what was then known as "Colorado Brown Stain." [9] The condition, now known as dental fluorosis, when in its severe form is characterized by cracking and pitting of the teeth. [10] [11] [12] Of 2,945 children examined in 1909 by Dr. McKay, 87.5% had some degree of stain or mottling. All the affected children were from the Pikes Peak region. Despite the negative impact on the physical appearance of their teeth, the children with stained, mottled and pitted teeth also had fewer cavities than other children. McKay brought this to the attention of Greene Vardiman Black, and Black's interest was followed by greater interest within the dental profession.

Initial hypotheses for the staining included poor nutrition, overconsumption of pork or milk, radium exposure, childhood diseases, or a calcium deficiency in the local drinking water. [9] In 1931, researchers from the Aluminum Company of America (ALCOA) concluded that the cause of the Colorado stain was a high concentration of fluoride ions in the region's drinking water (ranging from 2 to 13.7 mg/L) and areas with lower concentrations had no staining (1 mg/L or less). [13] Pikes Peak's rock formations contained the mineral cryolite, one of whose constituents is fluorine. As the rain and snow fell, the resulting runoff water dissolved fluoride which made its way into the water supply.

Dental and aluminum researchers then moved toward determining a relatively safe level of fluoride to be added to water supplies. The research had two goals: (1) to warn communities with a high concentration of fluoride of the danger, initiating a reduction of the fluoride levels in order to reduce incidence rates of fluorosis, and (2) to encourage communities with a low concentration of fluoride in drinking water to add fluoride in order to help prevent tooth decay. By 2006, 69.2% of the U.S. population on public water systems were receiving fluoridated water, amounting to 61.5% of the total U.S. population; 3.0% of the population on public water systems were receiving naturally occurring fluoride. [3]

In April 2015, fluoride levels in the United States were lowered for the first time in 50 years, to the minimum recommended levels of 0.7ppm, because too much fluoride exposure has become a common issue for children teeth, visible in the form of white splotches. The basis were the results of two national surveys (1999–2004 NHANES) which assessed the prevalence of dental fluorosis, and found that two out of five adolescents had tooth streaking or spottiness on their teeth - an increase of mostly very mild or mild forms. [14] [15]

On September 24, 2024, a federal judge ordered the U.S. Environmental Protection Agency (EPA) to take regulatory action citing the findings of an extensive federal review of many studies published in peer-reviewed scientific and medical journals showing a dosage-dependent negative impact on children's IQs. District Court Judge Edward Chen ruled that the current recommended fluoridation level of 0.7 ppm "poses an unreasonable risk of reduced IQ in children." [16] The judge based his ruling largely on a comprehensive review of the scientific literature by the U.S. National Toxicology Program (NTP), a federal inter-agency program within the U.S. Department of Health & Human Service (HHS). [17]

Early studies

H. Trendley Dean set out in 1931 to study fluoride's harm, but by 1950 had demonstrated the benefits of small amounts. H-Trendley-Dean.jpeg
H. Trendley Dean set out in 1931 to study fluoride's harm, but by 1950 had demonstrated the benefits of small amounts.

A study of varying amounts of fluoride in water was led by Dr. H. Trendley Dean, a dental officer of the U.S. Public Health Service. [19] [20] In 1936 and 1937, Dr. Dean and other dentists compared statistics from Amarillo, which had 2.8 – 3.9 mg/L fluoride content, and low fluoride Wichita Falls. The data is alleged to show fewer cavities in Amarillo children, but the studies were never published. [21] Dr. Dean's research on the fluoride-dental caries relationship, published in 1942, included 7,000 children from 21 cities in Colorado, Illinois, Indiana, and Ohio. The study concluded that the optimal amount of fluoride which minimized the risk of severe fluorosis but had positive benefits for tooth decay was 1 mg per day, per adult. Although fluoride is more abundant in the environment today, this was estimated to correlate with the concentration of 1 mg/L.

In 1937, dentists Henry Klein and Carroll E. Palmer had considered the possibility of fluoridation to prevent cavities after their evaluation of data gathered by a Public Health Service team at dental examinations of Native American children. [22] In a series of papers published afterwards (1937–1941), yet disregarded by his colleagues within the U.S.P.H.S., Klein summarized his findings on tooth development in children and related problems in epidemiological investigations on caries prevalence.[ citation needed ]

In 1939, Dr. Gerald J. Cox [23] conducted laboratory tests using rats that were fed aluminum and fluoride. Dr. Cox suggested adding fluoride to drinking water (or other media such as milk or bottled water) in order to improve oral health. [24]

In the mid-1940s, four widely cited studies were conducted. The researchers investigated cities that had both fluoridated and unfluoridated water. The first pair was Muskegon, Michigan and Grand Rapids, Michigan, making Grand Rapids the first community in the world to add fluoride to its drinking water to try to benefit dental health on January 25, 1945. [25] Kingston, New York was paired with Newburgh, New York. [26] Oak Park, Illinois was paired with Evanston, Illinois. Sarnia, Ontario was paired with Brantford, Ontario, Canada. [27]

In 1952 Nebraska Representative A.L. Miller complained that there had been no studies carried out to assess the potential adverse health risk to senior citizens, pregnant women, or people with chronic diseases from exposure to the fluoridation. [21] A decrease in the incidence of tooth decay was found in some of the cities which had added fluoride to water supplies. The early comparison studies would later be criticized as, "primitive," with a, "virtual absence of quantitative, statistical methods...nonrandom method of selecting data and...high sensitivity of the results to the way in which the study populations were grouped..." in the journal Nature . [28]

Water fluoridation

As of May 2000, 42 of the 50 largest U.S. cities had water fluoridation. [29] According to a 2002 study, [30] 67% of U.S. residents were living in communities with fluoridated water at that time.

The U.S. Centers for Disease Control has identified community water fluoridation as one of ten great public health achievements of the 20th century. [31] The CDC recommends water fluoridation at a level of 0.7–1.2 mg/L, depending on climate. The CDC also advises parents to monitor use of fluoride toothpaste, and use of water with fluoride concentrations above 2 mg/L, in children up to age 8. [32] There is a CDC database for researching the water fluoridation status of neighborhood water. [33]

In 1998, 70% of people polled in a survey conducted by the American Dental Association (ADA) believed community water should be fluoridated, with 18% disagreeing and the rest undecided. [34] In November 2006, the ADA began recommending to parents that infants from 0 through 12 months of age should have their formula prepared with water that is fluoride-free or contains low levels of fluoride to reduce the risk of fluorosis. [35]

The issue of whether or not to fluoridate water supplies frequently arises in local governments. For example, on November 8, 2005, citizens of Mt. Pleasant, Michigan voted 63% to 37% in favor of reinstating fluoridation in public drinking water after a 2004 ballot initiative ceased water fluoridation in the city. [36] At the same time, voters in Xenia, Ohio; Springfield, Ohio; Bellingham, Washington; and Tooele City, Utah all rejected water fluoridation. [37]

In Skagit County in the state of Washington, the county commissioners in 2007 voted 2 to 1 to order the local public utility district to begin fluoridating the public water supply by Jan. 2009. $1.2 million was to be provided by the privately funded Washington Dental Service Foundation to begin building the equipment needed to add fluoride to the Judy Reservoir, which supplies the majority of Skagit Valley's water customers. The source and type of fluoride to be added to the drinking water of more than 70,000 citizens had not been disclosed. [38] However, in February 2009, Skagit County commissioners rescinded the 2007 order, citing costs and possible lawsuits. [39]

The cost of adding fluoridation to the water of 44 Florida communities has been researched by the State Health Office in Tallahassee. [40] In communities with a population of over 50,000 people, fluoridation costs were estimated at 31 cents per person per year. The estimated cost rises to $2.12 per person in areas with a population below 10,000. Unintended consequences, such as equipment malfunction, can substantially raise the financial burden, as well as the health risks, to the consumer. [41] [42] [43] [44] [45] [46]

In the U.S., Hispanic and Latino Americans are significantly more likely to consume bottled instead of tap water, [47] and the use of bottled and filtered water grew dramatically in the late 1990s and early 2000s. [5]

Decisions about water fluoridation

Many political and popular entities and activities determine whether fluoride is added to water supplies. Those include courts, local governments, popular referendums, and water authorities.

Court cases

Fluoridation has been the subject of many court cases wherein activists have sued municipalities, asserting that their rights to consent to medical treatment and due process are infringed by mandatory water fluoridation. [48] Individuals have sued municipalities for a number of illnesses that they believe were caused by fluoridation of the city's water supply. In most of these cases, the courts have held in favor of cities, finding no or only a tenuous connection between health problems and widespread water fluoridation. [49] To date, no federal appellate court or state court of last resort (i.e., state supreme court) has found water fluoridation to be unlawful. [50]

Early cases

A flurry of cases were heard in numerous state courts across the U.S. in the 1950s during the early years of water fluoridation. State courts consistently held in favor of allowing fluoridation to continue, analogizing fluoridation to mandatory vaccination and the use of other chemicals to clean the public water supply, both of which had a long-standing history of acceptance by courts.

In 1952, a federal regulation was adopted that stated in part, "The Federal Security Agency will regard water supplies containing fluorine, within the limitations recommended by the Public Health Service, as not actionable under the Federal Food, Drug, and Cosmetic Act." [51]

The Supreme Court of Oklahoma analogized water fluoridation to mandatory vaccination in a 1954 case. [52] The court noted, "we think the weight of well-reasoned modern precedent sustains the right of municipalities to adopt such reasonable and undiscriminating measures to improve their water supplies as are necessary to protect and improve the public health, even though no epidemic is imminent and no contagious disease or virus is directly involved .... To us it seems ridiculous and of no consequence in considering the public health phase of the case that the substance to be added to the water may be classed as a mineral rather than a drug, antiseptic or germ killer; just as it is of little, if any, consequence whether fluoridation accomplishes its beneficial result to the public health by killing germs in the water, or by hardening the teeth or building up immunity in them to the bacteria that causes caries or tooth decay. If the latter, there can be no distinction on principle between it and compulsory vaccination or inoculation, which, for many years, has been well-established as a valid exercise of police power." [52]

In the 1955 case Froncek v. City of Milwaukee, the Wisconsin Supreme Court affirmed the ruling of a circuit court which held that "the fluoridation is not the practice of medicine, dentistry, or pharmacy, by the City" and that "the legislation is a public health measure, bearing a real, substantial, and reasonable relation to the health of the city." [53]

The Supreme Court of Ohio, in 1955's Kraus v. City of Cleveland, said, "Plaintiff's argument that fluoridation constitutes mass medication, the unlawful practice of medicine and adulteration may be answered as a whole. Clearly, the addition of fluorides to the water supply does not violate such principles any more than the chlorination of water, which has been held valid many times." [54]

Fluoridation consensus

In 1973, as cases continued to be brought in state courts, a consensus developed that fluoridation, at least from a legal standpoint, was acceptable. [49] In 1973's Beck v. City Council of Beverly Hills, the California Court of Appeal, Second District, said, "Courts through the United States have uniformly held that fluoridation of water is a reasonable and proper exercise of the police power in the interest of public health. The matter is no longer an open question." [49]

The Science Advisory Board, Subcommittee on Toxic Sprays first researched this in 1938, [55] after its creation by executive order issued by President Franklin D. Roosevelt. [56] This also included a National Resources Committee which studied Population Problems, in addition to The Committee for Research in Problems of Sex (CRPS). [57]

Contemporary challenges

Much of the contemporary debate on water fluoridation revolves around questions of how consumer demand for fluoride is determined and processed, which fluoridation costs and benefits are considered, how conflicts over its provision and production are addressed or resolved, and how the merits of relevant health policies can be equally recast in terms of their presumed demerits. [58] [59]

Opponents continue to make contemporary challenges to the spread of fluoridation. For instance, in 2002, the city of Watsonville, California, chose to disregard a California law mandating fluoridation of water systems with 10,000 or more hookups, and the dispute between the city and the state ended up in court. The trial court and the intermediate appellate court ruled in favor of the state and its fluoridation mandate, and the Supreme Court of California declined to hear the case in February 2006. [60] Since 2000, courts in Washington, [61] Maryland, [62] and Texas [63] have reached similar conclusions.

In 2017, multiple environmental groups sued the United States Environmental Protection Agency (EPA), alleging that water fluoridation at current levels was harmful and associated with reduced IQs. [64] U.S. District Judge Edward M. Chen, of the United States District Court for the Northern District of California, ruled that the scientific literature "provides a high level of certainty that a hazard is present," saying "fluoride is associated with reduced IQ" while stressing that he was not concluding with certainty that fluoridated water endangered public health. [64] Judge Chen's ruling ordered the EPA to address these risks, though it did not prescribe a specific method for doing so, and suggested options including warning labels about the risks of fluoride to tightening restrictions on its addition to water. [65]

Federal drinking water regulations

The U.S. Environmental Protection Agency (EPA) published a maximum contaminant level (MCL) standard of 4.0 mg/L for fluoride, applicable to public water systems. The standard was promulgated pursuant to the Safe Drinking Water Act (SDWA). [66] The SDWA allows states to set more stringent standards, and several states have done so, including New York, where the fluoride MCL is 2.2 mg/L. [67]

State law

San Diego, California, began water fluoridation in February 2011, despite its Municipal Code Section 67.0101, which prohibits the city from fluoridating. The local ordinance was preempted by California law that requires fluoridation when an outside funding source is available. In 2008, First 5 Commission of San Diego County, a state-funded child advocacy organization, provided nearly $4 million to San Diego, for fluoridation equipment and operating costs for the first two years of fluoridation. [68] That organization is funded with tobacco taxes instituted by California Proposition 10 (1998). [69] San Diego raises the fluoride level of its water to 0.7 mg/L, as recommended by CDC. [68]

In 2012, New Hampshire began requiring public water systems that fluoridate to post the following notice in their consumer confidence reports: "Your public water supply is fluoridated. According to the Centers for Disease Control and Prevention, if your child under the age of 6 months is exclusively consuming infant formula reconstituted with fluoridated water, there may be an increased chance of dental fluorosis. Consult your child's health care provider for more information." The law was passed with overwhelming majorities in the legislature and took effect August 4. [70] [71]

Local ordinances

On September 22, 2011, the city council of College Station, Texas, voted, 6–1, against fluoridating city water supplies. [72] ending 22 years of fluoridation. [73]

In 2011, the Pinellas County, Florida, commissioners voted to stop adding fluoride to the county's public drinking water. Tampa Bay Times editor Tim Nickens and columnist Daniel Ruth then published a joint series of ten editorials challenging the decision in 2012, and two of the commissioners who had voted to stop fluoridation were voted out of office and replaced with candidates who had pledged to add it back. [74] In March 2013, after a 6–1 vote, the county resumed the addition of fluoride, which the Times characterized as being "long considered the most effective method to prevent tooth decay". [74] Nickens and Ruth were awarded the 2013 Pulitzer Prize for Editorial Writing for their series. [74]

The Board of County Commissioners of Hernando County, Florida, voted, 4–1, on February 25, 2014, not to begin fluoridating the county's water. [75]

Referendums

On September 12, 2012, the Portland, Oregon City Council unanimously passed Ordinance No. 185612, authorizing and directing the Portland Water Bureau to begin fluoridating. [76] Those opposing the ordinance immediately began a petition process to hold a referendum that could reverse the ordinance. In October, it was revealed that four city council members had had undisclosed meetings with pro-fluoridation lobbyists. Public calendars of those four did not mention the meetings, except that one meeting was mentioned with a vague title. This was in violation of a city ordinance requiring the disclosure of such meetings. [77] Over 33,000 signatures were gathered for the petition, which led to the referendum that defeated fluoridation. In the campaign, the pro-fluoridation side out-raised opponents $850,000 to $270,000. [78] On May 21, 2013, Portland voters decided 61–39% not to commence fluoridation of the city's water, which is supplied to 900,000 people. It was the fourth defeat of fluoridation proposals in Portland, the first being in 1956. [79]

See also

Related Research Articles

Fluoride is an inorganic, monatomic anion of fluorine, with the chemical formula F−
, whose salts are typically white or colorless. Fluoride salts typically have distinctive bitter tastes, and are odorless. Its salts and minerals are important chemical reagents and industrial chemicals, mainly used in the production of hydrogen fluoride for fluorocarbons. Fluoride is classified as a weak base since it only partially associates in solution, but concentrated fluoride is corrosive and can attack the skin.

<span class="mw-page-title-main">Drinking water</span> Water safe for consumption

Drinking water or potable water is water that is safe for ingestion, either when drunk directly in liquid form or consumed indirectly through food preparation. It is often supplied through taps, in which case it is also called tap water.

<span class="mw-page-title-main">Tooth enamel</span> Major tissue that makes up part of the tooth in humans and many animals

Tooth enamel is one of the four major tissues that make up the tooth in humans and many animals, including some species of fish. It makes up the normally visible part of the tooth, covering the crown. The other major tissues are dentin, cementum, and dental pulp. It is a very hard, white to off-white, highly mineralised substance that acts as a barrier to protect the tooth but can become susceptible to degradation, especially by acids from food and drink. In rare circumstances enamel fails to form, leaving the underlying dentin exposed on the surface.

<span class="mw-page-title-main">Skeletal fluorosis</span> Medical condition

Skeletal fluorosis is a bone disease caused by excessive accumulation of fluoride leading to weakened bones. In advanced cases, skeletal fluorosis causes painful damage to bones and joints.

<span class="mw-page-title-main">Tooth decay</span> Deformation of teeth due to acids produced by bacteria

Tooth decay, also known as cavities or caries, is the breakdown of teeth due to acids produced by bacteria. The cavities may be a number of different colors, from yellow to black. Symptoms may include pain and difficulty eating. Complications may include inflammation of the tissue around the tooth, tooth loss and infection or abscess formation. Tooth regeneration is an ongoing stem cell–based field of study that aims to find methods to reverse the effects of decay; current methods are based on easing symptoms.

<span class="mw-page-title-main">Water fluoridation</span> Addition of fluoride to a water supply to reduce tooth decay

Water fluoridation is the addition of fluoride to a public water supply to reduce tooth decay. Fluoridated water contains fluoride at a level that is effective for preventing cavities; this can occur naturally or by adding fluoride. Fluoridated water operates on tooth surfaces: in the mouth, it creates low levels of fluoride in saliva, which reduces the rate at which tooth enamel demineralizes and increases the rate at which it remineralizes in the early stages of cavities. Typically a fluoridated compound is added to drinking water, a process that in the U.S. costs an average of about $1.32 per person-year. Defluoridation is needed when the naturally occurring fluoride level exceeds recommended limits. In 2011, the World Health Organization suggested a level of fluoride from 0.5 to 1.5 mg/L, depending on climate, local environment, and other sources of fluoride. In 2024, the Department of Health and Human Services' National Toxicology Program found that water fluoridation levels above 1.5 mg/L are associated with lower IQ in children. In 2024, U.S. court rulings have raised concerns about the potential health risks of water fluoridation, including findings by the EPA and new risk assessments that suggest the benefits may be waning. Bottled water typically has unknown fluoride levels.

Fluoride toxicity is a condition in which there are elevated levels of the fluoride ion in the body. Although fluoride is safe for dental health at low concentrations, sustained consumption of large amounts of soluble fluoride salts is dangerous. Referring to a common salt of fluoride, sodium fluoride (NaF), the lethal dose for most adult humans is estimated at 5 to 10 g. Ingestion of fluoride can produce gastrointestinal discomfort at doses at least 15 to 20 times lower than lethal doses. Although it is helpful topically for dental health in low dosage, chronic ingestion of fluoride in large amounts interferes with bone formation. In this way, the most widespread examples of fluoride poisoning arise from consumption of ground water that is abnormally fluoride-rich.

<span class="mw-page-title-main">Sodium fluoride</span> Ionic compound (NaF)

Sodium fluoride (NaF) is an inorganic compound with the formula NaF. It is a colorless or white solid that is readily soluble in water. It is used in trace amounts in the fluoridation of drinking water to prevent tooth decay, and in toothpastes and topical pharmaceuticals for the same purpose. In 2021, it was the 291st most commonly prescribed medication in the United States, with more than 600,000 prescriptions. It is also used in metallurgy and in medical imaging.

<span class="mw-page-title-main">Fluorine deficiency</span> Medical condition

Fluoride or fluorine deficiency is a disorder which may cause increased dental caries and possibly osteoporosis, due to a lack of fluoride in diet. Common dietary sources of fluoride include tea, grape juice, wine, raisins, some seafood, coffee, and tap water that has been fluoridated. The extent to which the condition truly exists, and its relationship to fluoride poisoning has given rise to some controversy. Fluorine is not considered to be an essential nutrient, but the importance of fluorides for preventing tooth decay is well-recognized, despite the effect is predominantly topical. Prior to 1981, the effect of fluorides was thought to be largely systemic and preeruptive, requiring ingestion. Fluoride is considered essential in the development and maintenance of teeth by the American Dental Hygienists' Association. Fluoride incorporates into the teeth to form and harden teeth enamels. This makes the teeth more acid resistant, as well as more resistant to cavity-forming bacteria. Caries-inhibiting effects of fluoride were first noticed 1902, when fluoride in high concentrations was found to stain teeth and prevent tooth decay.

The water fluoridation controversy arises from political, ethical, economic, and health considerations regarding the fluoridation of public water supplies. For deprived groups in both maturing and matured countries, international and national agencies and dental associations across the world support the safety and effectiveness of water fluoridation. Proponents of water fluoridation see it as a question of public health policy and equate the issue to vaccination and food fortification, citing significant benefits to dental health and minimal risks. In contrast, opponents of water fluoridation view it as an infringement of individual rights, if not an outright violation of medical ethics, on the basis that individuals have no choice in the water that they drink, unless they drink more expensive bottled water. A small minority of scientists have challenged the medical consensus, variously claiming that water fluoridation has no or little cariostatic benefits, may cause serious health problems, is not effective enough to justify the costs, and is pharmacologically obsolete.

<span class="mw-page-title-main">Fluoride therapy</span> Medical use of fluoride

Fluoride therapy is the use of fluoride for medical purposes. Fluoride supplements are recommended to prevent tooth decay in children older than six months in areas where the drinking water is low in fluoride. It is typically used as a liquid, pill, or paste by mouth. Fluoride has also been used to treat a number of bone diseases.

<span class="mw-page-title-main">Dental fluorosis</span> Tooth enamel discoloration due to excessive fluoride ingestion

Dental fluorosis is a common disorder, characterized by hypomineralization of tooth enamel caused by ingestion of excessive fluoride during enamel formation.

<span class="mw-page-title-main">H. Trendley Dean</span> American dentist (1893–1962)

Henry Trendley Dean was the first director of the United States National Institute of Dental Research and a pioneer investigator of water fluoridation in the prevention of tooth decay.

<span class="mw-page-title-main">Dental public health</span> Prevention of oral disease and promotion of oral health

Dental Public Health (DPH) is a para-clinical specialty of dentistry that deals with the prevention of oral disease and promotion of oral health. Dental public health is involved in the assessment of key dental health needs and coming up with effective solutions to improve the dental health of populations rather than individuals.

<span class="mw-page-title-main">Fluoride varnish</span> Highly concentrated form of fluoride

Fluoride varnish is a highly concentrated form of fluoride that is applied to the tooth's surface by a dentist, dental hygienist or other dental professional, as a type of topical fluoride therapy. It is not a permanent varnish but due to its adherent nature it is able to stay in contact with the tooth surface for several hours. It may be applied to the enamel, dentine or cementum of the tooth and can be used to help prevent decay, remineralise the tooth surface and to treat dentine hypersensitivity. There are more than 30 fluoride-containing varnish products on the market today, and they have varying compositions and delivery systems. These compositional differences lead to widely variable pharmacokinetics, the effects of which remain largely untested clinically.

<span class="mw-page-title-main">Water fluoridation by country</span>

Water fluoridation is the controlled addition of fluoride to a public water supply to reduce tooth decay, and is handled differently by countries across the world. Fluoridated water contains fluoride at a level that is proven effective for preventing cavities; this can occur naturally or by adding fluoride. Fluoridated water creates low levels of fluoride in saliva, which reduces the rate at which tooth enamel demineralizes, and increases the rate at which it remineralizes in the early stages of cavities. Typically, a fluoridated compound is added to drinking water, a process that in the U.S. costs an average of about $1.32 per person-year. Defluoridation is needed when the naturally occurring fluoride level exceeds recommended limits. In 2011, the World Health Organization suggested a level of fluoride from 0.5 to 1.5 mg/L, depending on climate, local environment, and other sources of fluoride. Bottled water typically has unknown fluoride levels.

<span class="mw-page-title-main">Remineralisation of teeth</span>

Tooth remineralization is the natural repair process for non-cavitated tooth lesions, in which calcium, phosphate and sometimes fluoride ions are deposited into crystal voids in demineralised enamel. Remineralization can contribute towards restoring strength and function within tooth structure.

<span class="mw-page-title-main">Water fluoridation in Australia</span>

Australia is one of many countries that have water fluoridation programs currently operating. As of March 2012, artificially fluoridated drinking water is administered to 70% or more of the population in all states and territories. The acceptance of the benefits of water fluoridation occurred in Australia in December 1953, roughly two years after acceptance in the United States. Many of Australia's drinking water supplies subsequently began fluoridation in the 1960s and 1970s. By 1984 almost 66% of the Australian population had fluoridated drinking water, represented by 850 towns and cities. Some areas within Australia have natural fluoride levels in the groundwater, which was estimated in 1991 to provide drinking water to approximately 0.9% of the population.

<span class="mw-page-title-main">Biological aspects of fluorine</span>

Fluorine may interact with biological systems in the form of fluorine-containing compounds. Though elemental fluorine (F2) is very rare in everyday life, fluorine-containing compounds such as fluorite occur naturally as minerals. Naturally occurring organofluorine compounds are extremely rare. Man-made fluoride compounds are common and are used in medicines, pesticides, and materials. Twenty percent of all commercialized pharmaceuticals contain fluorine, including Lipitor and Prozac. In many contexts, fluorine-containing compounds are harmless or even beneficial to living organisms; in others, they are toxic.

Topical fluorides are fluoride-containing drugs indicated in prevention and treatment of dental caries, particularly in children's primary dentitions. The dental-protecting property of topical fluoride can be attributed to multiple mechanisms of action, including the promotion of remineralization of decalcified enamel, the inhibition of the cariogenic microbial metabolism in dental plaque and the increase of tooth resistance to acid dissolution. Topical fluoride is available in a variety of dose forms, for example, toothpaste, mouth rinses, varnish and silver diamine solution. These dosage forms possess different absorption mechanisms and consist of different active ingredients. Common active ingredients include sodium fluoride, stannous fluoride, silver diamine fluoride. These ingredients account for different pharmacokinetic profiles, thereby having varied dosing regimes and therapeutic effects. A minority of individuals may experience certain adverse effects, including dermatological irritation, hypersensitivity reactions, neurotoxicity and dental fluorosis. In severe cases, fluoride overdose may lead to acute toxicity. While topical fluoride is effective in preventing dental caries, it should be used with caution in specific situations to avoid undesired side effects.

References

  1. ↑ Klein RJ (February 7, 2008). "Healthy People 2010 Progress Review, Focus Area 21—Oral Health". National Center for Health Statistics. Retrieved December 14, 2009.
  2. ↑ Lennon MA (September 2006). "One in a million: the first community trial of water fluoridation". Bulletin of the World Health Organization. 84 (9): 759–60. doi:10.2471/BLT.05.028209. PMC   2627472 . PMID   17128347.
  3. 1 2 Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, CDC (September 17, 2008). "Water fluoridation statistics for 2006" . Retrieved December 22, 2008.{{cite web}}: CS1 maint: multiple names: authors list (link)
  4. ↑ "Community Water Fluoridation --- 2012 Water Fluoridation Statistics". www.cdc.gov. Retrieved January 21, 2015.
  5. 1 2 Hobson WL, Knochel ML, Byington CL, Young PC, Hoff CJ, Buchi KF (2007). "Bottled, filtered, and tap water use in Latino and non-Latino children". Arch Pediatr Adolesc Med. 161 (5): 457–61. doi: 10.1001/archpedi.161.5.457 . PMID   17485621.
  6. ↑ Lalumandier JA, Ayers LW (March 2000). "Fluoride and bacterial content of bottled water vs tap water". Archives of Family Medicine. 9 (3): 246–50. doi:10.1001/archfami.9.3.246. PMID   10728111.
  7. ↑ "Study Finds Some Bottled Water Has More Bacteria And Less Fluoride Than Tap Water". www.sciencedaily.com. March 22, 2000. Retrieved July 29, 2012.
  8. ↑ Douglas, William A. (1959). History of Dentistry in Colorado, 1859–1959. Denver: Colorado State Dental Assn. p. 199. hdl:2027/mdp.39015055618535.
  9. 1 2 History of Dentistry in the Pikes Peak Region, Colorado Springs Dental Society webpage, page accessed February 25, 2006.
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  49. 1 2 3 Beck v. City Council of Beverly Hills, 30 Cal. App. 3d 112, 115 (Cal. App. 2d Dist. 1973) (citations omitted).
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  51. ↑ 17 Fed. Reg. 6743 (July 23, 1952).
  52. 1 2 273 P.2d 859, 862–63 (Okl. 1954) (available at FindLaw for Legal Professionals)
  53. ↑ 69 N.W.2d 242, 252 (Wis. 1955)
  54. ↑ 127 N.E.2d 609, 613 (Ohio 1955)
  55. ↑ Peirce, Alan Wilfred (1938), Observations on the toxicity of fluorine for sheep, Nutrit. Lab., Div. Animal Health, Adelaide
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  57. ↑ "Committee for Research in Problems of Sex, 1920-1965". The Committee for Research in Problems of Sex (CRPS) was established in 1922 within the National Research Council's Division of Medical Sciences with the cooperation of the Bureau of Social Hygiene and support from the Rockefeller Foundation.
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  60. ↑ Jones, Donna "Supreme Court turns down Watsonville's appeal to keep fluoride out of its water." Santa Cruz Sentinel. February 10, 2006.
  61. ↑ Parkland Light & Water Co. v. Tacoma-Pierce County Bd. of Health, 90 P.3d 37 (Wash. 2004)
  62. ↑ Pure Water Committee of W. MD., Inc. v. Mayor and City Council of Pure Water Comm. of W. MD., Inc. v. Mayor and City Council of Cumberland, MD. Not Reported in F.Supp.2d, 2003 WL 22095654 (D.Md. 2003)
  63. ↑ Espronceda v. City of San Antonio, Not Reported in S.W.3d, 2003 WL 21203878 (Tex. App.-San Antonio 2003)
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  71. ↑ "CHAPTER 122, HB 1416-LOCAL – FINAL VERSION". www.gencourt.state.nh.us. Retrieved January 18, 2015.
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  74. 1 2 3 Deggans, Eric (April 15, 2013). "Times' Tim Nickens, Daniel Ruth win Pulitzer Prize for editorial writing". Tampa Bay Times.
  75. ↑ Michael D. Bates (February 25, 2014). "Hernando commissioners say no to fluoridation". hernandotoday.com. Retrieved December 25, 2014.
  76. ↑ "2013 Referendum Petition Log, Measure 26-151". City of Portland. Retrieved December 25, 2014.
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