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Rethinking Water Fluoridation for the Economically Disadvantaged


Rethinking Water Fluoridation for the Economically Disadvantaged

By Marlene Lily 

Our public health officials claim water fluoridation is an effective way to prevent the high rates of tooth decay now found in low-income children. Here are four problems with this idea:

1) There are oral health crises in low-income areas that have been fluoridated for decades. Fluoridation has not prevented low-income neighborhoods from suffering what numerous state and local health officials describe as a crisis. It is unclear, therefore, how fluoridation can be expected to alleviate the alleged oral health crisis in Sonoma County when it has failed to prevent such crises in areas that have been fluoridated for 30 to 60 years.

2) Published studies have repeatedly found that fluoridation does not prevent the type of tooth decay – baby bottle tooth decay (BBTD) – that is one hallmark of the current local oral health crisis. Photos used (deceptively) by County Health Department employees to emphasize the urgent need for fluoridation are almost always photos of BBTD.  Only education can prevent BBTD.  Fluoridation will have no effect.

3) The Centers for Disease Control say that fluoride works topically – so there is no reason for ingesting it.

4) Evidence of disproportionate harm to communities of color turns on its head the notion that fluoridation is a benefit to the economically disadvantaged.  In fact, it is the poor who are most harmed by fluoride, suffering higher rates of dental fluorosis, as well as the other health effects of fluoride, especially diabetes and asthma. Poor diet results in more tooth decay and more harm from fluoride.

Fluoridation Is Not Dental Care

The addition of cheap industrial hazardous waste to the water supply has never been, and will never be, a substitute for dental care. If we really care about the oral health of our children we should put our money into dental care, hygiene, and nutrition education, free toothbrush/toothpaste programs, fluoride varnishes for those who need them most, and reduced sugar intake.

Among the groups often listed as supporting fluoridation is the World Health Organization (WHO).  WHO does favor fluoridation. But what is often ignored by proponents is the WHO’s precautionary caveat that water fluoridation programs should not be started unless the municipality/water authority has conducted prior tests on residents to establish their total daily fluoride intake from all sources of food and beverage and environmental exposures. 

The Board of Supervisors and the Department of Health services has spent hundreds of thousands of taxpayer dollars on an Engineering Report and water fluoridation promotion without allocating a single dime to determine whether the children of Sonoma County may already be ingesting an “optimal” or greater-than-optimal amount of fluoride.

More than 40 years ago, before southern Marin County was fluoridated, John Lee, M.D., did a study of children’s diets to determine fluoride intake.  Simultaneously, another group studied the fluoride in the urine of Marin teenagers.

Both studies revealed that Marin county children were ingesting more than enough fluoride without water fluoridation. Lee reported his findings in the Journal of Western Medicine:

Some 22,000 tons of fluoride-containing pesticides and fungicides are sprayed on Sonoma County crops each year, and some of that is absorbed from the air by local residents.  In addition, the fluoride content of foods and beverages has markedly increased since the 1970s.  And each brushing with fluoride toothpaste results in the absorption of about 1 mg. of fluoride.  So it would only make sense for the Sonoma County Department of Health Services to test local children before recommending water fluoridation.  Why has no one in the DHS thought of this?

According to the Centers for Disease Control, 41 per cent of American children now suffer from dental fluorosis, the visible sign of systemic fluoride poisoning incurred before the age of eight.  The rate is much higher for African Americans and Latinos.

When fluoridation began in the 1940s, its advocates stated that a maximum rate of 10 per cent of children getting “mild” dental fluorosis would be an “acceptable” trade-off for decay reduction.  Now, in some areas, 17 per cent of African-American teens have “severe” dental fluorosis—where the teeth show dark stains and pitting and decay is difficult to repair.  A new study has linked dental fluorosis to reduced IQs, and a Harvard scientist is asking whether “prevention of chemical brain drain should be considered at least as important as protection against caries.”

It has never been established that fluoride is a neccesary nutrient.  There are no bodily processes that require fluoride, and many people living in areas with no fluoride in their water or diets have excellent teeth.  Oral health depends on a nutritious diet, adequate dietary minerals, especially calcium and magnesium, Vitamin D, and a lack of sugar.

Before adding a toxin to our water to reduce tooth decay in poor children, shouldn’t we find out if those children may already be getting enough or too much fluoride from their diets and environment?


Fluoride is a WASTE

The world has learned the truth that fluoridation is ineffective for teeth and dangerous to health, so only 5% of the world and only 3% of Europe fluoridate their drinking water, more in the U.S. than the rest of the world combined. Last year Israel banned fluoridation.

 Data from the World Health Organization shows  that the tooth decay rate in Europe with 3% fluoridation is as good or better than any fluoridated country including the U.S., with over 70% fluoridation. That shows just how ineffective fluoride is for teeth.

To see why fluoride is dangerous, Google «Fluoride dangers» and read a few of the over 1,000,000 articles, many by M.D.›s, dentists and medical scientists.

In addition, Fluoridation is a WASTE of Tax Money.

All Civil Engineers and all water managers know that people drink only 1/2% of the water they use. The rest goes directly down the drain in toilets, showers, dishwashers, etc.
So for each $1000  of fluoride added annually to drinking water, people drink $5 and $995 is wasted down the drain. Children would drink only $0.50 (fifty cents).

That would be comparable to buying one gallon of milk, using six-and-one-half drops of it, and pouring the rest of the gallon in the sink.


James Reeves

n addition to the informed comments by Mariene, there's one little fact about the supposed 'community benefits' of fluoridation that you probably never thought about. There's a nasty little scam behind this practice that always sneaks in through the back door whenever fluoridation is being sold to us, the gullible public. 

Fluoride proponents proclaim its alleged economic benefits to everyone - even, remarkably, for the toothless. They are especially keen to emphasise its value to the 'underpriviledged'. But have you ever taken a closer look at those reassuring 'cost-benefit analyses' that they publish to support these claims? Accounting scams, it seems, are not confined to bankers and the finance industry! 

Using some 'best case' data from official sources here in England, I found that the supposed savings to the State in avoided dental costs through fluoridation, even if they exist at all, are at best minimal. It may save the average small town around a few thousand pounds a year. But what is never, ever, mentioned are the long term costs to the people themselves of treating just one of the adverse effects - dental fluorosis. 

If these staggering hidden costs were to be included in the 'cost-benefit analyses', the whole scam would collapse around their heads. The advocates of community fluoridation would be facing liability suits that would send them racing for cover.

If you get dental fluorosis you face a very nasty choice. Either you ignore it, and put up with serious social and employment disadvantages. Or you pay for a lifetime’s expensive treatment, to hide the disfiguring condition. The commonest treatment, veneers, will set you back as much as US$50,000 over the years. Here in the UK, that's how much a University education costs. So for many thousands of kids it's the choice between keeping their mouth shut in public and getting a good education, or looking good but expecting to be living on welfare. And for the 'disadvantaged' - the poorer members of our communities - that's 
a selective disadvantage, not a benefit. 

So who really does gain from fluoridation? Not the public - let's face it, the claimed positive effects are a sham. The ones who gain are the dentists themselves, the very people cheerfully recommending this practice to us. After all, they would, wouldn't they? They are the folk with the rigidly enforced monopoly on providing 'cosmetic' dental treatment for the very 'cosmetic' disease that their professional recommendation inflicts on the population. With the continued universal increase in fluoride overdose you have to admire the ingenuity of the profession in looking after its own, even if it's our teeth that suffer the consequences!

~ Doug Cross 

Dear Vesta,

Thank you so much for publishing Marlene Lily's article regarding fluoridation in our water and for Jim Reeve's letter explaining that fluoride is a waste. 

I would like to suggest that every one reading your paper take a moment to call or email their board of supervisor and tell them that fluoride is toxic and not an effective method for preventing tooth decay and should not be including in the drinking water. Only one percent of water is used for drinking so that means toxic fluoride is filling our sewer lines, then our streams, rivers and oceans. Surely, fragile river and ocean ecosystems deserve to be free from another man made chemical that is a byproduct of the nuclear power industry. European countries have banned fluoride for the health of their people and the health of their nations. Furthermore, twenty five studies show that fluoride reduces children's IQ.

For more information please visit:

Thank you,

Heather Hendrickson
That is an excellent summary of why we should not be fluoridating, and instead be looking at all the ways to reduce fluoride intake from other sources. I no longer buy California wine because of the fluoride residues from cryolite and I try to avoid US grown produce because of what is allowed in food storage facilities.

Let me add that fluoridation is of particular harm to formula-fed infants due to their high fluid intake per bodyweight, and that this subgroup also tends to the lower side of the economic scale.

One of the unfortunate side effects of the debate about fluoridation is that it distracts from the things that are really important in preventing decay.

David Green

Wonderful letter, Marlene!  

Since you correctly stated that Baby Bottle Tooth Decay is a major cause of tooth decay in economically disadvantaged children I would like to back your letter up with references showing just how worthless water fluoridation is for BBTD.  

Two ideas that are very successful: dental sealants applied to the surfaces of permanent-teeth molars where about 90% of tooth decay occurs, and, mobile dental units that visit elementary schools and offer dental cleanings and free toothbrushes. 

1) “Sippy cups are the worst invention in history. The problem is parents’ propensity to let toddlers bed down with the cups, filled with juice or milk.  The result is a sort of sleep-over party for mouth bacteria,” said pediatric dentist Dr. Barbara Hymer as she applied $5,000 worth of silver caps onto a 6-year-old with decayed upper teeth.  Dr. Brad Smith, a Denver pediatric dentist estimates that his practice treats up to 300 cases a year of what dentists call Early Childhood Caries.  Last year, Children’s Hospital did 2,100 dental surgeries, many of which stemmed from the condition, Smith said.  The condition crosses economic boundaries, but Smith said it is especially pervasive among children in poor families. (Caries means cavities)

Source:  Auge, K.  Denver Post Medical Writer.  Doctors donate services to restore little girl’s smile. The Denver Post, April 13, 2004.  (Denver has been fluoridated since 1954.)

2) “Baby Bottle Tooth Decay (BBTD) is a severe form of early childhood caries caused by frequent or prolonged use of nursing bottles that contain liquids with natural or added sugars, e.g., milk, sugared water, fruit juices.  The liquid pools around the upper front and back teeth, creating a perfect environment for bacteria to initiate tooth decay.  Children with such an early onset of decay are more prone to developing dental caries in other teeth as they erupt.” 

Source:  H. Pollick et al.  Neglected Epidemic. Selected Findings and Recommendations From the California Oral Health Needs Assessment of Children, 1993-94. Page 9.

3) “Oral Disease is still a neglected epidemic in our country, despite improvements in oral health due to fluoridation, other forms of fluorides, and better access to dental care.  Consider the following: 50 percent of Head Start children have had baby bottle tooth decay.”

Source:  Allukian, M. Symposium Oral Disease. Journal of Public Health Dentistry, Vol. 53, No 1, Winter 1993. (Bullet #5 of 8.)

4) Among 2,520 children, the largest proportion with a history of falling asleep sipping milk/sweet substance was among Latinos/Hispanics (72% among Head Start and 65% among non-HS) and HS Asians (56%). Regarding the 30% and 33% resultant decay rates respectively;  Our analysis did not appear to be affected by whether or not children lived in an area with fluoridated water.

Source:  Shiboski CH et al. The Association of Early Childhood Caries and Race/Ethnicity Among California Preschool Children. J Pub Health Dent; Vol 63, No 1, Winter 2003.

5) By either of the two criterion i.e., two of the four maxillary incisors or three of the four maxillary incisors, the rate for 5-year-olds was significantly higher than for 3-year-olds.  Children attending centers showed no significant differences based on fluoride status for the total sample or other variables. 

Source: Barnes GP et al.  Ethnicity, Location, Age, and Fluoridation Factors in Baby Bottle Tooth Decay and Caries Prevalence of Head Start Children. Public Health Reports; 107: 167-73, 1992.

6) The prevalence of BBTD in the 18 communities of Head Start children ranged from 17 to 85 percent with a mean of 53%.  The surveyed communities had a mixture of fluoridated and non fluoridated drinking water sources.  Regardless of water fluoridation, the prevalence of BBTD remained high at all of the sites surveyed.

Source: Kelly M et al. The Prevalence of Baby Bottle Tooth Decay Among Two Native American Populations.  J Pub Health Dent; 47:94-97, 1987.

7) Overall, 37 of the 125 children (29.6 percent) were found to have BBTD.  Compliance in putting fluoride drops in bottle once a day was identical between BBTD and non BBTD groups.

Source: Weinstein P et al.  Mexican-American parents with children at risk for baby bottle tooth decay:  Pilot study at a migrant farmworkers clinic.  J Dent for Children; 376-83, Sept-Oct, 1992.

8) “Data from Head Start surveys show the prevalence of baby bottle tooth decay is about three times the national average among poor urban children, even in communities with a fluoridated water supply.”

Source: Von Burg MM et al.  Baby Bottle Tooth Decay:  A Concern for All Mothers.  Pediatric Nursing; 21:515-519, 1995.

9) A survey was administered to parents of 139 children diagnosed with early childhood caries (ECC) in 5 pediatric dentistry practices in Canada. The factors providing the most caries risk are: (1) being left with a bottle while sleeping; (2) parents having problems brushing the child's teeth; (3) holding liquids in the mouth for prolonged times; and (4) ethnicity.

Source:  Tiberia MJ, et al. Risk factors for early childhood caries in Canadian preschool children seeking care. Pediatr Dentistry 2007 May-Jun;29(3):201-8.


Pit and Fissure Tooth Decay and Fluoridation

1) “Fluoride primarily protects the smooth surfaces of teeth, and sealants protect the pits and fissures (grooves), mainly on the chewing surfaces of the back teeth.  Although pit and fissure tooth surfaces only comprise about 15% of all permanent tooth surfaces, they were the site of 83% of tooth decay in U.S. children in 1986-87.”

Source: The Oral Health of California’s Children A NEGLECTED EPIDEMIC:  Selected

Findings and Recommendations from the California Oral Health Needs Assessment of Children, 1993-94.

2) “Because the surface-specific analysis was used, we learned that almost 90 percent of the remaining decay is found in the pits and fissures (chewing surfaces) of children’s teeth; those surfaces that are not as affected by the protective benefit of fluoride.”

Source: Letter, August 8, 2000, from Jeffrey P. Koplan, M.D., M.P.H. Director Centers for Disease Control and Prevention (CDC) Atlanta GA to Congressman Kenneth Calvert, Chair, Subcommittee on Energy and Environment, Committee on Science, Wash DC.

3) “Nearly 90 percent of cavities in school children occur in the surfaces of teeth with vulnerable pits and grooves, where fluoride is least effective.”

Source: Facts From The National Institute of Dental Research.  Marshall Independent Marshall, Minnesota.  May 28, 1992.

4) “Let me begin by saying that fluorides are most effective in preventing decay on the smooth surfaces of teeth.  However, the chewing surfaces of posterior are not smooth.  They have crevices and pits and it is our experience that fluorides don’t really get access to these pitted areas.” 

Source: Hearings:  Subcommittee of the Committee on Appropriations, House of Representatives.  March 1984.  Dr. Harald Loe, Director of the National Institute of Dental Research.

5) “Fluoridation and the use of other fluorides have been successful in decreasing the prevalence of dental caries on the smooth surfaces of teeth.  Unfortunately, these efforts have much less effect on dental caries that occur in the pits and fissures of teeth (particularly on the biting surfaces of teeth) where more than 85 percent of dental caries now occur.”

Source: Toward Improving the Oral Health of Americans. Public Health Reports. 108: 6, Nov ‘93

6) “The program focused on four caries-prevention techniques:  sealants, a plastic-like coating applied to the chewing surfaces of back teeth and to pits and fissures on the sides of teeth (these surfaces are most prone to decay and ones which fluorides cannot protect adequately)”.

Source: Dental study upsets the accepted wisdom.  Science News.  Vol. 125, No. 1. Jan.7, 1984.

7) “It is estimated that 84% of the caries experience in the 5 to 17 year-old population involves tooth surfaces with pits and fissures.  Although fluorides cannot be expected appreciably to reduce our incidence of caries on these surfaces, sealants can.”

Source: Preserving the perfect tooth. Editorial. J American Dental Assn Vol. 108.  March 1984.

8) “The type of caries now seen in British Columbia’s children of 13 years of age, is mostly the pit and fissure type.  Knudsen in 1940, suggested that 70 percent of the caries in children was in pits and fissures.  Recent reports indicate that today, 83 percent of all caries in North American children is of this type.  Pit and fissure cavities aren’t considered to be preventable by fluorides, they are prevented by sealants.”

Source: Fluoridation: Time For A New Base Line?  A.S. Gray, DDS, FRCD(C),  J Canadian Dental Asso. No. 10, 1987.

9) “Even though half of all kids are cavity-free today, 80% of the decay that does occur appears on the chewing surfaces of their back teeth, where fluoride isn’t as effective.”

Source: Dr. Stephen Moss, Chairman of pediatric dentistry at New York University.  Tooth Report, American Health March 1989.

10) “Although systemic and topical fluoride use has been shown to be highly effective in prevention of caries on smooth surfaces, enamel surfaces with pits and fissures receive minimal caries protection from either systemic or topical fluoride agents.”

Source: Pediatric Dentistry Infancy Through Adolescence, Third Edition, p. 485.  Sr Editor J R Pinkham, DDS MS (Head of Pediatric Dentistry, U of Iowa College of Dentistry) Published by WB   Saunders Co. 1999 ISBN 0-7216-8238-3.

11) “It has been recognized for years that fissured occlusal surfaces are the most vulnerable to caries.  With the continuing caries decline among children, caries is becoming a disease of the fissured surfaces as the rate of approximal caries development continues to decline faster than that of overall caries experience.  Occlusal surfaces are also those least protected by fluorides, so the case for sealant as a complementary procedure to fluoride is even stronger.  As of the early 1990s, at least 83% of all decayed or filled surfaces in the permanent teeth of 5-17-year-olds were in pit-and-fissure surfaces. 

Source: Dentistry, Dental Practice, and the Community 5th Edition.  Brian A Burt BDS MPH PhD and Stephen A Eklund DDS, MHSA, DrPH, WB Saunders Co. 1999  ISBN 0-7216-7309-0

Maureen Jones, Archivist 20 years
Citizens for Safe Drinking Water –
1205 Sierra Ave.
San Jose, CA 95126

408 297-8487

I'm writing to say how much I appreciated your article, Marlene.  It was a very fine piece of journalism.


Joy Warren, BSc. (Hons) Env. Sci; Cert. Nutrition & Health
Co-ordinator, West Midlands Against Fluoridation and For Pure Clean Water
Tel: 0044 (0)2476 467562