Mayor Sam Adams recently issued this letter to Portlanders telling why he decided to support fluoridation. Adams answers numerous questions he has received since he announced he will back the fluoride plan.
I hope you are enjoying the beginning of the Autumn season. Since I announced my support for adding fluoride to Portland's water system, many people have asked me how I came to my decision.
I have been studying the water fluoridation issue since I was elected as a City Commissioner and I am convinced now, more than ever, that adding fluoride to our water system is integral to our goals of making Portland a more prosperous, educated, healthy, and equitable city.
In addition to facts, I have sought out both the pro and con arguments about this issue. More than 3,000 studies have been completed on fluoridation and the overwhelming weight of the evidence–plus more than 65 years of experience–supports the safety and effectiveness of fluoridation.
Fluoridation is used in over 70 percent of the nation's public drinking water. Every large city in the nation except for Portland has adopted fluoridation, reaching over 200 million people. It's used in over 60 countries.
It reduces cavities by at least 25 percent in adults and children over and above brushing/flossing and access to dental health care. Fluoride combines with phosphate and calcium to create a strong barrier that protects teeth from cavities. It works on the surface of the teeth and, when swallowed, strengthens teeth from within during tooth development in childhood. Water fluoridation maintains a low level of fluoride in saliva, providing continuous protection to adults and children throughout the day.
The Centers for Disease Control named the "Fluoridation of drinking water" as one of "10 great public health achievements" of the 20th century. The American Academy of Family Physicians states that fluoridation of public water is "safe and effective".
For reviews of the safety and effectiveness, see this site that is overseen by all of the major medical associations and organizations:
Many have called, emailed or written to me on Facebook and Twitter and have asked me to answer their concerns. I'd like to respond to some of the most common questions in advance of the City Council hearing this Thursday on fluoridation.
1) "What is the effect of fluoride on IQ?"
I have read the "Harvard IQ Study" that many mention to me. Unfortunately, it is being misrepresented or misunderstood. Keep in mind, Portland's proposal for fluoridation will be 0.7 parts per million (also measured in mg/L). The Harvard study evaluated studies done in China with fluoridation exposures up to 11.5 parts per million compared to control groups with exposures around 1 parts per million. The control groups with low levels of fluoridation (around 1 ppm) even had slightly higher IQs! The authors said each study reviewed had "deficiencies" that limited their ability to draw conclusions and the differences in IQ were within the "measurement error of IQ testing." This study did not evaluate optimal water fluoridation, and it did not conclude that even high levels of water fluoridation reduces IQ or harms brains.
2) "Has fluoridation at the level proposed been linked to bad health effects?"
More than a half dozen expert review panels have looked at the scientific evidence on fluoridation and have concluded there is no credible evidence linking fluoridation at optimal levels to any negative health effect. Reviews have been conducted by the US Institute of Medicine, the US Task Force on Community Preventive Services, the US Public Health Service, the National Academy of Sciences, the Australian National Health and Medical Research Council, the World Health Organization, and the National Health Service, United Kingdom.
One study often brought up to me is a National Research Council report. This report looked at fluoridation levels between 2 and 4 parts per million. Again, Portland's suggested rate is 0.7 parts per million. Even at more than twice the optimal level, this study concluded that there were no negative health effects, but that there was a slight increase for a cosmetic issue of dental fluorosis. They stated that dental fluorosis was "near zero" at levels below 2 ppm, which is nearly three times the optimal level.
"When used appropriately, fluoride is both safe and effective in preventing and controlling dental caries."
- U.S. Center for Disease Control, August 17, 2001
"…no clear association between water fluoridation and incidence or mortality of bone cancers, thyroid cancer or all cancers was found."
- A Systematic Review of Public Water Fluoridation, NHS Centre for Reviews and Dissemination, University of York, September 2000
"Using a qualitative method of analysis, there is no clear association of hip fracture with water fluoridation. The evidence on other fractures is similar."
- A Systematic Review of Public Water Fluoridation, NHS Centre for Reviews and Dissemination, University of York, September 2000
"…there is no consistent evidence to demonstrate any association between the consumption of controlled fluoridated drinking-water and either morbidity or mortality from cancer (USPHS, 1991; USNRC, 1993; WHO, 1996; IPCS, 2002).
- Fluoride in Drinking-water Report, World Health Organization, 2006, (Page 34)
3) "Shouldn't we be scared of fluorosis?"
Most fluorosis in the U.S. is a white spotting on the teeth and does not cause any health problems. The National Research Council concluded that severe dental fluorosis is a risk at high water fluoridation levels such as 4 ppm, but that it was "close to zero" at water fluoridation levels at or below 2 ppm, which is almost three times the level found in optimally fluoridated water. At 0.7 ppm, the rate Portland is suggesting, children will not be getting a "high exposure."
4) "Children are given free fluoride treatments in school – why spend the money on fluoridation?"
The fluoride treatments in school are not enough. They are expensive, difficult to implement, and have significant gaps in coverage. Fluoride supplement programs miss kids at the critical age from 0-5 years old. They also miss older kids during summertime, weekends, and when parents fail to fill out the paperwork to enroll their children.
Water fluoridation is the single most cost-effective means of preventing tooth decay. It is less expensive than school programs or prescription supplements. Oregon has implemented the school dental program and still has the fifth worst rate of tooth decay in the nation.
Oregon children suffer from higher rates of tooth decay than all neighboring states. More than one in three children lives with untreated decay. Oregon children have more than double the rate of untreated tooth decay (35 percent) as in Washington state (15 percent), which is largely fluoridated.
5) "Why don't we just spend the money on dental care for low-income families?"
Prevention is the most cost-effective response to end the dental health crisis, and fluoridation would pay for itself many times over. Dental disease accounts for 30 percent of all healthcare costs for children, a significant portion of household income for struggling families.
Cities save an estimated $38 in dental costs for every $1 invested in fluoridation.
The lifetime per-person cost of Portland's proposed water fluoridation program would be about $50. That's a bargain compared to the lifetime cost of treating a single cavity: $2000.
Fluoridation reduces Medicaid expenditures, which is a savings for taxpayers. A Texas study found that water fluoridation reduced Medicaid expenditures by $24 per child/year. A New York study found that Medicaid recipients in less fluoridated communities required 33 percent more treatments for tooth decay than those in fluoridated counties.
6) "Will it affect the taste of the water or beer?"
Fluoride has no taste and no smell. Many brands of beer are brewed with fluoridated water, including all beer brewed in all cities larger than Portland and many smaller ones, too. This includes Fort George in Astoria, Block 15 in Corvallis, and the two other Widmer breweries outside Portland. Widmer recently told the Portland Tribune that the level of fluoride proposed " is not going to impact the aroma or flavor of the beer, nor will it impact the process. We're not expecting any changes from the brewing side or the final product either."
Here's what Alex Ganum, owner of Upright Brewing, wrote in a letter to the Oregonian: "As a local brewer, I can tell you that at standard levels (0.7 ppm), fluoride in water is tasteless, odorless, and doesn't affect the brewing process in any way. It is harmless to yeast and doesn't change the taste of beer one bit. Water fluoridation is just fine for beer, and it's important for good dental health as well. In fact, breweries across the U.S. have been making great beer with fluoridated water for 50 years."
7) "Why choose water fluoridation, which affects everybody?"
Adding fluoride to drinking water has been shown to be beneficial to everyone, and will not cause negative health impacts to anyone. Fluoride is a mineral that exists naturally in nearly all water supplies, including Bull Run. Everyone ingests fluoride every day: they just aren't ingesting the optimal level needed to fight cavities.
We already add chemicals to our current water supply to ensure public health, including chlorine and sodium hydroxide.
Water fluoridation is supported by a broad-based coalition of over 75 community organizations from the education and social justice sectors, as well as all the main health institutions including: the Oregon Academy of Family Physicians, Oregon Medical Association, Oregon Public Health Association, Kaiser Permanente NW, Legacy Health, Providence Health & Services, Oregon Health & Science University, and the Coalition of Community Health Clinics.
8) "Where does fluoride come from, and how do we know it's safe?"
Fluoride used in drinking water is tested for toxins, monitored, and certified annually. It must meet American Water Works Association (AWWA) and National Sanitation Foundation (NSF) standards for purity, which are stricter than pharmaceutical grade. The Environmental Protection Agency regulates fluoride additives in drinking water, and has had a Memorandum of Understanding with the Food & Drug Administration since 1979 recognizing this authority.
Fluoride is manufactured through a process that separates fluoride from phosphorite rock. Phosphorus is later used by the fertilizer industry for fertilizer. Fluoride is not a byproduct of fertilizer.
9) "Why is Council moving forward without looking to voters?"
We care about public health and believe this is the right thing to do. Most public health decisions are made by elected officials, like: motorcycle helmet and seatbelt laws, smoke-free workplaces, and nutrition standards for schools. Portlanders are invited to contact us, come to the hearing, and provide input. Portlanders also have a right to collect signatures and bring the issue to the ballot.
Fluoridation has not been discussed recently at the Portland City Council. The last vote was in 1980, during a special election with only 19 percent voter turn-out. That was 32 years ago. A lot has changed since then. The dental health crisis has only grown worse, and the evidence base for water fluoridation has only grown stronger.
In 1978, the voters approved fluoridation. And, the two previous votes were in the 1950s and 60s, when fluoridation was new. This was the time of McCarthyism and the Red Scare when fluoridation was portrayed as a "communist plot."
It is time for fluoridation to be weighed by the city council and analyzed based on the scientific evidence of its safety and effectiveness.
"…frequently ignored question: 'In debates about fluoridation, are you hearing the voices of the vulnerable?' When political arguments erupt between policy-makers, interest groups and oral health professionals, are the groups who are most vulnerable even part of the discussions?"
- The Ethics of Water Fluoridation, 2000
10) "Who is lining your pockets? What are you getting out of this?"
Both the construction of the system and the fluoride supply will be put out for public bid in a very proscribed and transparent fashion. We all stand to gain when fluoridation reduces personal dental care expenses and offers savings for taxpayers on healthcare programs such as Medicaid.
The Everyone Deserves Healthy Teeth coalition includes over 75 education organizations, health institutions and community nonprofits in the Portland region.
11) "What about the EPA Staff union's concerns?"
The EPA is not opposed to water fluoridation. Just last year, a senior EPA official issued a joint statement with another federal health official, citing the "strong evidence that water fluoridation is safe and effective" for preventing tooth decay.
The criticism that anti-fluoride groups are referring to was made many years ago by EPA's internal staff union, not the agency's leaders. The union raised concerns about fluoride's safety and called for "double blind" studies to be done, particularly related to osteosarcoma.
Since then, a 15-year Harvard study that examined actual fluoride levels in bone found no link between fluoride and osteosarcoma (2011). The design of this study was approved by the National Cancer Institute. According to the Agency for Toxic Substances Disease Registry, fluoride is safe and effective for fighting tooth decay with a Cancer Effect of "None."
Every respected scientific committee or health organization that has reviewed the evidence on the safety and effectiveness of fluoridation has concluded that fluoridation is a healthy and effective public health practice. As such, and after much consideration, I am voting to bring Portland in line with other major cities when it comes to public health efforts to protect our city.
Read Charlie White's article opposing fluoridation