James Laughlin
Editor
Fluoride is one of those hot-button topics that never seems to go away. There's always someone out there who views it as poison and hotly contests its use in municipal water. Two recent studies published in the British Medical Journal should help alleviate some of those fears, but probably won't.
In a study of nearly 5,800 U.S. women, investigators from the Oregon Health Sciences University in Portland found that those exposed to years of fluoridated water had greater bone density and were less likely to break their hips or spines, compared with women who lived in fluoride-free areas.
A separate study, commissioned by the British government, examined 50 years of research on the safety of adding fluoride to drinking water. It found no evidence of harm, and some experts said the findings should ease lingering fears that fluoridation can cause cancer, osteoporosis or Down Syndrome.
The review involved 214 studies and was the most comprehensive since fluoridation was introduced in the United States after World War II.
Fluoride opponents dismissed the British research, saying it ignored some studies showing adverse effects, such as an increase in bone fractures among the elderly, and did not account for fluoride from other sources.
Both studies showed that tooth decay declined about 15 percent in areas with fluoridation. However, fluoride-fortified water does raise the risk of fluorosis, a condition in which the tooth enamel becomes discolored or pitted, researchers said.
According to researchers led by Dr. Marian S. McDonagh of the University of York, when the fluoride level in water hits one part per million, the risk for fluorosis rises 12 percent. One ppm is the fluoride level recommended for preventing tooth decay.
In a separate study reported in the British Dental Journal, investigators compared rates of fluorosis among 8- and 9-year-old children who lived in communities with and without fluoridated water. The research team examined permanent incisor teeth for discoloration and interviewed parents about their child's use of fluoridated toothpaste.
The results indicate that 54 percent of children in areas with fluoridated water had fluorosis, compared with 23 percent in areas where the water was not fluoridated. However, trained examiners are needed to detect signs of fluorosis, and ``aesthetically important dental fluorosis was low,'' the authors reported.
The British government is contemplating a nationwide fluoridation program. As in other countries, fluoride is added to the water in some British communities but not in others. Worldwide, more than 360 million people live in areas with fluoridated water. That figure includes about 145 million in the United States.
Part of the concern in modern society is the amount of fluoride people come in contact with. Fluoride is found naturally in some water supplies, tea, fish and other foods, and is added to some toothpastes.
Researchers suggested that children use toothpaste with lower concentrations of fluoride. They should also be supervised when brushing, and should only use a pea-sized portion.
I spent part of my childhood living on a farm in eastern Oklahoma. Everyone drank well water and fluoridation wasn't an issue. I remember a lot of children and young adults in the region with rotting teeth. I have to wonder how much of that was fluoridation and how much was a simple lack of dental hygiene.
Yet, when we moved back into town I don't remember that many of the town kids with bad teeth. Looking back, the only differences I can see are access to municipal water and a slightly higher standard of living.
