Remember the toothpaste commercial in which the child proclaims, "Look, Ma, no cavities!"? For many of us, that decades-old line sums up the way we thought about the benefits of fluoride.
Yet more than 50 years after communities across the United States began getting fluoride from the tap, at a time when most Americans take for granted that having it in their drinking glass--and their toothpaste--gives them better dental checkups, anti-fluoride sentiment persists.
California remains one of the few states where fluoride is still a contentious subject, thanks to a vocal minority who like to remind the public that fluoride is a waste byproduct of fertilizer production. They question why anyone would put it in their own body.
Of course, many of them have similar concerns about chlorine and opt for bottled water rather than the tap. In a nation where 40% of American adults drink bottled water, Californians are the largest bottled water consumers. They drank an average of 27.9 gallons per person in 1997, contrasted with 12.7 gallons per person nationwide, according to the Beverage Marketing Corp. in New York.
Although the state Legislature mandated fluoridation of water supplies in 1995 to combat cavities, lawmakers never supplied the funding to carry it out. As a result, 83% of Californians still don't get fluoride through their drinking water.
That's about to change.
Los Angeles ponied up money to fluoridate the water for 3.3 million city residents beginning next month in the San Fernando Valley, West Los Angeles, West Hollywood and parts of Hollywood. Two Los Angeles County communities, Long Beach and Beverly Hills, have been fluoridating for 20 years.
"All water supplied to Los Angeles has some fluoride in it, so it's not like we're adding something foreign to the water," says Dr. Timothy Collins, dental director for the county Department of Health Services and co-chairman of the California Fluoridation Task Force. "We're adjusting upward the naturally occurring level to a level that would prevent tooth decay."
Currently, water coming to the city has levels ranging from 0.3 to 0.6 parts per million. The fluoridation will increase that to 0.8 ppm. At that level, it should be safe and within the optimal daily dose, he said.
Children Won't Need to Take Supplements
Officials expect that fluoridation could produce 40% fewer cavities, particularly among children of poorer families, who traditionally have higher-than-average rates of dental decay. They plan to get the word to dentists, doctors, pediatricians and parents that once the water supply is fluoridated, they must stop giving fluoride supplements to their children or risk too high a dose.
Sacramento voted March 30 to accept $1.4 million in fluoridation funding from the California Endowment, a not-for-profit health care charity that has promised $10 million so far toward community fluoridation. City councils in Mountain View and Yuba City have voted to proceed with fluoridation. The city of San Diego, which voted about 20 years ago to ban it, is reconsidering.
But voters in the Northern California college town of Santa Cruz and others around San Diego, including the city of Escondido and the Helix Water District in east San Diego County, recently approved bans.
"The biggest issue for us is the opponents have managed to create a level of fear among people," says Ken August, spokesman for the state Department of Health Services.
Fluoridation advocates acknowledge that vocal foes have grabbed footholds in some communities.
"In politics, it's always easier to block something than it is to do something," says Dr. Donald O. Lyman, a Department of Health Services official and co-chairman of the California Fluoridation Task Force. "It's embarrassing that of all the states, we are No. 47 in terms of proportion of population covered by fluoride."
Back in Cold War times, opponents branded fluoridation part of a conspiracy, an allegation that made its way in satiric form into director Stanley Kubrick's film "Dr. Strangelove."
Today, when 56% of Americans drink fluoridated tap water, opponents have more sophisticated arguments. It's wrong, they say, to force everyone to ingest fluoride when there are drops and tablets for those who want it, and when soft drinks and juices are formulated with fluoridated water. They're armed with human and animal studies linking fluoride to bone fractures, genetic and neurological damage and cancer.
"The first thing we're concerned with is no one has a choice," says Jeff Green, director of San Diego-based Citizens for Safe Drinking Water. "We're all overexposed already . . . even in non-fluoridated communities."
Fluoride Effective When Used Topically
Opponents also argue that fluoride only does good when applied topically: "Credible science shows that fluoride topically can kill bacteria and help reduce tooth decay. Ingested fluoride does not reduce tooth decay," Green says.