Dozens of research studies have proven the safety and benefits of drinking water fluoridation. For decades, people in the United States have benefited from drinking water with fluoride. It has kept people’s teeth strong and reduced cavities by about 25 percent in both children and adults. By preventing cavities, community water fluoridation has been shown to save money for families and for the healthcare system as a whole.
Here in Rhode Island, more than 60 years ago, the Bristol Water Company first followed the recommendation of the U.S. Public Health Service and started adding a very small amount of fluoride to its water: a ratio of 1 milligram per liter (mg/L). Imagine a little packet of salt in a bathtub filled with water. This recommendation was based on compelling evidence. Just a few years earlier, scientists found that children in Grand Rapids, Michigan had half as many cavities as their matched controls in nearby Muskegon. The difference was that the Grand Rapids children had fluoride in their water, whereas the Muskegon children did not.
Providence and other systems followed shortly, and in the decades since, fluoridation has been recognized by the American Dental Association (ADA), American Academy of Pediatrics (AAP), Centers for Disease Control and Prevention (CDC) and dozens of other organizations as the single most effective public health measure to prevent tooth decay. Fluoride is a mineral which is found naturally in water, although these natural levels differ widely by region. Fluoride works by strengthening tooth enamel to be more resistant to acids in bacterial plaque.
I can personally attest to the benefits of fluoridated water, as a beneficiary of it. My siblings and I drank fluoridated water in the 1960’s as young children in Warwick and then as school-age children in Providence. Our healthy teeth are in stark contrast with my father, who had cavities, fillings and then later crowns in most of his teeth. He grew up in Taunton, Mass in the 1930s and 1940s, decades before the city started fluoridating in 1965.
I have also witnessed firsthand among my patients the benefits of fluoridation and the long-term dental disadvantages of those spared its benefit. Working at a community health center in Providence in the 1980s, I regularly treated adults and children who had grown up outside of the U.S., in countries without fluoridation. It was rare to see a patient without extensive tooth decay. Decades later I worked as a dentist at Edison (NJ) Job Corps, a residential vocational program for low-income 16-24-year-olds. New Jersey has the second lowest fluoridation rate in the United States. In stark contrast, just across the Hudson River, New York City began fluoridation for its more than 7 million residents in 1965. It was clear that the Job Corps students who hailed from New Jersey had much more tooth decay than their classmates from New York. The difference was so extreme that I could guess where a student was from based on a quick look at their teeth.
There are triggers pockets of opposition of opposition when it comes to water fluoridation. A recently published, and largely discredited, in article published in JAMA Pediatrics questioning the health benefits of water fluoridation has not helped the situation in some parts of the country. However, here in Rhode Island, we are fortunate that our communities are committed to ensuring that every resident has access to safe and healthy water. Our state’s water operators play an important role in upholding public health and have been recognized for their diligence in assuring levels of fluoridation meet CDC recommendations. As we approach the 70th anniversary of fluoridation in our state, we should recognize, uphold, and promote this important and often unsung public health measure.
Samuel Zwetchkenbaum, DDS, MPH, is Dental Director, Rhode Island Department of Health.