Surfing the Internet while sitting in a coffee shop is a great pastime. I enjoy a good cup of coffee and listening to the conversations around me. As I sit, I hear some really amazing debates. The debate today really caught my interest. Two men had engrossed themselves in steaming cups of coffee and mild irritation about each other’s viewpoints about something I had never heard about: Fluoridation of the Public Water Supply. Both had great points, but neither could convince the other. I quickly made up my mind this was something I wanted to research on my own. This project gave me a great opportunity to research this topic and answer the question: Should the public water supply be fluoridated?
Many people do not realize how important water is to our wellbeing. Our bodies can live weeks without food, but only days without water. The importance of clean drinking water cannot be exaggerated. The public water system supplies the people with on-demand water which we would expect to be pure. However, in 1945, Grand Rapids, Michigan, became the first city in the U.S. to add fluoride to its water supply (Fagan par. 7). Today, nearly 60% of the U.S. population drinks water with added fluoride. This includes 46 of the 50 largest cities in the U.S. (Fagan par. 2).
Fluoridation is an adjustment to the concentration of fluoride in the water (Swain par. 1). The element fluoride is anything that contains fluorine and, according to the American Dental Association (ADA), is found in all food and beverages (Swain par. 2). The reasons to fluoridate the water relate to improving dental health of all individuals through one source.
THE BENEFITS
The existence of fluoride in the tooth builds resistance to tooth decay (Waldbott 61). Fluoride does this through the utilization of two different processes. First, fluoride becomes embedded in the crystalline structures of the main mineral component of teeth and replaces some molecules to increase resistance to acid. Secondly, fluoride improves the tooth surface’s ability to displace calcium and phosphate which assist in the sustained rebuilding of the enamel (Fagan par. 10). Decreasing tooth decay is also helpful in preventing some diseases because bad dental health promotes cavities which act as avenues for bacteria and toxins to enter the blood stream (Waldbott 75). The statistics relating to how well fluoridation serves the public for improved dental health are staggering.
In the fifteenth year of fluoridation, Grand Rapids reported a 50% – 63% drop in tooth decay for children 15-16 years old (Waldbott 70). After three years of fluoridation in Newburgh, New York, officials announced a 31% reduction in tooth decay in children (Waldbott 69). These statistics accelerated the proliferation of fluoridation in America. In 1960, 23% of the U.S. Population was using fluoridated water. That percentage increased to 39% by 1970 and 50% by 1980 (Doyle 214). Many public-health officials now consider fluoridation “to be one of the great health advances of the last one hundred years, ranking it with pasteurization of milk, immunization against disease, and the provision of safe drinking water” (Doyle 213). The U.S. Centers for Disease Control has also endorsed fluoridation “as one of the 10 greatest health achievements of the 20th century, alongside vaccines and family planning” (Fagan par. 2).
THE DISADVANTAGES
As I waded through the accolades and endorsements of fluoridation, a snowball of adverse effects on the internal health of people began to surface and build its case against fluoridation. Dr. George Waldbott in Fluoridation the Great Dilemma asserts that “no other procedure in the history of medicine has been praised so highly nor at the same time condemned so thoroughly” (353). Waldbott also warns that fluoridation assessment must not include only its effectiveness against dental decay, but must include “possible hazards of increased fluoride ingestion and absorption” (108).
Ingestion and absorption appear to be having adverse effects to both the heart and the kidneys while increasing cancer risks to other parts of the body. Studies have brought awareness that excess fluoride may have doubled deaths from heart disease in some communities (Walbot 158). Kidneys take on the main responsibility of excreting fluoride and high levels of fluoride have been prevalent in cases of kidney failure (Doyle 219). Dr. Jacob Bruce, a graduate from Harvard Medical School, asserts that continued ingestion of fluorine can bring the beginning of a cancer due to the cells coming apart and spurring out of control reproduction (qtd. in Buck 51). Elise Bassin of the Harvard School of Dental Medicine collected data from cancer patients with a matched control group and “concluded that fluoride is a risk factor for cancer among boys” (Fagan par. 21).
Skeletal fluorosis, the hardening of bones making them brittle, can be caused by excessive fluoride intake (Doyle 218). Walbott asserts that the way fluoride reacts to bone is similar to teeth in that it incorporates into the main building block of bones creating greater density, but this new bone is unhealthy and can break easily. Newly formed bone can result in arthritis and bone spurs which pinch nerves causing numbness to paralysis (81). Walbott adds, “The intake of fluoride, even in amounts as small as those consumed in fluoridated communities, produces a kaleidoscope of adverse effects” (168). At a National Research Council public meeting, Joyce Donohue, toxicologist in the Environmental Protection Agency’s (EPA) Office of Water, asserted that “new research suggests that low levels of fluoride have negative developmental effects and effects on the brain” (Hileman, “Fluoride Concerns” par. 8).
The negative effects of fluoride do not stop there. It appears the general welfare of communities may be at risk from fluoridation. Mr. Cox, who was one of the originators of fluoridation, stated simply that “fluorides are among the most toxic of substances” (qtd in Waldbott 76). Another researcher, Dr. Veikko Hurme, specifically labeled fluorine as “a protoplasmic and enzymatic poison” (qtd in Buck 113). The EPA recommended fluoride levels contain less fluoride needed to cause the excessive ingestion, but because there is uncertainty of the exact amount of fluoride people ingest from food, dental hygiene products, and drinking water, they cannot guarantee ingested levels will not reach a level that might cause harm (Fagan par. 3). This idea caused the NRC to release a report in 2006 insisting the EPA’s limit “be lowered because of health risks to both children and adults” (Fagan par. 3). Twenty-four years earlier, Dr. Dennis Leverett of the Eastman Medical Center in New York made the same observation, theorizing that the food chain is adding fluoride and that fluoridation of public water should be reevaluated (Doyle 223).
Another aspect of this debate is whether fluoridation of the public water supply violates our civil rights. The Delaney Committee which reported to the House of Representatives wrote that “it is safe to say that fluoridation is mass medication without parallel in the history of medicine” (qtd. in Buck 97). The Medical-Dental Ad Hoc committee on the Evaluation of Fluoridation called fluoridation “compulsory mass medication without precedent” (Buck 45). When individuals do not have a choice, it can be said that liberty has been taken away. Forcing a population to use fluoridated water is a violation of their civil rights. That same committee also penned strongly that “the function of a public water supply is to provide pure, safe water for everybody; not to serve as a vehicle for drugs” (Buck 45).
PROTECT THE PEOPLE AS A WHOLE
I cannot agree more that the public water facilities should provide the most pure and safe water possible. People should know that one of their most basic needs is not tainted. In light of this research, I believe that fluoride should be removed from the public water supply. It is hard to believe that so many organizations endorse an activity that has such a potential to hurt communities. 1945 was a different time and much of what we eat and drink now contains fluoride. The authorities cannot be sure how much fluoride you ingest and whether you are overdosed. The kicker is that “fluoridation mainly benefits children through the age of permanent-teeth formation (fourteen years)” (Doyle 215). So, why force everyone to partake in this mass medication? It seems logical to ensure that you do not do something that might hurt people.
There are alternatives to fluoridation including focusing on the main benefit: better dental health. Dr. Harris before the US Senate in 1951 stated his preference to treat teeth is to have a dentist dry the tooth surface and apply fluoride directly to the teeth. Let it stand a few minutes then rinse it off (qtd in Buck 97). That seems so easy and I can already hear an objection: What about those who cannot afford to go to the dentist? The answer is to continue using fluoride toothpaste. Essentially, we already do as Dr. Harris suggests by squirting some fluoride on our toothbrushes, brushing for a time and rinsing.
THE MORAL LENSE
It would not be ethical for me not to analyze my position that we should stop fluoridating our water supply. To do this, I will use the Ruggiero Model for moral decision-making. The Ruggiero Model considers facts, obligations, ideals and consequences. First, the facts are simple. Fluoridation improves dental health. Excessive fluoride intake causes many health issues.
The obligations may seem sticky. The authorities appear to believe they have an obligation to provide the best dental health available. In reality, that obligation is the people’s not the authorities. The authorities have an obligation to provide the information about the best dental health possible. The authorities also have an obligation to adhere to the civil rights of the public. Also, the obligation to ensure that they do not inadvertently hurt people is important. The conflict is between what the authorities believe they should provide, the possibility of hurting someone due to fluoridation, and the people’s right to make decisions about their health. The obligation to ensure that they do not inadvertently hurt someone is most important here. By continuing to fluoridate, authorities are risking excessive fluoride ingestion.
The ideal that exists in this debate is that people should have the best heath care possible. Values that are prevalent in this ideal are loyalty, fairness, and forgiveness. Loyalty is represented by both the people and the authorities. The authorities must be loyal to the people to ensure their welfare while the people must be loyal in their appreciation and civic duties to their community. The authorities must be fair to the people by ensuring that they do not add fluoride to the food chain that will have adverse effects. The people must forgive the authorities and know that 1945 was a different time and that the decisions to fluoridate were based on what they knew then. Science changes all the time.
The consequences of fluoridating water are that dental health will be improved, but that general welfare of the people will be infringed and some people may die. The consequences of not fluoridating indicate that money will need to be spent retooling water treatment facilities and the fluoride market will be impacted. Also, the population’s dental health will be adversely affected unless an alternative is provided and endorsed. The later consequences are more preferable to the first. Quality of life and long healthy lives outweigh monetary needs.
END OF THE LINE
I believe the logical lense of the Ruggiero Model clearly indicates that we should stop fluoridating our water supply to ensure we do not hurt people. The research shows that ingestion and absorption of excessive fluoride can cause a host of ailments that could ultimately lead to death. My wife and I have agreed to limit our fluoride ingestion and absorption while using toothpaste as a means to fluoridate our family’s teeth. Fluoridation is wonderful for increasing dental health; however, the ingestion of fluoride can cause health concerns that outweigh the benefits.
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(Normally, a Works Cited would have tabs and stuff; however, due to software limitations, I am unable to properly format it.)
Works Cited
Buck, Robert M. The Grim Truth About Fluoridation. New York: Putnam’s Sons, 1964.
Doyle, Rodger Pirnie. The Medical Wars. New York: William Morrow and Company, 1983.
Fagin, Dan. “Second Thoughts about Fluoride.” Scientific American 298.1 (Jan. 2008): 74-81.Military & Government Collection. EBSCO. St. Edward’s University, Austin, TX. 24 Nov. 2008 <https://ezproxy.stedwards.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mth&AN=27817795&site=ehost-live>.
Hileman, Bette. “Fluoride Concerns Surface Once Again.” Chemical and Engineering News 81.34 (2003): 22-23. St Edwards University. 24 Nov. 2008 <http://pubs.acs.org.ezproxy.stedwards.edu:5000/isubscribe/journals/cen/81/i34/html/8134gov1.html>.
—. “Fluoride Risks Are Still A Challenge.” Chemical and Engineering News 84.36 (2006):34-37. St Edwards University. 24 Nov. 2008 <http://pubs.acs.org.ezproxy.stedwards.edu:5000/isubscribe/journals/cen/84/i36/html/8436gov1.html>.
Swain, Liz. “Fluoridation.” Environmental Encyclopedia. Ed. Marci Bortman, Peter Brimblecombe and Mary Ann Cunningham. 3rd ed. Detroit: Gale, 2003. Opposing ViewpointsResource Center. Gale. St Edwards University. 24 Nov. 2008 <http://find.galegroup.com/ovrc/infomark.docontentSet=GSRC&type=retrieve&tabID=T001&prodId=OVRC&docId=EJ3018200559&source=gale&srcprod=OVRC&userGroupName=txshracd2555&version=1.0>.
Waldbott, George, Albert Burgstahler, and H. Lewis McKinney. Fluoridation the Great Dilemma. Kansas: Coronado Press, 1978.