Too much of a good thing? Fluoride water levels to be lowered

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Only a century ago, Americans could expect to lose most of their teeth by age 40. But, since fluoridation of tap water was introduced in the mid-twentieth century, the incidence of tooth decay has nosedived. Now, however, the Department of Health and Human Services (HHS) and the EPA have announced that they want to reduce the maximum allowable fluoride levels in municipal water supplies as recent data showed that more than one in three U.S. children have fluorosis, a condition caused by an excess of fluoride that can lead to tooth enamel mottling and discoloration. From 1987 to 2004, the proportion of American 12 to 15 year-olds suffering from fluorosis is reported to have increased from 23 percent to 41 percent.

Fluoride exposure has risen as more and more children now receive it in toothpaste and from dental applications. Thus, though fluoride was added to tap water at the level of one part per million (ppm) when it was discovered that the chemical reduced cavities, the HHS wants the fluoride concentration in public water supplies reduced to 0.7 ppm. This is on the low end of the government recommended levels of 0.7 to 1.2 ppm established in 1962.

New York State Oral Health Coalition Chair and ACSH advisor Tom Curran supports the proposed fluoride reduction measure. In a letter, he comments:

They [public health officials] want to reduce fluorosis and this is appropriate...[W]e support the reduction of fluoride in municipal water from 1 mg/L to 0.7mg/L now with the ubiquitous use of fluoride toothpaste. Although I agree with Dr. Liu [President of the American Academy of Pediatric Dentistry] that fluoride toothpaste is a bigger problem when used by children in an unsupervised setting. That is the reason you see fluorosis [even] in communities that don't have municipal water fluoridation. You can expect [anti-fluoridation groups] to try to have a field day with this announcement. [Fluoride Action Network Executive Director Paul Connett, for example, has] targeted NYC along with 6 other areas for his campaign for 2011. Be prepared.

ACSH’s Dr. Elizabeth Whelan, who believes the addition of fluoride to tap water was one of the most beneficial public health measures of the twentieth century, expresses her concern. “The anti-fluoride activists will be all over this and will try to convince the public that fluoride is a government-sanctioned poison that should be banned altogether. We’ve had fluoridation in New York City since 1965, and now kids are also using fluoridated toothpaste. If the combined use of other fluoride sources is causing too much fluorosis, then why not try to lower the amount of fluoride in toothpaste and convince dentists that kids in areas with fluoridated water don’t need extra fluoride applications?”

ACSH’s Dr. Gilbert Ross, however, points out that the new advisory may not be off-base: “Though fluorosis is not the worst thing in the world, perhaps now we should be more flexible and allow the recommended fluoride levels to be reduced as needed for continued protection against cavities while curbing fluorosis.”