CDHP Fluoridation Report Brief (March 2006)

The National Research Council (NRC) of the National Academies released a report on March 22, 2006 entitled "Fluoride in Drinking Water: A Scientific Review of EPA's Standards". Contracted by the U.S. Environmental Protection Agency (EPA), the NRC convened the Committee on Fluoride in Drinking Water to conduct a review of data from toxicologic, epidemiologic, and clinical research on fluoride studies generated since 1993 in assessing the adequacy of the EPA's current standards for maximum contaminant level goal (MCLG) and secondary maximum contaminant level (SMCL) on adverse health effects. In 1986, the EPA established a drinking water standard for fluoride at a maximum of 4 mg/L (MCLG) and a maximum concentration of 2 mg/L (SMCL) to prevent cosmetic consequences. The committee not only examined the dental effects of exposure to high concentrations of fluoride, but also musculoskeletal, reproductive/developmental, neurobehavioral, endocrine, and carcinogenic effects of fluoride concentrations within the 2 mg/L (SMCL) to 4 mg/L (MCLG) range.

Based on its comprehensive review, the committee concluded that the EPA's current MCLG of 4 mg/L should be lowered, while insufficient evidence precludes any changes to the current SMCL of 2 mg/L. The committee found that fluoride exposure at 4 mg/L puts children at risk of developing severe enamel fluorosis, where enamel loss and pitting may compromise the ability of tooth enamel to protect the dentin and, ultimately, the pulp of the tooth from decay and infection. Also, high concentrations of fluoride were found to be associated with weakened bones over time and, thus, an increased risk of bone fractures. A majority of the committee members concluded that the MCLG was not likely to be protective with respect to bone fractures. No conclusions were made regarding other potential adverse health effects due to exposure to high levels of fluoride.

However, as the American Dental Association stated in its response to the release of this report, the conclusions made by NRC deal with the EPA's standards for naturally occurring fluoride in drinking water, as compared to the optimal fluoride levels of 0.7-1.2 mg/L in fluoridated community water systems. The concentration levels for artificially fluoridated water systems are substantially lower than the concentrations examined by the committee. Along with school-based dental sealant programs, community water fluoridation remains one of the most cost-effective, equitable, and safe methods of preventing tooth decay.

Endorsed by the Surgeon General's Report on Oral Health in 2000 as well as by the creators of Healthy People 2010 and the Task Force on Community Preventive Services, community water fluoridation is further vindicated in terms of safety as a result of this report. If anything, it is imperative that community water fluoridation efforts be widely promoted to expand well beyond the 160 million people currently being served by this valuable public health activity.

Professional Response to NRC Fluoride Report

April 6, 2006

National fluoride report prompts confusion over a "top 10" health strategy

This guest opinion is by Gordon Empey, D.M.D, MPH, a dental health consultant to the Oregon Department of Human Services.

Length: 498 words

By Dr. Gordon Empey

News stories about a new national report that recommends reduced fluoride levels in drinking water is causing confusion among people who have an interest in this issue.

As the consultant to the state's oral health program, I'd like to offer a perspective on the report and share some important facts about fluoridation.

The report, commissioned by the Environmental Protection Agency (EPA), is intended to guide the EPA in developing standards for water systems with naturally occurring fluoride concentrations that serve about one-half of one percent of the nation's population.

This report does not apply to communities that adjust the fluoride in water supplies at the lower levels effective for preventing tooth decay.

Natural fluoride, a mineral present in water, soil and air, is the focus of this report. It recommends that the maximum level of natural fluoride in drinking water be lowered from the current upper limit of 4 milligrams per liter. The report finds that children who continually drink water at these levels are not protected from a condition called severe enamel fluorosis, whose symptoms include discolored, pitted or hard-to-clean enamel. It also finds that a lifetime exposure to fluoride concentrations of 4milligrams per liter or higher is likely to increase bone fractures.

Community water fluoridation is the adjustment of fluoride in drinking water to a level of about 1 mg/liter. The NRC report does not evaluate the risks or benefits of these lower concentrations. Most of the expert panel members who wrote the report indicate they do not question the use of lower levels of fluoride, which have been shown to reduce tooth decay by 18 percent to 40 percent.

Over the past 60 years, extensive research has shown that fluoridating public water supplies is a safe, effective and economical way to reduce tooth decay. Fluoridation has been extensively studied and is now widely accepted--nearly 170 million Americans (68 percent of the population) drink fluoridated water.

Tooth decay causes toothaches and premature loss of teeth in children. Infections and inflammations resulting from oral disease in adults have been linked to chronic diseases such as heart disease, diabetes, HIV and even pregnancy complications. Good oral health is essential for good general health.

Following the report's release, CDC, the nation's lead agency in promoting health and quality of life, issued a statement recommending continued community water fluoridation as a safe, effective and inexpensive way to prevent tooth decay. Nearly every reputable national and international health-related organization recognizes the benefits of water fluoridation and the past five Surgeons General have supported fluoridation.

Oregon ranks 48 out of 50 states for water fluoridation. Although Salem, Hood River, Corvallis, Beaverton and other communities have chosen fluoridation, only about 19 percent of the state's residents drink fluoridated water.

I sincerely hope the NRC report does not dissuade Oregon communities from learning the facts about community water fluoridation, which has been called one of the 20th century's top 10 public health achievements. Learn more about the report at www.nationalacademies.org and www.ada.org.

Gordon Empey, DMD., MPH, is the dental health consultant to the Oregon Department of Human Services and can be contacted at (email address).