Fluoride is a mineral that occurs naturally in almost all foods and water
supplies. The fluoride ion comes from the element fluorine. Fluorine, the 13th
most abundant element in the earth\'s crust, is never encountered in its free
state in nature. It exists only in combination with other elements as a fluoride
compound. Fluoride is effective in preventing and reversing the early signs of
tooth decay. Researchers have shown that there are several ways through which
fluoride achieves its decay-preventive effects. It makes the tooth structure
stronger, so teeth are more resistant to acid attacks. Acid is formed when the
bacteria in plaque break down sugars and carbohydrates from the diet. Repeated
acid attacks break down the tooth, which causes cavities. Fluoride also acts to
repair areas in which acid attacks have already begun. The remineralization
effect of fluoride is important because it reverses the early decay process as
well as creating a tooth surface that is more resistant to decay. Community
water fluoridation is the adjustment of the amount of the beneficial trace
element fluoride found in water to provide for the proper protection of teeth.
Fluoridation has been widely utilized in this country since 1945. It does not
involve adding anything to the water that is not already there, since virtually
all sources of drinking water in the United States contain some fluoride.
Fluoridation is a form of nutritional supplementation that is not unlike the
addition of vitamins to milk, breads and fruit drinks; iodine to table salt; and
both vitamins and minerals to breakfast cereals, grains and pastas. The
protection of fluoridation reaches community members in their homes, at work and
at school -- simply by drinking the water. The only requirements for the
implementation of fluoridation are the presence of a treatable centralized water
supply and approval by appropriate decision makers. Some people believe that
there are effective alternatives to community water fluoridation as a public
health measure for the prevention of tooth decay in the United States. The fact
of the matter is that while other community-based methods of systemic and
topical fluoride delivery (i.e. school-based fluoride mouthwash or tablet
programs) have been developed over the five decades that water fluoridation has
been practiced, none is as effective as community water fluoridation and none is
free from financial constraints or other drawbacks. Alternatives to community
water fluoridation remain useful only for populations significantly isolated
from public water systems. Nearly 145 million Americans are currently receiving
the benefits of optimally fluoridated water. With the 1995 enactment of Assembly
Bill 733 in California, ten states and territories in the United States now
mandate fluoridation through legislation. Besides California, these include
seven other states (Connecticut, Georgia, Illinois, Minnesota, Nebraska, Ohio
and South Dakota), as well as the District of Columbia and Puerto Rico. Three
states (South Dakota, Rhode Island and Kentucky), as well as the District of
Columbia, have achieved the ultimate success with 100 percent of their treatable
community water systems providing the benefits of fluoridation to their citizens.
While safety has been an issue frequently raised by those opposed to
fluoridation, scientific data from peer-reviewed clinical research provide
overwhelming evidence that the adjustment of fluoride levels in drinking water
to the optimal level is undoubtedly safe. Hundreds of studies on fluoride
metabolism have tracked the outcomes of ingested fluoride. Ingested fluoride
essentially travels three metabolic pathways. It is either excreted by the
kidneys, absorbed by the teeth or taken up in the skeleton. At optimal levels
fluoride has never been demonstrated to cause skeletal fluorosis or other bone
problems. On the contrary, there is mounting evidence that continued exposure of
individuals to low levels of fluoride, as in optimally fluoridated drinking
water, results in a decrease in osteoporosis and a decrease in concurrent
susceptibility to vertebral fracture. Furthermore, there is no evidence of
increased morbidity or mortality from any disorder for those with lifetime
exposures to optimally fluoridated drinking water. Those opposed to water
fluoridation claim that exposure to fluoridated water increases an individual\'s
risk of suffering from several forms of cancer. Again, the overwhelming weight
of scientific evidence indicates otherwise. Over 50 studies have evaluated the
potential relationship of water fluoridation and cancer mortality. None found
any credible evidence that exposure to water fluoridation is in any way related
to an increased risk of cancer in humans. A number of national and international
scientific commissions, after reviewing all of the available scientific
literature, also concluded that water fluoridation was safe and that it in no
way related to increased risk to humans of any form of cancer. Finally, a 1990
study of fluoridated and fluoride-deficient communities by the U.S. National
Cancer Institute revealed no