Nutrition Column – Saving Water Fluoridation: the Right Choice

To fluoridate or not to fluoridate: that is the decision Fort Collins voters are facing as they mark their ballots this month. Vote no and the city continues its long-standing water fluoridation program. Vote yes and not only will Fort Collins lose the benefit of having the optimum level of fluoride in city water, but so will much of Northern Colorado.

The materials being distributed by opponents of fluoride contain enough scare tactics to make one think twice about which way to vote. And it is true that fluoride, like water itself, is toxic when consumed in excessive quantities. On the other hand, when consumed in the right levels – the levels currently contained in our drinking water – fluoride is quite safe and most helpful in preventing tooth decay in both children and adults.

Fluoridation of community water supplies is one of the most widespread preventative health measures in the United States and other economically developed countries. Nearly two-thirds of the U.S. population is currently served by drinking water that contains either natural or added fluoride.

Fluoride, a mineral found naturally in water and soil, helps harden developing tooth enamel, which in turn protects teeth from decay. Dental scientists discovered fluoride’s benefits for teeth in the 1930s when very low tooth decay rates were observed among people whose water supply contained significant amounts of natural fluoride. Subsequent studies in the 1940s and 1950s led to the conclusion that the addition of minute levels of fluoride to community water supplies resulted in decreased decay rates among residents. This process, known as water fluoridation, adjusts the level of fluoride in a community’s water supply to the level necessary to prevent dental decay – approximately one part fluoride per million parts water.

Multiple professional health organizations, including the American Dental Association, the American Academy of Pediatrics, the American Dietetic Association and the World Health Organization, recognize water fluoridation as the most effective dental public health measure in existence. The general consensus among these organizations is that water fluoridation is a cost-effective approach (approximately 50 cents per person per year) for providing protection from tooth decay that reaches all population segments, regardless of age or socioeconomic status. These organizations cite countless studies that have demonstrated a reduction in tooth decay among people who consume water fluoridated to the recommended levels.  

According to a report published in 2003 by the Fort Collins Fluoride Technical Study Group, taking fluoride out of the water would cost Fort Collins tax payers approximately $4.25 per person per year in increased dental costs, costs that would be disproportionately borne by those least able to pay, persons of lower socio-economic status.  

Today, the incidence of dental caries, like many other diseases, is directly related to low socioeconomic status. Those children without good diets and without good dental health care are the ones most likely to suffer dental caries. So, while the caries experienced in some communities have diminished to the point where some water boards are beginning to question the need for fluoridation, most professionals in the public health field argue that water fluoridation is still the most effective and practical method for minimizing the incidence of dental caries in children in low-income families and thereby minimizing the associated burden of health care on society.

The benefits of fluoride do need to be weighed against the potential for any adverse health effects. Numerous animal and epidemiological studies have assessed the potential for adverse health effects from fluoride. While most studies have been unable to connect water fluoridation with adverse health effects, there are a few studies showing that fluoride increases (and others that it decreases) one’s risk of bone cancer and hip fracture.

After spending more than a year evaluating the evidence for and against fluoride, the Fort Collins Fluoride Technical Study Group concluded that the evidence in support of fluoridated water far outweighed the evidence against it and recommended that water fluoridation in Fort Collins be continued. The one potential adverse effect noted, mild dental fluorosis (white spots on the teeth), was considered acceptable given the benefits of caries prevention. While fluorosis is often given as a reason for discontinuing the use of water fluoridation, the bigger culprits for mottled teeth are inappropriate use of fluoridated toothpaste and fluoride supplements among young children. Children only need a pea-sized amount of toothpaste on their toothbrushes and should be encouraged not to swallow toothpaste or mouth rinses.

A copy of the final report of the Fluoride Technical Study Group can be obtained on the Web at

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by Pat Kendall, Ph.D., R.D., Food Science and Human Nutrition Specialist, Colorado State University, Cooperative Extension