'Undoubtedly Fluoridation Benefit'

A letter to the editor from Joseph A. Cotruvo PhD. Cotruvo is on the board of directors of the Washington, DC Water and Sewer Authority and formerly of the Environmental Protection Agency.

I came across your article that Pottstown Water's BOD was going to cease fluoridation of the municipal drinking water.

Please excuse my temerity in commenting.

Although I am not a resident of Pottstown I have been there.

I am writing to express my curiosity as to the basis for the decision, since I have been engaged in drinking water and health issues for most of my professional life. 

We all know that water fluoridation has been practiced for about 60 years in many communities in the U.S. and numerous other counties, and that it continues to be endorsed by many U.S. and worldwide professional and scientific organizations as a means for reducing the incidence of tooth decay.

Some of these include the National Institute for Dental Research, U.S. Centers for Disease Control, American Dental Association, International Association for Dental Research and the World Health Organization.

The news article did not cite a specific reason for ceasing fluoridation, but apparently it was primarily a cost cutting measure. The article also did not indicate that a critical analysis was carried out to consider the potential community consequences and the overall costs and benefits of fluoridation or non fluoridation.

More about the decision will be understood when the BOD proceedings are issued.

Initially water fluoridation demonstrated large benefits in tooth decay reduction. The benefits are probably smaller now due to socioeconomic changes, better access to dental care especially for children, topical fluoride treatment and use of fluoridated toothpaste. 

However, there is undoubtedly fluoridation benefit especially for children of lower income members of populations who probably do not have as much dental care access.  

Concerns about skeletal fluorosis from very high concentrations in drinking water in the U.S. are unfounded. When fluoride was regulated in the (1980s, the) EPA could not locate a single water related case of crippling skeletal fluorosis associated with public drinking water supplies that had high natural fluoride -- greater than four parts per million.

Crippling skeletal fluorosis is known in some countries such as India when the natural drinking water supply has extremely high concentrations and the high ambient temperatures result in greater daily water consumption.

The only credible, possibly somewhat negative consequence of water fluoridation in the U.S. is some increased incidence of mild dental fluorosis, which actually is barely noticeable.

In fact, some studies associate very mild to mild dental fluorosis whitening with improved appearance/oral health related quality of life. 

Recently, CDC and EPA recommended that only 0.7 mg/L (0.7 parts per million) of fluoride was sufficient to achieve the dental benefits and minimize potential mild fluorosis.

Prior to that, some communities fluoridated at levels up to 1.2 mg/L (1.2 parts per million) in regions of cooler temperature. 

The important questions are about the net cost and net benefit to the community of the decisions that might be made. Cost benefit assessments are a standard methodology for examining the consequences of health related decisions.

In 2006, CDC indicated that the median annual cost of fluoridation in large communities was about 32 cents per person; in communities smaller than 5000 persons, annual per capita costs were about $3.37.

The best way to assess benefits and foregone costs is by consultation with the local dental professionals who can inform the BOD on the incidence of decayed, missing and filled teeth of various age groups and especially young children, and the incidence of mild dental fluorosis.

I hope the community and the BOD will find these comments helpful and in the positive spirit they are intended.


Joseph A. Cotruvo PhD

Editor's note: Cotruvo is on the board of directors of the Washington, DC Water and Sewer Authority and formerly of the Environmental Protection Agency.

nyscof August 19, 2011 at 12:54 PM
Cotruvo hasn't kept up with recent fluoride science. Respected scientific bodies reviewed fluoride science to report they are scientifically invalid and do NOT prove fluoridation is safe and effective. National Institutes of Health Consensus Statement on Diagnosis and Management of Dental Caries Throughout Life (2001) - "... the (NIH) panel was disappointed in the overall quality of the clinical data that it reviewed. According to the panel, far too many studies were small, poorly described, or otherwise methodologically flawed" (over 560 studies evaluated fluoride use). York Review: "We were unable to discover any reliable good-quality evidence in the fluoridation literature world-wide." "The evidence about reducing inequalities in dental health was of poor quality, contradictory and unreliable." Scientific American: “What the [National Research Council's 2006 fluoride] committee found is that we’ve gone with the status quo regarding fluoride … for too long… and now we need to take a fresh look,” [Chairman and PhD] Doull says, “ In the scientific community, people tend to think that its settled… But when we looked at the studies that have been done, we found that many of these questions are unsettled and we have much less information than we should, considering how long this [fluoridation] has been going on. I think that’s why fluoridation is still being challenged so many years after it began, In the face of ignorance, controversy is rampant."
jwillie6 August 19, 2011 at 02:56 PM
Many large studies show fluoridation is totally ineffective in improving tooth decay. THe World Health Organization studied 16 countries and showed fluoride is of no value. I am a Civil Engineer, so I am very familiar with community water systems. Even if fluoride was helpful to teeth, trying to distribute any drug in drinking water is the most expensive and wasteful way to do it. People drink only 1/2% (one-half percent) of the water they use. The remaining 99 ½ % of the toxic fluoride chemical is dumped directly into our environment through the sewer system. I am a Civil Engineer, so I am very familiar with community water systems. For example, for every $1000 of fluoride chemical added to water, $995 would be directly wasted down the drain in toilets, showers, dishwashers, etc., $5 would be consumed in water by the people, and less than $0.50 (fifty cents) would be consumed by children, the target group. Your local water department can confirm all of this. That would be comparable to taking 1 gallon of milk, using six-and-one-half drops of it, and pouring the rest of the gallon in the sink. Can you think of a more wasteful government program? Giving away fluoride tablets free to anyone who wants them would be far cheaper and certainly more ethical because then we would have the freedom to choose
Suzanne jefferis August 21, 2011 at 01:33 AM
Pottstown doesn't need to waste it's taxpayers money on a detrimental additive to it's drinking water. If you study both sides of the issue you'll stay off the shady side of the street and opt for 'no fluoride'.
Jim Schultz August 26, 2011 at 02:11 PM
May I mention the water disaster in Dc. Nov 1 2000 they added chloramine and lead levels skyrocketed which they detected right away. Sadly they allowed this to continue for almost three years providing lead toxic water ummentioned to the public. They had used high chlorine levels for years and produced lots of lead blisters which were blasted off by the H2sif6 siliofluoride chloramine mixture. This risk was well documented but ignored. Maas 2007 Coplan 2007 both did further documentation proving this increased lead leaching. In addition Marc Edwards a Virginia tech corrosion expert had warned the EPA and DC water of the disaster about to happen. The blame game is still bering played in hearings . 100 million was spend changing out some lead pipes but done incorrectly as they had been warned. This also put more lead in the water. 25,000 in one section of the city were warned and given free bottled water or filters for aout a year but three years late. Others with water as toxci were never warned. So being from DC is nothing to brag about. I should mention the EPA headquerters union has been against fluoridation starting in 1985. By 2005 11 EPA unions had asked congress to halt fluoridation. By Feb 29 2008 it was 19 unions with 10,000 professionals asking for the halt. Listen the the video of Bill Hirzy PHD VP of the union ask congress to halt fluoridation. Not all PHD's are created equal.


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