'Undoubtedly Fluoridation Benefit'

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.

Sincerely,

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.