Archive for the ‘Fluoride’ CategoryDecember 3, 2013
At the December 3, 2013, Board of Water Works Trustees’ Planning Committee meeting, Des Moines Water Works (DMWW) staff announced the utility, which serves approximately 500,000 customers in Central Iowa, will continue community water fluoridation at the current level of 0.7 mg/L.
“Staff has reviewed currently available data and the data overwhelmingly supports that fluoridation of drinking water at current levels does not pose a detectable health risk,” said Bill Stowe, CEO and General Manager, Des Moines Water Works. “From these findings, together with the health and economic benefits provided, staff concludes that the current levels of fluoride delivered to our customers (0.7 mg/L) is appropriate for public health and is consistent with the balance of scientific and medical opinion currently available.”
The issue was opened up for public comment at the October committee meeting and staff solicited comments, research and studies on fluoridation. Unlike other providers of drinking water, including private water companies and corporate bottled water providers, DMWW actively sought and received public comment and engaged in public discussions, providing transparency in its process, inviting the public to provide their opinions and point toward scientific data or studies. As anticipated, the solicitation of public comments drew significant interest and elicited many emotional responses. Approximately 650 comments were received. Comments can be viewed online at http://www.dmww.com/water-quality/fluoride-comments/.
Community water fluoridation is supported by more than 100 national and international health, service, and professional organizations. A few of these supporters are American Dental Association (ADA), American Medical Association (AMA), American Water Works Association, Centers for Disease Control and Prevention (CDC), the U.S. Surgeon General, and the World Health Organization. The CDC proclaimed community water fluoridation as one of the ten great public health achievements of the 20th century.
“Des Moines Water Works continuously reviews its water treatment and distribution practices to ensure both regulatory compliance and economic delivery of safe, affordable, and abundant drinking water,” said Stowe. “Processes are dynamic, and as new science becomes available, DMWW will adjust accordingly; however, the clear weight of peer-reviewed scientific evidence shows that fluoridated water, at proper levels, safely and effectively reduces tooth decay in children and adults.”
Numerous studies have also shown the cost benefits of fluoridation. One study, “An economic evaluation of community water fluoridation,” has shown every dollar spent on fluoridation can save residents $38.00 in dental costs. DMWW spends approximately $130,000 annually in direct costs for water fluoridation.
Anti-fluoridation proponents point toward several concerns about adding fluoride to public water supplies. However, studies citing significant health detriment have been based on fluoride concentrations well beyond the current levels of 0.7 mg/L. This level of fluoridation is supported by the AMA, ADA, CDC, Department of Health and Human Services, and Iowa Department of Public Health. DMWW’s policy of fluoridation through the public water system supports its mission of providing safe and quality drinking water for the public health of its community.
The Board of Water Works Trustees will hold their regularly scheduled meeting, which includes a public comment period, on December 17, at 3:30 p.m. at the Greater Des Moines Botanical Garden, located at 909 Robert D. Ray Drive.
Fluoridation of municipal drinking water has aroused some controversy from its beginnings in 1945. There is no doubt high concentrations of fluoride are toxic to the human body. But it’s important to remember that the toxicity of any material depends on the dose amount and the exposure duration. In the case of municipal water fluoridation, the overwhelming weight of evidence shows the current recommended dose – 0.7* part per million (ppm) – to be safe. The measurement unit of ppm is one part substance per million parts of water. One ppm is equivalent to a half gallon jug of water in an Olympic-size pool.
Des Moines Water Works’ source water (the Raccoon and Des Moines Rivers, and shallow groundwater under river influence) contains fluoride naturally, usually between 0.1 and 0.5 part per million (ppm). The addition of fluoride to Des Moines Water Works’ drinking water is monitored every minute of every day by DMWW staff, so that the proper amount of fluoride is always maintained in the drinking water delivered to your home.
Des Moines Water Works and the water industry continue to examine and react to new research. But at the current time, the weight of evidence overwhelmingly supports continued fluoridation of municipal drinking water. Fluoridation of municipal drinking water is endorsed by:
- American Dental Association
- American Medical Association
- American Heart Association
- American Cancer Society
- American Water Works Association
- Centers for Disease Control
Every U.S. Surgeon General and every sitting President since Kennedy have publicly endorsed fluoridation. As the Centers for Disease Control has recognized, municipal drinking water fluoridation is one of the great public health achievements of the 20th century. We know good dental health is important to our overall physical well being. Good teeth enable us to eat a healthy diet throughout our life and into old age, helping lengthen our lifespan.
Fluoridation opponents like to say that only a handful of countries fluoridate their water, most notably the US and countries of the former British Empire. This is not accurate.
- Fluoridated countries: USA, Argentina, Australia, Brazil, Canada, Chile, Colombia, Hong Kong, Ireland, Israel, Korea, Malaysia, New Zealand, the Philippines, Singapore, Spain, UK, and Vietnam.
- Countries where natural fluoridation provides adequate benefit: Argentina, France, Gabon, Libya, Mexico, Senegal, Sri Lanka, Tanzania, USA, and Zimbabwe.
- Countries/areas with fluoride levels above therapeutic levels: Africa, China, India.
Much controversy has been made of the fact that most western European countries do not fluoridate their water, and their rate of tooth decay is similar to the USA. What they don’t say: Many of these countries (plus Japan) once had fluoridated water, but discontinued fluoridation at some point. Discontinuation was almost always accompanied by intervening strategies: widespread use of sealants and topical fluoride treatments that kept decay rates similar to the U.S. It is important to point out that nearly all these countries had some sort of nationalized medical care which gave their citizens easy access to these interventionist strategies once water fluoridation was stopped. Notably, Germany and France both replaced water fluoridation with fluoridated salt. Many other European countries also fluoridate salt. So the arguments about Western Europe really don’t hold much water (pun intended)
FREQUENTLY ASKED QUESTIONS
Are there side effects to fluoride?
Excess amounts of fluoride can be harmful to teeth and bones. Many people of the early American West had brown-stained teeth because they were consuming spring and mineral water with extremely high amounts of fluoride. It is also thought that infants should not consume fluoride in amounts greater than that found in breast milk. For this reason, the American Dental Association recommends that infant formula be prepared with unfluoridated water.
What if I’m pregnant or have an infant?
The American Dental Association makes these recommendations regarding infants and fluoride:
- Breast milk is the most complete form of nutrition for infants. The American Academy of Pediatrics recommends human milk for all infants (except for the few for whom breastfeeding is determined to be harmful).
- For infants who get most of their nutrition from formula during their first 12 months, ready-to-feed formula is preferred over formula mixed with water containing fluoride to help ensure that infants do not get more fluoride than they need.
- Powdered or liquid concentrate infant formula can be mixed with water that is fluoride free or contains low levels of fluoride. These types of water are labeled as purified, demineralized, deionized, distilled or reverse osmosis filtered water. Many stores sell these types of drinking water for approximately $1.00 per gallon.
- Occasional use of fluoridated water should not greatly increase the chance of over-exposure to fluoride for the infant.
- After their first birthday, children can drink fluoridated water because they’ve grown and they weigh more.
- Children under the age of two should not use fluoride toothpaste.
Breast milk is very low in fluoride. Nursing mothers or pregnant women who drink fluoridated water do not pass on significant amounts of fluoride to their child. Avoiding fluoridated water during pregnancy is not necessary. Use of fluoride supplements by the expectant or nursing mother does not benefit the baby. Parents should consult with their dentist or physician if questions or concerns about fluoride exist.
Should I be concerned about Fluoride?
If you have concerns about fluoride, you should discuss this topic with your dentist and doctor. If you wish to eliminate fluoride from your drinking water, home treatment devices are available – primarily reverse osmosis systems. Before buying, make sure the system you are purchasing can remove fluoride.
Want more info on Fluoride, check out our blog series.
*Updated January 7, 2011, due to new fluoride concentration recommendation.
How does water get from the river to your faucet? Follow the journey as Des Moines Water Works explains in this treatment process video on YouTube!
Effective Monday, January 10, Des Moines Water Works (DMWW) will adjust levels of fluoride such that the final concentration is 0.7 parts per million (ppm) in finished water at both Fleur Drive and L.D. McMullen Treatment Plants. Natural levels of fluoride in DMWW’s source water range from 0.2 to 0.5 ppm.
This adjustment is in accordance to recent recommendations by the U.S. Department of Health & Human Services (HHS), Environmental Protection Agency (EPA), American Dental Association, American Water Works Association and Iowa Department of Public Health.
According to HHS and EPA, the adjustment will maximize the health benefits of water fluoridation, an important tool in the prevention of tooth decay while reducing the possibility of children receiving too much fluoride.
Legality of Fluoridation
Fluoridation of municipal drinking water has aroused some controversy from its beginnings in 1945. Determined people have questioned its effectiveness, safety, and legality. Most scientists, dentists, and physicians are satisfied that the effectiveness and safety questions have been resolved. Some people, however, still object to fluoridation from the perspective that it denies them a legally protected choice.
There is a Constitutional basis for fluoridation. The preamble states the purpose of government is “to promote the general welfare.” The 10th Amendment gives to the states all powers not specifically delegated to the federal government, and this includes control of public health legislation. The development of public health law illustrates the conflict between individual rights and the greater good. Historically, the courts have sided with the greater good on issues of public health, two examples being vaccinations and quarantines. The same legal basis supports our regulations on toxic air emissions, timber harvesting, and wastewater discharges.
The courts have rejected opposition arguments based on the pursuit of happiness and personal liberty, the right to privacy, and forced medication (violation of the principle of informed consent). In Rogowski v. City of Detroit, the court held that it was “common knowledge” that fluoridation is beneficial, and “the fact that a belief is not universal is not controlling, for there is scarcely any belief that is accepted by everyone.” An Oklahoma court found that fluoridation is “no more practicing medicine or dentistry than a mother would be who furnishes her children a well-balanced diet.” The courts have recognized the similarity of water fluoridation and disinfection with chlorine, a practice which has been upheld in the courts many times. The U.S. Supreme Court has never chosen to hear an appeal regarding the legality of fluoridation, with six cases dismissed because they did not warrant the court’s attention, and seven cases dismissed for lack of a substantial “federal question.”
Science works best within its structure of hypothesis, experiment, theory, interpretation and publication. Its likely fluoridation has been more rigorously evaluated by this process than any other public health measure, and this has been recognized by our courts and elected bodies.
DMWW continues to stay current with all the latest research and regulations regarding fluoride. This is the final article in a series of five. Links to previous articles are below. Thanks for reading!
Safety of Fluoridation
Fluoridation of municipal drinking water has aroused some controversy from its beginnings in 1945. There is no doubt high concentrations of fluoride are toxic to the human body. But it’s important to remember that the toxicity of any material depends on the dose amount and the exposure duration. In the case of municipal water fluoridation, the overwhelming weight of evidence shows the dose (~1 part per million) to be safe.
It is interesting that the fluoride controversy through the decades reflects the medical concerns of the day. Early on, concerns focused on a possible fluoride connection with Down’s syndrome. Present day concerns focus more on allergies and cancer.
When the entire body of information is examined, there is simply no statistical evidence that fluoridation has caused any significant decline in societal health. On the contrary, the period in which fluoride exposure has been increasing has been a period of steady health improvement in the U.S. Age-adjusted mortality rates for almost all diseases, including heart disease and most cancers, have been decreasing. The notable exceptions are lung cancer and melanoma, which are lifestyle diseases.
Well-constructed experiments have generated data that imply research should continue on fluoride’s possible side effects. DMWW and the water industry will continue to examine and react to this research. But at the current time, the weight of evidence overwhelmingly supports continued fluoridation of municipal drinking water. There really is no controversy right now among the medical and water industry establishments.
We do know that good dental health is important to our overall physical well being. Good teeth enable us to eat a healthy diet throughout our life and into old age, helping lengthen our lifespan. Fluoridation of municipal drinking water is endorsed by:
- American Dental Association
- American Medical Association
- American Heart Association
- American Cancer Society
- American Water Works Association
- Centers for Disease Control
Every U.S. Surgeon General and every sitting President since Kennedy have publicly endorsed fluoridation. As the Centers for Disease Control has recognized, municipal drinking water fluoridation is one of the great public health achievements of the 20th century.
Fluoridation During Municipal Water Treatment
Municipal water treatment is very similar to a manufacturing process where the composition of the final product must meet certain specifications, many of these prescribed by regulation. There are several steps in the DMWW process: coagulation and sedimentation to remove dirt in the river water, hardness reduction, filtration, nitrate removal, disinfection, and fluoridation.
DMWW source water (Raccoon and Des Moines Rivers, and shallow groundwater under river influence) contains some fluoride, usually between 0.1 and 0.5 part per million (ppm). This is increased to about 1 ppm by addition of fluorosilicic acid. There are other ways to add fluoride, most notably with sodium fluoride. Fluorosilicic acid can be added in the liquid form, which is mechanically simpler than adding solid sodium fluoride. Fluorosilicic acid is the most economical vehicle for fluoride addition.
Fluorosilicic acid is a co-product formed during the production of fertilizer. Phosphate rock used to produce fertilizer contains significant amounts of fluoride. This is recovered as fluorosilicic acid and used in water treatment, brewing, and other applications. Like all chemicals used for municipal water treatment, fluorosilicic acid must meet stringent requirements for composition and impurities.
The addition of fluorosilicic acid to the water is monitored every minute of every day by DMWW staff, so that the proper amount of fluoride is always maintained in the drinking water delivered to your home.
How Fluoride Works
Archeologists know that tooth decay was rare in human beings until the Renaissance, when refined sugar became available to wealthy people. The problem became epidemic during the industrial revolution as sugar consumption increased among the entire population of industrialized societies. Queen Elizabeth I was known to have a fondness for sugar, and suffered greatly from tooth decay.
Until 1757, medical practitioners believed cavities were caused by worms. In 1556 Pope John XXI recommended inhalation of smoke from burning henbane seeds to kill the worms and assuage the pain. When dentistry became a recognized profession, researchers zeroed in on two potential causes for tooth decay: 1) bacteria, and 2) diet. It turns out both causes are correct.
The bacterium Streptococcus mutans colonizes tooth surfaces, forming plaque. They metabolize and ferment sugar, releasing acid in the process. The acid dissolves the mineral apatite which comprises tooth enamel, forming a cavity.
Fluoride forms a complex with the apatite mineral of the tooth enamel. The fluoro-apatite complex is much more acid-resistant than normal apatite, and forms a protective veneer on the teeth. Fluoro-apatite forms much more quickly than the body can naturally re-mineralize the teeth.
The original fluoride researchers felt the protective mechanism was entirely systemic (within the body). This has proved to be wrong. The primary protection mechanism is now known to be topical (on the surface of the tooth), but evidence for systemic protection continues to be revealed by research. An October 2010 article appearing in the American Journal of Public Health reports a strong relationship between fluoride levels in a resident’s county at the time of their birth, with tooth loss as an adult. It seems that fluoride exposure at birth affects tooth loss at age 40 and older, which is evidence for a systemic mechanism.
Fluoridation of municipal drinking water at safe levels (~1 part per million) provides dental protection through both topical and systemic mechanisms. This has helped reduce rates of tooth decay in the U.S. to the frequency archeologists observe in skeletons from 1000 years ago.
The history of fluoridated water is like many of the great scientific findings throughout the ages. It started with an observation.
Archeologists have long known that tooth decay is a modern problem that was rare until the Renaissance, when refined sugar became available to wealthy people. The problem reached epidemic proportions during the industrial revolution, when income levels grew to the point that sugar could be purchased by nearly everyone in an industrialized society.
During the 1870s, scientists and physicians began to notice that people living in some areas of the world seemed immune to tooth decay. Many of these same people also had brown-stained teeth. One of the first cities where this was observed was Naples, Italy. Medical examiners on Ellis Island also noticed many Italian immigrants with this same phenomenon. Similar observations were made in the American West, especially amongst miners in the gold fields of Colorado. It was eventually determined after many years of study that the water these people were drinking contained very high levels of naturally-occurring fluoride, which found its way into groundwater wells via the mineral deposits of the local area.
Researchers determined that these people were getting too much fluoride, and this caused the brown staining which is now known as dental fluorosis. The water they were drinking contained as much as 30 parts per million (ppm) of the element. Studies eventually determined that the optimum drinking water concentration which delivered protection from cavities but did not produce fluorosis was about 1 ppm.
Water intentionally fluoridated at the 1 ppm (parts per million) level was first produced in four cities in 1945: Grand Rapids, MI; Newburgh, NY; Evanston, IL; and Brantford, Ontario. These trials were overseen by an eminent scientist of time, H. Trendley Dean. The results were profound: a 40% reduction in cavities in four years, and up to 57% within 15 years.
It was near the end of this 15-year study, in 1959, that Des Moines Water Works (DMWW) began fluoridating water delivered to Des Moines and surrounding areas. Natural levels of fluoride are supplemented during treatment so that water leaves the treatment plants with the optimum level of 1 ppm.
This article is the first in a series of five articles addressing the subject of fluoride in City water. Please leave a comment, and come back to read the next articles in the series. Thanks for reading!