Is all fluoride bad? No. Direct application of fluoride to the teeth puts the fluoride where it is most needed and in the concentration most compatible. Dr. Paul Keyes, retired director of the Dental Division of the National Institutes of Health, has published findings which show that fluoride applied directly to the teeth can have a profound effect in decreasing decay, especially when combined with the elimination of refined syrups, sugars and white flour ingestion. I applaud the direct application of fluoride to the teeth and suggest it freely when the clinical situation warrants.

But, fluoride in the public water system is a bad choice that used to be believed to be a good choice. When I last wrote to the BDN about fluoride in the public water system (in the late 1960s), I supported the concept. I can no longer do so.

The original (and, I think, only) large scale population study of systemic fluoride administration in the water was the Kingston/Newburgh study in the 1940s. That study was terminated well before final results were tabulated; speculation has it that the control city experienced a decrease in decay that was about equal to that in the city that had the fluoride added. Additionally, a number of noted researchers are of the opinion that the study had significant design faults and would not be accepted for publication today in any peer-reviewed journal.

When we combine the above information with the knowledge that fluoride can be toxic at fairly low levels, that it may be implicated in increased hip fracture incidence in the elderly who live in fluoridated areas, and that there may be a connection with systemic fluoride ingestion and increased lead levels in children, I cannot recommend that we continue to have fluoride added to our water system.

Robert E. Clukey, Jr., D.M.D.

Holden