GIVING FLUORIDATION TEETH

The public doesn’t make decisions about what drugs best manage diabetes or what treatments are most effective for lowering cholesterol. Yet, Maine law allows local voters to decide whether fluoride should be added to their water. This leads to situations like the recent vote in which Mount Desert residents agreed to eliminate fluoride, based largely on warnings from one person. If the state administered the program, with a provision to allow communities to opt out only after scientific information had been presented to voters, the debate and the outcome would likely be more reasoned.

Fluoride, a naturally occurring mineral that strengthens tooth enamel and helps reduce decay, has been added to many public water supplies for 60 years. Early critics claimed fluoridation was a Communist plot. Criticism now is that the practice is unsafe, leading to more health problems than it solves.

Cost is also raised as a concern, although fluoridation annually costs between 50 cents per person in large cities and $3 per person in rural areas.

Opponents cite studies that show too much fluoride leads to more bone fractures and increased cases of autism. They frequently point to a 2006 report by the National Research Council, a branch of the National Academies of Science. The report was very careful to differentiate between fluoridation, which is restricted to between 0.7 and 1.2 mg of fluoride per liter of water, and fluoride contamination, which the Environmental Protection Agency limits to 4 mg per liter. More than 170 million people, about two-thirds of the country’s population, had artificially fluoridated water but only 200,000 people nationwide had drinking water with fluoride concentrations higher than 4 mg per liter.

Even at the extremely high concentrations, the council found that further study was needed to determine whether the fluoride was causing bone fractures or endocrine, developmental and reproductive problems.

The Centers for Disease Control called community water fluoridation one of the 10 greatest public health achievements of the 20th century. Fluoridation reduces tooth decay by 20 to 40 percent and even more among children, with the benefits reaching all socioeconomic sectors.

Antigo, Wis., stopped fluoridation in 1960. Five years later, second-graders had a 200 percent increase in tooth decay and fourth-graders had 70 percent more. Residents voted to restart fluoridation in 1965.

Rather than revisit this experience four decades later, Maine communities should have a more sophisticated debate. Having the state require and pay for fluoridation is one solution. Communities could opt out after holding a meeting where public health officials were invited to provide information on the benefits of fluoridation.

This is more reasonable than votes based on confusion or misplaced concern.