NYC Gazette

In 1999, the Centers for Disease Control and Prevention recognized fluoridated drinking water as one of the significant public health achievements of the 20th century. However, recent research and a new administration in Washington, D.C., have prompted a reevaluation of fluoride's role in water systems. Despite calls to remove it from drinking water, many dentists continue to support its use due to its benefits for dental health.

Richard Valachovic, clinical professor and executive director at NYU College of Dentistry's Center for Oral Health Policy and Management, stated: “Fluoride is a naturally occurring mineral that plays a critical role in promoting dental health and preventing tooth decay.” He emphasized its importance in strengthening tooth enamel and preventing cavities.

The introduction of fluoride into drinking water began in Grand Rapids, Michigan, in 1945. Research by the National Institutes of Health showed a more than 60 percent reduction in dental cavities among children born after fluoride was added to community water sources. This led other communities to adopt similar practices.

Decades of research indicate that water fluoridation effectively prevents tooth decay across populations. The CDC reported that between 1945 and 1999, community water fluoridation reduced cavities in children by 40 to 70 percent and tooth loss in adults by 40 to 60 percent. Additionally, the cost-effectiveness of fluoridation is notable; every dollar spent saves about $20 to $50 in dental treatment costs.

However, with advancements such as fluoridated toothpaste becoming widespread since the mid-1970s, studies suggest fluoride is not as crucial as it once was. A Cochrane report found fewer decayed teeth on average in areas with fluoridated water but noted reduced impact post-introduction of fluoridated toothpaste.

Recent analysis published in JAMA Pediatrics linked high levels of fluoride exposure overseas with lower IQs in children. Yet studies from the US and Australia show no association between US-level fluoride exposure and lower IQs.

Valachovic concludes that current US fluoride levels are safe but acknowledges diminished impact on cavity incidence compared to earlier years: “While it’s not as effective, it’s still effective.” Ongoing evaluation of emerging research is necessary to refine safety guidelines.

Removing fluoride has shown adverse effects on oral health. In Juneau, Alaska discontinuing fluoride resulted in increased cavity-related procedures among youth. Similarly, Calgary experienced more tooth decay post-fluoride removal compared to Edmonton which maintained it.

Lower-income communities are particularly affected when fluoride is removed due to barriers like lack of Medicaid-accepting dentists or transportation issues leading to over two million annual emergency room visits related to dental problems nationwide. As Benjamin Franklin said: “An ounce of prevention is worth a pound of cure.”

Until universal access to preventive dental care becomes available across the US removing fluoride could exacerbate existing health disparities making it an essential equitable public health measure currently available.