Position Papers


Children's Dental Health Month: A Time to Think About Fluoridation

As National Children's Dental Health Month enters its final week, we should think about the thousands of children in our state without access to dental care, and what measures we can take to improve the poor oral health of New Hampshire's children. It's a good time to think about the public health benefits of fluoridated water.

Fifty years ago, it was discovered that people who lived in communities with naturally fluoridated drinking water had far less tooth decay than people in similar communities without fluoridated water. Since that time, thousands of communities in the United States and worldwide have fluoridated their water or adjusted the natural level of fluoride to a sufficient level to prevent tooth decay. Today, half of all children ages 5 - 17 in the United States have never had a cavity in their permanent teeth. According to the Journal of Dental Research (April, 2000), the use of fluoride over the past four decades has been the primary factor in saving $40 billion in oral health care costs in the United States. It is estimated that the lifetime cost to fluoridate a water system is less than the cost of one dental filling.

Last year, US Surgeon General David Satcher said that community fluoridation is "one of the great achievements of public health in the twentieth century." According to former Surgeon General C. Everett Koop, "Fluoridation is the single most important commitment that a community can make to the oral health of its citizens." And American Dental Association President Richard F. Mascola says that "fluoride's benefits are particularly important for those Americans, especially children, who lack adequate access to dental care."

In New Hampshire, thousands of children have access to neither adequate dental care nor fluoridated water. As a result, thousands of New Hampshire children are seen in hospital emergency rooms with painful and severe oral health problems. School nurses all over the state report that children routinely come to their offices with severe toothaches, and that many of these children rarely see a dentist. In addition to causing pain and discomfort, poor oral health has a negative impact on children's overall health and well-being in a number of ways. The poor self-image and self-esteem caused by dental problems can result in anxiety and depression. Dental problems affect children's ability to communicate verbally and nonverbally with peers and teachers, negatively impacting school performance and attendance. In addition, poor nutrition due to restricted diet can compromise children's healthy growth and development. Over time, poor oral health can lead to limitations in educational and career opportunities, and affect a wide range of social relationships. Recent research has demonstrated an association between poor oral health and diabetes, heart disease, stroke, and complications in pregnancy.

Lack of access to dental care and poor oral health in our state has many causes, including uninsurance, underinsurance, Medicaid reimbursement patterns, and a shortage of dentists in several areas. These are complex issues with no clear, agreed-upon solution. But the oral health benefits of fluoridation, and its safety, have been proven repeatedly by over fifty years of rigorous scientific research and dramatic declines in tooth decay in fluoridated communities.

Many fluoride opponents are swayed by pseudo-scientific research that tries to link fluoridated water supplies to cancer, immune system dysfunction, AIDS, genetic damage, Down's Syndrome, Alzheimer's, heart disease, and kidney dysfunction. Fifty years of medical, dental and public health evidence has been reviewed and evaluated numerous times by academicians, committees of experts, government bodies, and major national and international health organizations. The verdict of the scientific community is that fluoridation at the recommended levels provides major oral health benefits. Thorough medical investigation of side effects caused by optimal concentrations throughout life have shown no harm to general health.

Many fluoride opponents embrace and perpetuate Cold War-era conspiracy theories that understand fluoridation as "mass medication" that will create a compliant and easily brainwashed population. As with most conspiracy theories, close scrutiny reveals an absence of logic, no plausible motive on the part of the conspirators, and a significant amount of paranoia.

Other opponents of fluoridation invoke the "freedom of choice" argument that is so much a part of the New Hampshire ethos. The freedom of choice of a few outspoken fluoride opponents - who are also free to choose bottled water - is taking precedence over the basic health needs of thousands of our youngest citizens, who have neither a voice nor a choice. Denying cost effective, far-reaching and long-term public health benefits to our most vulnerable population is not only economically foolhardy; it is also morally indefensible. It should be noted, too, that while the benefits of fluoridation are greatest for our poorest and youngest citizens, the entire population benefits, regardless of financial resources. Why aren't more New Hampshire residents benefiting from one of the greatest public health achievements of the twentieth century?

The New Hampshire Child Advocacy Network (NH CAN), a diverse coalition of nearly one hundred individuals and organizations, led by the Children's Alliance of New Hampshire, has included public education about the benefits of fluoridation as an important piece of its Children's Agenda 2001. Residents and health professionals in non-fluoridated communities who are interested in learning more about the fluoridation process can call Nancy Martin at the Office of Community and Public Health at 271-4535. For information about how to organize and mobilize your community in support of fluoridation, call Rich DiPentima, Deputy Public Health Director at the Manchester Health Department at 624-6466. Also, a comprehensive document about all aspects of fluoridation, in a very user-friendly, question and answer format, is available at the American Dental Association web site (www.ada.org).