Granite Geek: I have long dismissed opponents of public water fluoridation but maybe I went too far

By DAVID BROOKS

Monitor staff

Published: 10-07-2024 4:07 PM

A couple of recent events have created a really horrifying thought for me: “Oh my gosh, what if the cranks were right and I was wrong?!?”

In this case the cranks – my term, not theirs – are the people who say fluoride shouldn’t be added to public drinking supplies because of dangers being ignored by The Powers That Be. 

Fluoride is added to municipal water in Concord, Manchester and a number of other places in New Hampshire, usually at the rate of 7 parts per million, because it’s a proven way to reduce tooth decay in the population, especially among children. Tooth decay is much more of a public health problem than you might think; it can cause a variety of medical issues.

Part of the reason I’m a big supporter of fluoridation is that dentists are fans, too, even though it undercuts their business model by reducing cavities. It’s pretty convincing when the people who know the most about a topic support an action that goes against their financial interests.

“We have dentists that can tell where a patient is from just by looking at their mouth,” said Mark Hartzler,  a dentist in Gorham who is president of the New Hampshire Dental Society, referencing the fact that many communities don’t have fluoridation, including towns with no public water system. “You know that one has been fluoridated, that one hasn’t.”

Despite this, a lot of people are against public fluoridation. The Legislature has considered a half-dozen bills in recent years to scale back or derail it. None have passed but the opponents keep trying. I have often bumped heads with those folks, including the only time in a decade of hosting Science Cafe that I had to tell people in the audience to shut up.

I have been so adamant partly because anti-fluoride arguments reek of the flawed thinking I hear from anti-vaccine cranks and their COVID-conspiracy brethren. Start with “the government can’t tell me what to do,” add in cherry-picked data pushed by attention-seeking blowhards, top off with suspicion about “chemicals” and voila! you’ve got endless attempts to block something that is a benefit to humanity.

But a couple of events in recent weeks have raised questions about my self-righteous certainty.

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The first was a Sept. 24 ruling from the U.S. District Court Judge Edward Chen in California that the EPA needs to examine whether fluoride should be regulated under the Toxic Substances Control Act because “a preponderance of the evidence” indicates that fluoridation at 0.7 ppm presents an “unreasonable risk of injury” to the still-developing brains of children because of outside sources of fluoride. That ruling came in a lawsuit filed by Food & Water Watch, which has been fighting fluoridation for at least a decade.

The second event was research from the Cochrane Library, which is respected for comprehensive reviews of clinical trial data related to public health topics. They examined 22 studies on community water fluoridation programs, differentiating between studies conducted before and after 1975, when fluoride began to be widely added to toothpaste. 

Overall, they found that today’s programs may still lead to slightly less tooth decay in children’s baby teeth, and slightly more children free of tooth decay altogether – both very good things – but that the benefits of water fluoridation are probably smaller than they were prior to 1975. 

One of the main arguments of anti-fluoridation people is that in today’s America we get fluoride from other sources, such as toothpaste or natural water supplies, which increases the chance that unavoidable fluoridation might push people over the limit and cause tooth discoloration, weakening of bones or neurologic problems. The Cochrane Library study did not address this argument but gave it some indirect support by indicating that the risk/benefit ratio has changed, which supports the idea of taking a second look at an established process.

Dr. Hartzler says the state dentists are sticking with fluoride because they’ve seen the benefits.

The lawsuit “doesn’t raise any doubts because the communities that the study was looking at were using naturally occurring fluoride, (levels) so beyond what the recommendations are here that it doesn’t seem applicable,” he said. “Any medication used in high quantities can have negative effects” but that doesn’t mean the therapeutic advantages must be discarded. 

“There’s no evidence that that number is unsafe … no reason in our mind to change what we’re doing,” he said.

“We’ll continue to follow the science,” said Michael Auerbach, executive director of the state dental society. 

As for me, I’m still a fluoridation fan but with less certainty than before. 

I’m also embarrassed that my past certainty turned into a snooty, holier-than-thou attitude. This attitude isn’t just annoying but can cut off debate: If you’re a “crank” then I don’t need to listen to you.

That position is understandable when dealing with extremes like people who talk about chemtrails in the sky or think that medical masks don’t reduce disease transmission and must be banned. The craziness brought out by COVID, fueled by Trump’s erratic and irrational statements, makes it hard not to dismiss any opposition to established medical practices. Otherwise you’ll spend your life trying to stop out BS, which takes 10 times as much effort as generating nonsense in the first place.

But I’ve come to realize that fluoridation is a case where my devotion to rational argument spilled over into smugness. 

In other words, maybe I was the crank.  Boy, that’s a  disturbing thought.