State Health Lawmakers' Digest: Community Water Fluoridation (Vol. 3, No. 2), Who Knows (unedited)

Who Knows

Lewis Lampiris, D.D.S.
Rep. Glenn Donnelson (UT)

An interview with Lewis Lampiris, D.D.S., Chair of the Fluoride Committee of the Association of State and Territorial Dental Directors.

How do you view your position on water fluoridation-philosophical, public health, environmental?

In the field of public health our goal standard is primary prevention, which really means preventing disease before it happens. ...and that's what I think community water fluoridation does from a public health perspective. It prevents disease before it happens. You don't get any better than that.

As a public health professional and as a dentist, particulary the dentist part, I strongly feel that preventing dental decay serves the common good and that's what community water fluoridation does-serve the common good, and it's environmentally safe. So I guess from all three perspectives, particularly from my perspective as a public health practitioner I really feel that it's the way to go.

Is this an issue best dealt with by the state or by individual communities? Why?

Well, the usual answer to something like that is that it depends. ...But I have an opinion, it can be handed at either the state or the community level. In Illinois, we chose to, the state chose to, back in 1967 actually, to handle the question of reducing dental decay at the state level with a mandatory law. And I kind of think that's the best way to go for this, to handle this issue. A state, the state tends to be more immune to many of the emotional charges that are brought to the table by the anti-fluoridationists. They have a greater capacity to garner the expert opinions necessary so that they can develop policies that protect the health and the safety of residents. ...and I do believe that's part of the state's mandate, also, to protect the health and safety of its residents. So I do feel it should be done at the state level.

Opponents claim water fluoridation damages health and abrogates an individual's right to free choice. What are key counterpoints for a state legislator to consider?

Well first of all it doesn't damage health, community water fluoridation does not damage health, it improves health, key point. It improves dental health. A lot of our legislators are continuing to struggle with that issue of access to oral health services. And they must consider in their deliberations that community water fluoridation benefits everyone in the community, not only those who have access but those who don't have access to benefits-low-income kids, those living in nursing homes, it benefits seniors, it benefits those with special health care needs.

Another counterpoint for a legislator would be the fact that reputable public health entities in the US-the CDC, the Public Health Service, the Surgeon General-all support community water fluoridation.

As far as that other issue of abrogating one's right, I think in our society the need for protecting health, protecting one's health or protecting health is considered the responsibility both the individual and the state. The state, for example, requires their drinking water be chlorinated to protect overall health, rather than have individuals choose to add cholrine to their water or to boil it. I don't think it's any different with fluoridation. As long as you believe that oral health is part of overall health and is equally deserving of protection.

On that note about chlorine, some opponents say that chlorine-because it is something to purify water and make it potable-falls under EPA jurisdiction, and that fluoride-because it effects a health concern-is something that requires FDA approval prior to EPA approval prior to public water usage. Do you know anything about that?

A little, tiny bit. I know that some of the states have been dealing with this fluoride product quality control act, or something. I can't remember the name of it. The FDA does not approve chemicals that are used in water plants. It doesn't approve chemicals. They regulate pharmaceuticals-fluoride, for example, that's used in toothpastes. Pharmaceutical grade chemicals, fluoride, for example, are not appropriate for water fluoridation. The industrial grade fluoride chemicals that are used in water plants are just that, they are industrial grade. The American Waterworks Association, for example, sets those standards for the chemicals that are used in water treatment facilities. The FDA doesn't really have a role here, because they are in charge of pharmaceuticals.

Are there safety differences between different compounds (i.e. fluorisilic acid vs. sodium fluoride, etc.)?

No, there's no, absolutely no differences despite what you might read on the internet between the different fluoride compounds-the acid versus the sodium fluoride or the silicofluorides versus the sodium fluorides. Absolutely no differences.

Overall, what key policy recommendations would you make to state legislators on this issue?

I think that I would recommend to a state legislator that they work with their medical community, their pediatric physicians, their dental community, their public health community, to make community water fluoridation available to all of the people in their state. That's the key policy recommendation.

We know that it's been identified as one of the top ten public health achievements of the 20^th century. It's certainly not surprising that differences of opinion between scientists and professionals in research and medicine may occur. But, you know, what you've got here is pretty much universal agreement on its safety and the effectiveness of community water fluoridation.

So that's my recommendation, that they make it available to everyone in their state.

It's certainly the one thing the state can do to assure the dental health of its children.

An interview with Representative Glenn Donnelson of Utah.

How do you view your position on water fluoridation-philosophical, public health, environmental?

All three areas are of great concern. However, my position places public health as a top priority.

Philosophically: As a matter of principle it is improper to use a basic commodity such as drinking water as a vehicle for medication. This is a frightening and dangerous precedent to set and an inappropriate use of the public water supply.

Environmentally: 99.94% of fluoride in water systems ends up in the environment. It is non-biodegradable and a cumulative poison. Fluoride affects the reproductive cycles in fish and animals, and over time, the cumulative effects sterilize the ecosystem. Environmental impact studies should be conducted before any consideration to fluoridate water in any community.

Public Health: Most people do not realize that the fluoride chemicals placed in water are not the same fluoride chemicals placed in toothpastes, mouth rinses, and topical gels. More than 90% of the chemicals used to fluoridate water in the US are not pharmaceutical grade. Instead, they come from the wet scrubbing systems of the superphosphate fertilizer industry. These chemicals, known as silicofluorides, are sodium fluorosilicate and fluorosilic acid and are classified by the EPA as hazardous wastes. But when they are sold for as little as a penny, they are classified as a product. Silicofluorides are contaminated with toxic metals and trace amounts of radioactive isotopes such as lead, mercury, arsenic, uranium, radium, and cadmium. In fact, recent testing by the National Sanitation Foundation suggest that the levels of arsenic in these chemicals are high and of significant concern.

A major concern is that the Food and Drug Administration has never approved fluoride for safety or effectiveness. Chemicals added to water make it safe or potable are within the jurisdiction of the Environmental Protection Agency. When a product, substance or chemical is added to the public water supply for the purposes of treating or preventing a disease, that chemical must have an approved health claim by the U.S. Food and Drug Administration. To say that "fluoridated water will decrease tooth decay" is an illegal health claim.

Recent research shows overwhelming evidence of increased health problems and lack of efficacy associated with fluoridation. The York Review showed that 48% of people in fluoridated areas suffer from dental fluorosis (stained and mottled teeth due to a fluoride overdose). 12.5% have moderate to severe dental fluorosis that will require extensive cosmetic dentistry. One study in particular analyzed over 280,000 children, (Roger D. Masters, Professor of Government Emeritus at Dartmouth College, and Myron J. Coplan, Emeritus Professor of Government at Dartmouth College) and reported that levels of lead in children's blood were significantly higher in Massachusetts communities using the silicofluorides (fluorosilic acid and sodium silicofluoride) than in towns where water is treated with sodium fluoride or not fluoridated at all. It was this study that raised a red flag to the Environmental Protection Agency. This past April, the EPA announced a Request for Assistance (RFA) asking for research entities to investigate the reactions that take place among the chemicals added to drinking water to make it safe to drink and the fluorosilicates added to the water in fluoridated communities.

Additional public health concerns include:

In the case of fluoridation, individuals have the de facto right to force their neighbor to take a particular medication, regardless of whether or not that neighbor wishes to take it. "The voluntary consent of the human subject" which the writers of the Nuremberg Code saw as "absolutely essential" to protect citizens against medical abuse, is unfortunately not seen as essential in the case of fluoridation.
According to the U.S. Department of Health and Human Services Agency for Toxic Substances and Disease Registry (ATSDR, 1993), some people are particularly vulnerable to fluoride's toxic effects. These include: the elderly, diabetics and people with poor kidney function or heart disease. Again, can we in good conscience force these people to ingest fluoride on a daily basis?
According to the ATSDR report, also vulnerable are those who suffer from malnutrition (e.g., calcium, magnesium, vitamin C, vitamin D and iodide deficiencies and protein-poor diets). Those most likely to suffer from poor nutrition are the poor, who are precisely the people being targeted by new fluoridation proposals.
Although the Centers for Disease Control continues to endorse fluoridation, it acknowledged in 1999 that the mechanism of fluoride's benefits is mainly topical not systemic.
There is no way to control the dose of fluoride consumed because of the "one-size-fits-all" approach without regard to the quantities of water consumed over a lifetime, age and weight of individuals, or preexisting medical conditions.

Last session, you introduced a bill (HB 158) that tied water fluoridation to FDA approval of use fluoride compounds in drinking water. What is your response to those who would cite the EPA as the appropriate agency to approve water fluoridation, rather than the FDA?

The EPA is responsible for treating water with chemicals to make it potable (safe to drink). When any chemical is added to the water to treat the people by virtue of a health claim, those chemicals are classified as an unapproved drug and are within the exclusive jurisdiction of the U.S. Food and Drug Administration. The EPA has absolutely no jurisdiction in treating people. For example: Chlorine treats water; Fluoride treats people.

When the town of Wasilla, Alaska chose to halt fluoridation of its water supply, they were told that they could not give away their remaining fluoride to a neighboring town, as it would be considered hazardous waste under EPA rules. Under the same rules, however, they would be allowed to sell their remaining fluoride as a product. My question would be why? It does not make sense!

Is this an issue best dealt with by the state or by individual communities? Why?

Fluoridation issues will always concern the health, safety and welfare of the public. This is best dealt with by individual communities. However, the state must require that any substance added to water supplies for treating people, rather than treating water, must have an approved health claim for that substance by the FDA. Nationally, a moratorium on fluoridation should take place until fluoride chemicals are approved by the FDA as safe and effective for the purpose for which they are being added to the water.

Advocates claim that water fluoridation has a low cost to the public with long-term oral health benefit. What are key counterpoints for a state legislator to consider?

In Utah, the advocates' claim of low cost has proven to be incorrect. Prior to voting on the fluoridation issue in November 2000, advocates claimed that fluoridation would cost less than 50 cents per family per year. As of October 2002, the cost, in Centerville alone will be $7.89 per person, per year. Costs in Davis County, Utah have yet to be finalized. Weber Basin Water estimates that its cost to implement fluoridation will be close to 1.5 million dollars with less than 1 percent of the 8 billion gallons that flow from Weber Basin into Davis County being ingested.

There are no long-term oral health benefits with fluoridation. States are reporting a "Dental Crisis" within their major cities.

Boston - fluoridated since 1978: The Boston Globe (November 11, 1999). "City to launch battle against dental 'crisis'"
Cincinnati - fluoridated since 1979: The Cincinnati Enquirer (October 6, 2002) "Special Report: Cincinnati's Dental Crisis, Shortage, Cost Can Be Torture for Poor"
Williamsburg, Kentucky. (Kentucky is 100% fluoridated): Associated Press (November 26, 2001). "Dental Clinic Helps Rural Children"
March 2002, Oral Health America report: The two least fluoridated states in the US (Utah & Hawaii) were awarded the highest grade for oral health in the nation.
August 1, 2002: A ban on the sale of over-the-counter fluoride supplements (fluoride tablets, fluoride drops, and fluoride chewing gum) was passed by Belgian health minister.
Despite dental pressure, 99% of western continental Europe has rejected, banned, or stopped fluoridation due to environmental, health, legal, or ethical concerns. The World Health Organization (WHO) may endorse fluoridation, but many of its countries DO NOT practice fluoridation because of health concerns.

There are no long-term oral health benefits with fluoridation.

Overall, what key policy recommendations would you make to other state legislators on this issue?

My recommendation would be that no chemicals, fluorides or otherwise, be added to the public water supply for the intended purpose of preventing a disease unless the health claim made for that chemical has been first approved as both safe and effective by the U.S. Food and Drug Administration-the only agency that can approve health claims.

Also, it is my recommendation that other state legislators look at the full range of considerations-health cost, moral and ethical issues involved in forced medication, efficacy, and safety of the product. Insist on public debate on these considerations which proponents consistently refuse to do. The more people learn about fluoridation, the more they will realize that the only thing that supports fluoridation is the endorsements.

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