From those who favor fluoridation of Newport’s drinking water:
Public Health Professionals for the Enforcement of Resolution 1165-A:
Gary Lahman, MPH, Public Health Advisory Council*
William Wiist, DHSc, MPH, Public Health Advisory Council*
Colleen Lennard-Love, MD, Samaritan Health Services*
Bruce Austin, DMD, Oregon Health Authority
Rebecca Austen, MSN, RN, Lincoln County Health and Human Services
Rachel Peterson, MA, Lincoln County Health and Human Services
Since 1962 the best public health science supporting community water fluoridation (CWF) has strengthened, and the number of reputable health organizations and official government agencies supporting community water fluoridation has grown.
Reports prepared by teams of distinguished scientists who are selected on the basis of their expertise to look at all scientific sides of an issue, and who debate the evidence, have been convened on multiple occasions over the past 70 years. Every such panel of experts that has met to review and critique the merits of community water fluoridation has concluded that it is safe and effective. This has resulted in all leading health organizations, including the Centers for Disease Control and Prevention (CDC), National Research Council, the Environmental Protection Agency, American Dental Association, and others supporting CWF.
The Oregon Health Authority (OHA) also recognizes the tremendous value of community water fluoridation. The OHA recently released its State Health Improvement Plan, and one of the seven sections outlines goals to improve the oral health of Oregonians. The only public health measure in this section is the goal to support and increase community water fluoridation. We know of no other public health measure that can eliminate at least 25% of a disease as water fluoridation does.
The OHA’s and CDC’s endorsement of water fluoridation is based on assessment of scientific evidence by many independent committees of experts, review of the findings of individual studies, and the research conducted by many scientists. **It is this large body of evidence, rather than the findings of any single study**, which affirms that CWF prevents tooth decay, is safe, reaches people regardless of race or income, throughout their lifespans, and is very cost-effective. To not take advantage of such an effective public health measure seems to discriminate against those without regular dental care.
Newport could substantially benefit from this public health measure, as the burden of dental disease in our community is significant. The City’s failure to comply with the law has deprived residents of the health benefits of community water fluoridation and has caused many children and adult residents of Newport undue suffering, pain, and financial costs. Examples of the health benefits of community water fluoridation and the costs of not fluoridating include:
- Emergency Department visits for dental infections at Samaritan Pacific Community Hospital among uninsured and Oregon Health Plan (Medicaid) insured patients cost $70,035 in 2014, according to the Benton, Lincoln, Linn Regional Oral Health Coalition Report, Feb. 2015.
- Pediatric dental disease in Lincoln County far surpassed the Healthy People 2020 target or 48.3%, according to the Oregon Smile Survey, 2012 (no city-specific data):
- 51% of children ages 6-9 had cavities
- 73.2% of children in 8th grade had cavities
- 78.2% of children in 11th grade had cavities
- Adult dental disease in low income uninsured or under-insured residents of Lincoln County, per the Assessment of Dental Care Needs in Lincoln County 2012:
- 28% need fillings
- 12% need dental extraction
- 12% need crowns
- 36% had not seen a dentist in 1 year; 21% had not seen a dentist in 5 years
- 1.1. About 863 school days are missed by Newport students each year because of dental problems.
The Centers for Disease Control and Prevention has estimated that for every $1 spent on community water fluoridation in the U.S., an average of $38 per person per year is saved in dental treatment costs. In communities of less than 5,000 residents, the savings is about $16 per person per year, while communities larger than 20,000 residents see a benefit of $19 or more per person per year. This suggests that at minimum the annual cost savings in Newport, based on the 2013 population size of 10,150, is $162,400.
The return on the investment to reinstate water fluoridation, based on the City of Newport’s $300,000 equipment estimate, would be met before the end of the second year after reinstating water fluoridation.
- Please feel free to rebut any information/comments that were shared, in writing or in person, at this public hearing to help the Council better understand your position on this matter._
Several false claims and misrepresentations of scientific data were presented by opponents to community water fluoridation at the Sept. 8 Newport City Council Public Hearing. Several of these are listed below, with corrections based on creditable, evidence-based, scientific peer-reviewed literature.
Claim: Fluoride has harmful health effects.
- The Science: Most of the scientifically valid information regarding the health impacts of fluoride comes from a National Research Council (NRC) report on water with naturally occurring levels of fluoride at rates significantly higher than what is recommended for community water fluoridation. The NRC explicitly states that its report was not an evaluation of water fluoridation: “…it is important to note that the safety and effectiveness of the practice of water fluoridation was outside the scope of this report and is not evaluated.”
Additionally, the Centers for Disease Control and Prevention (CDC) wrote that the NRC’s findings “are consistent with CDC’s assessment that water is safe and healthy at the levels” used for community water fluoridation.
Claim: Fluoride is a by-product of the phosphate fertilizer industry.
- The Science:
- Fluoride is extracted from phosphate rock, and so is phosphoric acid—an ingredient in Coke and Pepsi. Neither one of them comes from fertilizer.
- Fluoride is extracted from the same phosphate rock that is also used to create fertilizers that will enrich soil.
- The quality and safety of fluoride additives are ensured by Standard 60, a program commissioned by the Environmental Protection Agency (EPA). Standard 60 is a set of standards created and monitored by an independent committee of health experts. This committee provides regular reports to the EPA. More than 80 percent of fluoride additives are produced by U.S. companies, but no matter where they come from, Standard 60 uses on-site inspections and even surprise “spot checks” to confirm the additives meet quality and safety standards
- Claim: A Harvard study shows that fluoride lowers IQ scores.
- The “Harvard study” was a review of previous studies on IQ scores for children living in areas of China, Mongolia and Iran where the water supplies have very high levels of natural fluoride. In many cases, these areas had significantly higher levels than those used to fluoridate public water systems in the U.S. — more than 10 times as much as the optimal level used in the U.S.
- The Harvard researchers who reviewed these studies were quoted as saying, “While the studies the Harvard team reviewed did indicate that very high levels of fluoride could be linked to lower IQs among schoolchildren, the data is not particularly applicable here because it came from foreign sources where fluoride levels are multiple times higher than they are in American tap water.”
- The studies that were reviewed were observational in nature, were conducted over several decades, and did not account for confounding factors. Neither these studies nor the Harvard analysis can conclude a cause for the change in IQ scores that was observed.
- Between the 1940s and the 1990s, the average IQ scores of Americans improved 15 points. This gain — about 3 IQ points per decade — came during the very period when fluoridation steadily grew to serve millions and millions of additional Americans.
- British researchers who evaluated similar fluoride-IQ studies found “basic errors” and wrote that different data were combined in a way “that does not give a valid or meaningful result.
- Claim: The U.S. Food and Drug administration requires a warning label on toothpaste, therefore fluoride is a dangerous.
In 1996, the American Dental Association reviewed studies and concluded that “a child could not absorb enough fluoride from toothpaste to cause a serious problem” and added that fluoride toothpaste has an “excellent safety record.” The American Dental Association (ADA) believes the warning label on toothpaste exaggerates the potential for negative health effects from swallowing toothpaste. Every day, millions of Americans use fluoride toothpaste without any negative effect. The warning label simply reflects the fact that:
- The concentration of fluoride in toothpaste is much higher than that of fluoridated water.
- Parents are advised to supervise children’s tooth brushing to prevent swallowing because consumption of more concentrated forms of fluoride when children are young and their teeth are forming can lead to fluorosis.
Additionally, the same FDA warning can be found on toothpastes that do not contain fluoride.
- Claim: “Europe doesn’t engage in fluoridation, so why should we?”
- Salt fluoridation is widely used in Europe, and milk fluoridation is used in several countries. In fact, more than 70 million Europeans consume fluoridated salt or milk. Fluoridated salt reaches most of the population in Germany and Switzerland. These two countries have among the lowest rates of tooth decay in all of Europe.
- Fluoridated water is provided to 13 million Europeans, mostly reaching residents of Great Britain, Ireland, Spain and other countries.
- Italy has not tried to create a national system of water fluoridation, for two reasons. First, the drinking of bottled water is well established in Italian culture. Second, a number of areas in Italy have water supplies with natural fluoride levels that already reach the optimal level to prevent decay.
- Technical challenges are a major reason why fluoridated water isn’t common in Europe. In France and Switzerland, water fluoridation is logistically difficult because there are tens of thousands of separate sources for drinking water. This is why these countries use salt fluoridation, fluoride-rinse programs and other ways to get fluoride to their people.
Claim: Fluoridating water is ‘medicating’ people without their approval.
- Fluoride is a nutrient, not a medicine. Medicine is used to cure or control a medical problem that has already been diagnosed, such as hay fever or high blood pressure. Fluoridated water is not a cure; it’s a proven way to prevent a medical problem: tooth decay.
- Fortifying drinking water with fluoride is a lot like fortifying milk with Vitamin D. These additives prevent poor health. America has a history of fortifying foods or beverages to strengthen health—for example, adding iodine to table salt, fortifying milk with Vitamin D, and adding folic acid to breads and cereals.
Claim: Fluoridation is harmful because it causes fluorosis.
- Dental fluorosis is a change in the appearance of the tooth’s enamel surface. Nearly all fluorosis in the U.S. is mild, leaving faint white markings on teeth. It does not cause pain, and it does not affect the health or function of the teeth. It’s so subtle that only a dental professional can correctly identify it.
- Dental fluorosis occurs among some people in all communities, even those that do not fluoridate their local water systems. For example, fluorosis occurs in countries like Norway, which does not fluoridate its public water systems.
- Fluorosis results from increased consumption of fluoride, over an extended period of time, while the teeth are developing under the gums. One source is toothpaste, which contains a much higher concentration of fluoride than optimally fluoridated water. This is why parents of children under the age of 6 are advised to supervise their kids’ tooth-brushing and apply the age-appropriate amount of toothpaste to the toothbrush.
- A study published in 2010 found that mild fluorosis was not an adverse health condition and that it might even have “favorable” effects on overall health. That’s why the study’s authors said there was no reason why parents should be advised not to use fluoridated water in infant formula.
- Fluoride opponents use photos of people with a severe form of fluorosis to paint an inaccurate picture of fluorosis. Less than 1% of dental fluorosis in the U.S. is severe. People who live in countries where the water supply has extremely high, natural levels of fluoride can have severe fluorosis. The fluoride in these water supplies is not adjusted down to the optimal level that is used to fluoridate public water systems in the U.S.
This research was compiled by the Campaign for Dental Health, a program of the American Academy of Pediatrics with support from the California Dental Association, Delta Dental of Minnesota Foundation, DentaQuest Foundation, The Pew Charitable Trusts, and Washington Dental Service Foundation. A complete list of facts for these and other claims, and references to the peer-reviewed literature, can be found at [http://ilikemyteeth.org/wp-content/uploads/2012/05/Is-Fluoride-Dangerous-What-Do-Critics-Say.pdf]()
- Summarize your conclusion as to what action the Council should take on this matter.
The City Council should direct city employees to immediately reinstate the addition of fluoride to the public water supply at levels currently recommended by federal and state government public health agencies, as specified by Resolution 1165-A.
The City Council should act responsibly and protect the health of all Newport residents by upholding community water fluoridation based on the credible scientific evidence supported by 190 reputable scientific health organizations around the world.
The Lincoln County Health and Human Services, Public Health Division, and the Public Health Advisory Council can support this action through providing community education on the benefits of water fluoridation, if needed.
Should the City Council resume the addition of fluoride to the City of Newport’s water system in accordance with Resolution No. 1165-A?
The only action that the City Council should take regarding fluoridation is to comply with City law by immediately reinstating the addition of fluoride to the public water supply at levels currently recommended by official federal and state government public health agencies.
Fluoridation of Newport’s public water is required under City Council Resolution 1165-A. Resolutions are the mechanism by which Oregon cities exercise their administrative authority and as such, the term is incorporated over 120 times in the Newport Municipal Code. The Newport City Charter requires that resolutions be in force until City Council amends or repeals them. The City of Newport enforces resolutions as law, for example, delinquent water bill, business license, construction and airport fees; declaring a state of emergency; forming reimbursement districts to improve streets, water or sewage systems; renaming streets, etc. Likewise, Resolution 1165-A is the “law.”
As such, putting the question of fluoridation of the public water supply to the voters is unwarranted because:
a. City records and employee statements indicate that stopping fluoridation due to operations or budgetary reasons was temporary. Reinstitution to comply with Resolution 1165-A is an administrative and operational procedure, not a public policy debate.
b. The Councils’ delay in operationally reinstituting fluoridation and by initiating a policy debate and conducting a public hearing has already unnecessarily cost the City (its taxpayers) money as well as the costs, time and energy to Newport residents and health professionals.
c. The City Council has taken numerous health-related actions without putting them to a public vote. For example, not allowing tobacco smoking in City parks, allowing early sales of marijuana, installation of cross-walks on highway 101, adding chlorine to purify city drinking water, and not allowing dogs in City buildings. Also, it seems inconsistent that the Council would submit the effects of 1165-A to a public vote but no other resolutions passed and operationalized in the 1960’s.
d. If fluoridation was discontinued in 2005 due to worker safety issues, the City should provide water treatment workers protective equipment and procedures as it does for police and firefighters.
e. Fluoridation has been Newport law since 1960-62 and was implemented for 43 years, during which time any Newport residents who opposed fluoridation took no public action (e.g., proposal of a ballot initiative), nor reported any ill health effects.
f. Opponents of fluoridation may only now be trying to influence the City Council because they see City’s employees and City Council’s failure to reinstate fluoridation as a “hole in the dike” through which they can force outside professional agitators and outside financing to overwhelm local resources and try to sway Council to repeal 1165-A.
g. Because a small number of vocal Newport residents and outside agitators have recently expressed opposition to fluoridation with statements unsupported by the best and generally accepted scientific evidence, and with arguments long ago decided upon by the courts, is insufficient reason for the Council to call for a public vote. The opinion about fluoridation expressed in the 2012 vote in Portland is irrelevant to Newport where fluoridation is already the law, resulting from Newport residents’ votes twice.
h. By putting fluoridation to another public vote the City of Newport would incur additional costs for the process of developing the wording of the ballot measure, etc. A ballot measure would also put unnecessary financial costs and burdens of time demands on Newport residents to counter the large financial resources and personnel that outside national and state organizations are already bringing to Newport to try to unduly influence the outcome of a local matter. Plus they use information not recognized as valid by the reputable scientific community of health scientists, health professions organizations, not-for-profit health organizations, and government agency officials.
Campaign for Dental Health (2012). What do critics say? Retrieved from [http://ilikemyteeth.org/wp-content/uploads/2012/05/Is-Fluoride-Dangerous-What-Do-Critics-Say.pdf]()
Benton, Lincoln, Linn Regional Oral Health Coalition. (2015). Oral Health Needs in Benton, Lincoln, and Linn Counties: An Assessment. Local publication; not available online.
Centers for Disease Control and Prevention (2015). Statement on the Evidence of the Safety and Effectiveness of Community Water Fluoridation. Retrieved from, [http://www.cdc.gov/fluoridation/pdf/statement-cwf-6-8-2015.pdf]()
U.S. Dept. of Health & Human Services / CDC – Statement on the Evidence Supporting the Saftey and Effectiveness of Community Water Fluoridation: [http://www.cdc.gov/fluoridation/pdf/statement-cwf-6-8-2015.pdf]()
CDC Water Fluoridation Additive Fact Sheet: [http://www.cdc.gov/fluoridation/basics/index.htm]()
U.S. Public Health Service Position July August 2015: [http://www.publichealthreports.org/issueopen.cfm?articleID=3359]()
World Health Organization: Water Sanitation Fact Sheet (too little or too much Fluoride): [http://www.who.int/water_sanitation_health/naturalhazards/en/index2.html]()
Can Fluoride cause cancer?: [http://www.cancer.org/cancer/cancercauses/othercarcinogens/athome/water-fluoridation-and-cancer-risk]()
Fluoride and hypothyroidism: [http://www.webmd.com/women/news/20150225/fluoride-in-drinking-water-tied-to-higher-rates-of-underactive-thyroid]()
Can Fluoride in water reduce I.Q.?: [https://www.sciencebasedmedicine.org/antifluoridation-bad-science/]()
Fluoride and hip problems or other bone effects: [http://www.ncbi.nlm.nih.gov/pubmed/10675073]()
_6. Provide the name and contact information from the individual responsible for submitting the report on behalf of your organization:_
Gary Lahman, MPH
428 NW 17th Street
Newport, Oregon 97365