Community Water Fluoridation and Policy Reform (8-10 page Argumentative Research Paper for Eng 102)
Introduction:
Community water fluoridation is considered of the most significant public health advancements of the 20th century with its ability to dramatically reduce tooth decay for millions of Americans. Hundreds of scientific studies have concluded that fluoride, both in concentrated doses as well as added to community water, is safe, effective, and virtually free to its consumers. However, despite an abundance of evidence substantiating its benefits, community water fluoridation remains a controversial topic with skeptics arguing that it leads to fragile skeletal bones, cancer, and impaired brain development, to name a few (Palsdottir). Recently, Robert F. Kennedy Jr., President Donald J. Trump's nominee for United States Secretary of Health and Human Services, reignited the debate by proposing a complete ban on fluoridated water. As policy debates intensify and misinformation spreads, it is important that communities continue fluoridating community water, as it offers a cost effective, readily available, and safe measure to promote dental health.
To understand the controversy surrounding fluoridated water, one must understand the origin of fluoride and how it works in preventing dental decay. According to Hrefna Palsdottir with Healthline.com, "Fluoride is the negative ion of the element fluorine ... and it occurs naturally in air, soil, plants, rocks, fresh water, seawater, and many foods." Fluoride has the ability to strengthen bones and teeth, so it is often added to dental toothpastes, mouth rinses, and even applied in concentrated doses in the dental chair as a scientific-backed means for preventing tooth cavities. While fluoride occurs naturally in many sources of ground water, the levels are often too low to effectively prevent cavities, so many municipalities add fluoride to its community water. This method offers an easy and cost-effective means to supply whole towns and communities with a consistent flow of fluoride to improve dental health.
History of the problem
The history of fluoridated water, and the concerns of safety surrounding it, goes back many decades. According to the Center for Disease Control and Prevention, the use of fluoride in community water dates to the 1930's when Dr. H. Trendley Dean, a public health officer and founder of the Dental Hygiene Unit at the National Institute of Health, discovered that fluoride in small amounts could strengthen tooth enamel and prevent cavities. These findings then led to the first introduction of fluoridated water in Grand Rapids, Michigan, in 1945 (Centers for Disease Control Prevention). 10 years after its introduction, the rate of tooth decay among children dropped more than 60% (National Institute of Dental and Craniofacial Research). These numbers are difficult to argue and reinforce the idea that adding a small amount of fluoride to community water is an easy and inexpensive way to reduce decay. Just as fluoridated water was proving effective, critics began conducting their own studies. These studies ultimately concluded that, "prolonged exposure to elevated fluoride concentrations could cause skeletal fluorosis, a condition where fluoride accumulates in bones and leads to pain, stiffness, and bone damage," as well as "neurological effects, kidney damage and even possible links to cancer" (National Research Council 21). Since that time, there have been contentious debates surrounding the safety and effectiveness of fluoridated water. Kennedy's recent proclamation of eliminating fluoride in water has sparked the debate on a national level.
Extent of the problem:
Coming off the 2024 presidential election win, President Trump said he would place health related decisions in the hands of Kennedy, to which Kennedy then announced he would make removing fluoride from public water a "day one priority" (Mello-Klein). While associations like the American Dental Association (ADA) and the CDC consider fluoride one of the "top ten greatest public health achievements," Kennedy claims it leads to arthritis, cancers, reduced IQ, and bone fractures, among other health related issues. However, Palsdottir argues the validity of those accusations and states that skeletal fluorosis is not typically seen in countries, like the U.S. where fluoridated water is tightly regulated. Additionally, a 2015 toxicology report concluded that the link to decreased IQ was seen only in children outside the U.S. who drank water with higher levels of fluoride than what is currently permitted in the U.S (NIDCR). The repercussions of removing fluoride from community water would have immediate and catastrophic consequences in the realm of dental health and put millions of Americans at an increased risk of major dental issues; all on the unfounded belief that it causes more serious health problems.
During Kennedy's Health and Human Services confirmation hearing, he addressed his views on fluoride saying he would warn local and municipal water districts about their "legal liability" to deliver safe drinking water (Dorn). Currently, the recommended fluoride level in public water supplies is 0.7 parts per million (ppm.) In 2011, the U.S. Department of Health and Human Services decreased the allowed amount of fluoride from 1.0% ppm to 0.7% ppm solely on the heels of a study that found that 1.0% ppm increased the risk of dental fluorosis; not because they recognized any additional risks associated with fluoride (Burger.) The current level of fluoride is considered the optimal level for preventing cavities without increasing the risk of dental fluorosis. If Kennedy's plan were implemented, it could fuel more distrust toward other scientifically backed health initiatives and set a dangerous precedent to dismiss those too.
Repercussions of the problem:
With a potential ban of fluoride in community water on the horizon, various immediate and long-term repercussions could soon be observed. Some of these implications include cost ramifications, access to care disparities, and an increase in more severe dental and systemic issues. Without fluoride, more costly and invasive dental treatments would be needed to treat the decay. For example, if left untreated, a small cavity could progress into a crown, root canal, an extraction, or even a deadly infection. Studies have shown that fluoridation reduces dental decay by 25%, resulting in increased healthcare costs for families (CDC). The ADA has echoed that statistic and agrees that fluoridation is both safe and effective, citing numerous studies that demonstrate a clear reduction in cavities in populations with fluoridated water, without the consumer incurring any monetary expense to themselves (Burger). According to the CDC, on average communities with water fluoridation saved $32 per person annually by avoiding dental treatment costs and leading to fewer missed work and school days. Incorporating fluoride into dental water provides a cost-effective means of preventing costly dental treatments down the road.
In addition to the monetary ramifications of eliminating fluoride, it would have significant consequences for Americans in rural and underserved areas. For low-income families who lack access to regular dental care or who live far from dental clinics, fluoridated water often serves as the only form of preventive dental care they receive. Neil Maniar, director of Northeastern University's Master of Public Health program, warns that "Communities that are already at risk are going to be put at greater risk, and we're going to see widening disparities" (Mello-Klein). Water fluoridation plays a crucial role in closing the gap for individuals who face geographical or financial barriers to dental care by providing an affordable, effective solution for improving oral health. As the National Institute of Dental and Craniofacial Research points out, one of the greatest advantages of water fluoridation is that it ensures "anyone, regardless of income, age, access to dental care, or other social circumstances, can benefit from its cavity-preventing abilities at home, school, work, or anywhere public water is available." By making fluoride readily available in public water, this approach significantly enhances access to preventive care and ensures that all community members can benefit without incurring monetary expenses.
While fluoridated water is primarily touted as a means of preventing dental cavities, its benefits go beyond small enamel lesions. It is important when considering the ongoing fluoride debate that the snowball effect is also considered. Poor oral health does not always stop in the oral cavity. Maniar asserts that "the newly discovered links between oral health and other health outcomes - chronic diseases and cancer that comes later in life as well as Alzheimer's and dementia - are vital." Additionally, the ADA claims that poor dental health can lead to cardiovascular disease, diabetes, strokes, and artificial joint rejection. Given these connections, preventative dental care, such as fluoride in drinking water, is essential not just for oral health but for overall systemic health.
Quick Fix
As Kennedy rushes to eliminate fluoride from community water, proponents of fluoridated water are just as quick to contend that Kennedy has misdiagnosed the problem. Phil Brown, director of the Social Science Environmental Health Research Institute agrees with Kennedy that excessive, concentrated doses of fluoride can prove detrimental. However, he believes that removing it entirely would cause more harm than good (Mello-Klein). He asserts that, "All medical treatments have some adverse effects for a small number of people. We've always known that... but the overall benefits are so great to so many more people that we accept them." Instead of removing fluoride from community water sources all together, increased monitoring and tailored levels of fluoride on a city-by-city basis would be more appropriate. Much is to be gained from the failures of other countries who have gone on to ban fluoridated water, just as Kennedy has recommended. According to a study published by the Journal of Epidemiology and Community Health, researchers analyzed 13 countries who eliminated fluoride from their water, and they concluded that there was an "overall" increase in tooth decay (McLaren and Singhal). While concerns about fluoride's effects are understandable, a measured approach involving tailored fluoride levels and increased monitoring would be a better option than outright removal, as past instances of fluoride bans have proven negative consequences for dental health.
Removing fluoride from public water systems would affect vulnerable populations, undermine valid research, and ultimately burden the public health sector. According to the ADA, "Seventy years of research, thousands of studies and the experience of more than 210 million Americans tell us that water fluoridation is effective in preventing cavities and is safe for children and adults." As it stands today, the best solution for this contentious debate comes down to one simple solution; do nothing. Until there is enough evidence supporting claims of unintended risks, keeping water fluoridation as it currently is has proved to result in an effective balance between cavity prevention while maintaining minimal risk for systemic illnesses.
Long Term Fix
Anti-fluoridation activists disregard recommendations of leading public health, organizations, like the ADA and the CDC. Overcoming their negative perception of fluoridated water is not an easy task, despite hundreds of studies backing its safety. Many of the misconceptions about fluoride stem from misinformation and a lack of understanding about its benefits. Looking forward, it is important to educate the public on the truth about fluoride to ensure policy makers like Kennedy do not unravel decades of good thanks to fluoride. Public awareness campaigns, public service announcements, and community engagement are all avenues that would help to shine light on the real facts. These efforts should focus on clear, scienced-backed messaging that leaves no room for doubt. They should be endorsed by trusted organizations such as the CDC and the ADA and collaboration with organizations like the American Fluoridation Society could be helpful as well. These campaigns should vary in their medium, whether it be short advertisements, social media posts, flyers and handouts, and even billboards to ensure they reach all avenues and demographics of people.
In addition to media campaigns, it is important for communities to have open dialogue with community officials, neighbors, and policy reformers to come up with the best solutions for their specific communities. Science is an always evolving industry so as time goes on, a better understanding of fluoride's risks and benefits will become clearer, resulting in better regulations surrounding the use of fluoride. For example, Palsdottir notes that most of the studies regarding the safety of fluoride were conducted in the 1970's, highlighting the importance that more recent studies are needed to truly evaluate its safety. By combining large-scale service announcements, strategic outreach, and continued scientific studies, public perception can move toward a more positive and informed understanding of fluoridated water, and American's can continue reaping the dental protection it provides.
Conclusion
Fluoridation of community water has been one of the most effective public health advancements of the past century, providing a cost-effective, accessible means of preventing tooth decay for millions of Americans. Robert F. Kennedy, Jr.'s proposal to eliminate fluoride from community water disregards decades of scientific research and would bring harm to public health. Rather than eliminating fluoride, a more effective and balanced approach would include continued monitoring, public education, increased research, and city specific adjustments to ensure the greatest benefits with minimal risks. The solution is not to abandon a proven health measure but to improve the public's understanding that water fluoridation is safe, highly effective, and scientifically backed health measure.
Works Cited
Introduction:
Community water fluoridation is considered of the most significant public health advancements of the 20th century with its ability to dramatically reduce tooth decay for millions of Americans. Hundreds of scientific studies have concluded that fluoride, both in concentrated doses as well as added to community water, is safe, effective, and virtually free to its consumers. However, despite an abundance of evidence substantiating its benefits, community water fluoridation remains a controversial topic with skeptics arguing that it leads to fragile skeletal bones, cancer, and impaired brain development, to name a few (Palsdottir). Recently, Robert F. Kennedy Jr., President Donald J. Trump's nominee for United States Secretary of Health and Human Services, reignited the debate by proposing a complete ban on fluoridated water. As policy debates intensify and misinformation spreads, it is important that communities continue fluoridating community water, as it offers a cost effective, readily available, and safe measure to promote dental health.
To understand the controversy surrounding fluoridated water, one must understand the origin of fluoride and how it works in preventing dental decay. According to Hrefna Palsdottir with Healthline.com, "Fluoride is the negative ion of the element fluorine ... and it occurs naturally in air, soil, plants, rocks, fresh water, seawater, and many foods." Fluoride has the ability to strengthen bones and teeth, so it is often added to dental toothpastes, mouth rinses, and even applied in concentrated doses in the dental chair as a scientific-backed means for preventing tooth cavities. While fluoride occurs naturally in many sources of ground water, the levels are often too low to effectively prevent cavities, so many municipalities add fluoride to its community water. This method offers an easy and cost-effective means to supply whole towns and communities with a consistent flow of fluoride to improve dental health.
History of the problem
The history of fluoridated water, and the concerns of safety surrounding it, goes back many decades. According to the Center for Disease Control and Prevention, the use of fluoride in community water dates to the 1930's when Dr. H. Trendley Dean, a public health officer and founder of the Dental Hygiene Unit at the National Institute of Health, discovered that fluoride in small amounts could strengthen tooth enamel and prevent cavities. These findings then led to the first introduction of fluoridated water in Grand Rapids, Michigan, in 1945 (Centers for Disease Control Prevention). 10 years after its introduction, the rate of tooth decay among children dropped more than 60% (National Institute of Dental and Craniofacial Research). These numbers are difficult to argue and reinforce the idea that adding a small amount of fluoride to community water is an easy and inexpensive way to reduce decay. Just as fluoridated water was proving effective, critics began conducting their own studies. These studies ultimately concluded that, "prolonged exposure to elevated fluoride concentrations could cause skeletal fluorosis, a condition where fluoride accumulates in bones and leads to pain, stiffness, and bone damage," as well as "neurological effects, kidney damage and even possible links to cancer" (National Research Council 21). Since that time, there have been contentious debates surrounding the safety and effectiveness of fluoridated water. Kennedy's recent proclamation of eliminating fluoride in water has sparked the debate on a national level.
Extent of the problem:
Coming off the 2024 presidential election win, President Trump said he would place health related decisions in the hands of Kennedy, to which Kennedy then announced he would make removing fluoride from public water a "day one priority" (Mello-Klein). While associations like the American Dental Association (ADA) and the CDC consider fluoride one of the "top ten greatest public health achievements," Kennedy claims it leads to arthritis, cancers, reduced IQ, and bone fractures, among other health related issues. However, Palsdottir argues the validity of those accusations and states that skeletal fluorosis is not typically seen in countries, like the U.S. where fluoridated water is tightly regulated. Additionally, a 2015 toxicology report concluded that the link to decreased IQ was seen only in children outside the U.S. who drank water with higher levels of fluoride than what is currently permitted in the U.S (NIDCR). The repercussions of removing fluoride from community water would have immediate and catastrophic consequences in the realm of dental health and put millions of Americans at an increased risk of major dental issues; all on the unfounded belief that it causes more serious health problems.
During Kennedy's Health and Human Services confirmation hearing, he addressed his views on fluoride saying he would warn local and municipal water districts about their "legal liability" to deliver safe drinking water (Dorn). Currently, the recommended fluoride level in public water supplies is 0.7 parts per million (ppm.) In 2011, the U.S. Department of Health and Human Services decreased the allowed amount of fluoride from 1.0% ppm to 0.7% ppm solely on the heels of a study that found that 1.0% ppm increased the risk of dental fluorosis; not because they recognized any additional risks associated with fluoride (Burger.) The current level of fluoride is considered the optimal level for preventing cavities without increasing the risk of dental fluorosis. If Kennedy's plan were implemented, it could fuel more distrust toward other scientifically backed health initiatives and set a dangerous precedent to dismiss those too.
Repercussions of the problem:
With a potential ban of fluoride in community water on the horizon, various immediate and long-term repercussions could soon be observed. Some of these implications include cost ramifications, access to care disparities, and an increase in more severe dental and systemic issues. Without fluoride, more costly and invasive dental treatments would be needed to treat the decay. For example, if left untreated, a small cavity could progress into a crown, root canal, an extraction, or even a deadly infection. Studies have shown that fluoridation reduces dental decay by 25%, resulting in increased healthcare costs for families (CDC). The ADA has echoed that statistic and agrees that fluoridation is both safe and effective, citing numerous studies that demonstrate a clear reduction in cavities in populations with fluoridated water, without the consumer incurring any monetary expense to themselves (Burger). According to the CDC, on average communities with water fluoridation saved $32 per person annually by avoiding dental treatment costs and leading to fewer missed work and school days. Incorporating fluoride into dental water provides a cost-effective means of preventing costly dental treatments down the road.
In addition to the monetary ramifications of eliminating fluoride, it would have significant consequences for Americans in rural and underserved areas. For low-income families who lack access to regular dental care or who live far from dental clinics, fluoridated water often serves as the only form of preventive dental care they receive. Neil Maniar, director of Northeastern University's Master of Public Health program, warns that "Communities that are already at risk are going to be put at greater risk, and we're going to see widening disparities" (Mello-Klein). Water fluoridation plays a crucial role in closing the gap for individuals who face geographical or financial barriers to dental care by providing an affordable, effective solution for improving oral health. As the National Institute of Dental and Craniofacial Research points out, one of the greatest advantages of water fluoridation is that it ensures "anyone, regardless of income, age, access to dental care, or other social circumstances, can benefit from its cavity-preventing abilities at home, school, work, or anywhere public water is available." By making fluoride readily available in public water, this approach significantly enhances access to preventive care and ensures that all community members can benefit without incurring monetary expenses.
While fluoridated water is primarily touted as a means of preventing dental cavities, its benefits go beyond small enamel lesions. It is important when considering the ongoing fluoride debate that the snowball effect is also considered. Poor oral health does not always stop in the oral cavity. Maniar asserts that "the newly discovered links between oral health and other health outcomes - chronic diseases and cancer that comes later in life as well as Alzheimer's and dementia - are vital." Additionally, the ADA claims that poor dental health can lead to cardiovascular disease, diabetes, strokes, and artificial joint rejection. Given these connections, preventative dental care, such as fluoride in drinking water, is essential not just for oral health but for overall systemic health.
Quick Fix
As Kennedy rushes to eliminate fluoride from community water, proponents of fluoridated water are just as quick to contend that Kennedy has misdiagnosed the problem. Phil Brown, director of the Social Science Environmental Health Research Institute agrees with Kennedy that excessive, concentrated doses of fluoride can prove detrimental. However, he believes that removing it entirely would cause more harm than good (Mello-Klein). He asserts that, "All medical treatments have some adverse effects for a small number of people. We've always known that... but the overall benefits are so great to so many more people that we accept them." Instead of removing fluoride from community water sources all together, increased monitoring and tailored levels of fluoride on a city-by-city basis would be more appropriate. Much is to be gained from the failures of other countries who have gone on to ban fluoridated water, just as Kennedy has recommended. According to a study published by the Journal of Epidemiology and Community Health, researchers analyzed 13 countries who eliminated fluoride from their water, and they concluded that there was an "overall" increase in tooth decay (McLaren and Singhal). While concerns about fluoride's effects are understandable, a measured approach involving tailored fluoride levels and increased monitoring would be a better option than outright removal, as past instances of fluoride bans have proven negative consequences for dental health.
Removing fluoride from public water systems would affect vulnerable populations, undermine valid research, and ultimately burden the public health sector. According to the ADA, "Seventy years of research, thousands of studies and the experience of more than 210 million Americans tell us that water fluoridation is effective in preventing cavities and is safe for children and adults." As it stands today, the best solution for this contentious debate comes down to one simple solution; do nothing. Until there is enough evidence supporting claims of unintended risks, keeping water fluoridation as it currently is has proved to result in an effective balance between cavity prevention while maintaining minimal risk for systemic illnesses.
Long Term Fix
Anti-fluoridation activists disregard recommendations of leading public health, organizations, like the ADA and the CDC. Overcoming their negative perception of fluoridated water is not an easy task, despite hundreds of studies backing its safety. Many of the misconceptions about fluoride stem from misinformation and a lack of understanding about its benefits. Looking forward, it is important to educate the public on the truth about fluoride to ensure policy makers like Kennedy do not unravel decades of good thanks to fluoride. Public awareness campaigns, public service announcements, and community engagement are all avenues that would help to shine light on the real facts. These efforts should focus on clear, scienced-backed messaging that leaves no room for doubt. They should be endorsed by trusted organizations such as the CDC and the ADA and collaboration with organizations like the American Fluoridation Society could be helpful as well. These campaigns should vary in their medium, whether it be short advertisements, social media posts, flyers and handouts, and even billboards to ensure they reach all avenues and demographics of people.
In addition to media campaigns, it is important for communities to have open dialogue with community officials, neighbors, and policy reformers to come up with the best solutions for their specific communities. Science is an always evolving industry so as time goes on, a better understanding of fluoride's risks and benefits will become clearer, resulting in better regulations surrounding the use of fluoride. For example, Palsdottir notes that most of the studies regarding the safety of fluoride were conducted in the 1970's, highlighting the importance that more recent studies are needed to truly evaluate its safety. By combining large-scale service announcements, strategic outreach, and continued scientific studies, public perception can move toward a more positive and informed understanding of fluoridated water, and American's can continue reaping the dental protection it provides.
Conclusion
Fluoridation of community water has been one of the most effective public health advancements of the past century, providing a cost-effective, accessible means of preventing tooth decay for millions of Americans. Robert F. Kennedy, Jr.'s proposal to eliminate fluoride from community water disregards decades of scientific research and would bring harm to public health. Rather than eliminating fluoride, a more effective and balanced approach would include continued monitoring, public education, increased research, and city specific adjustments to ensure the greatest benefits with minimal risks. The solution is not to abandon a proven health measure but to improve the public's understanding that water fluoridation is safe, highly effective, and scientifically backed health measure.
Works Cited
