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Typical Cavity Prevention


Fluoride might not leap to mind when you think of top pharmaceuticals. But considering that fluoride has become ubiquitous in water, food, and nearly every toothpaste on the market, there's a strong argument to be made that the little 10-electron ion is the most pervasive pharmaceutical of them all--at least in the U.S.

MOUTHFUL Jane Snyder of Alpharetta, Ga., receives a fluoride treatment at her first visit to the dentist. PHOTO BY DAVID & MEI SNYDER

MOUTHFUL Jane Snyder of Alpharetta, Ga., receives a fluoride treatment at her first visit to the dentist.

The idea of using fluoride to prevent dental caries was born out of an observation made by a young dentist named Frederick S. McKay. In 1901, the story goes, McKay set up shop in Colorado Springs, Colo., where he found many of his patients' teeth mottled brown. Despite their rotten-looking appearance, the mottled teeth were strongly resistant to decay, McKay later learned.

It took 30 years, but McKay and other scientists were eventually able to trace the source of the stains, and possibly the cause of the caries resistance, to the high concentration of naturally occurring fluoride in the town's water. Additional studies showed that water with a lower fluoride concentration, about 1 ppm, could prevent cavities without staining teeth.

To test fluoride's cavity-fighting abilities in a large-scale scientific study, field tests were initiated in 1945 using four pairs of cities: Grand Rapids and Muskegon, Mich., to begin, followed by Newburgh and Kingston, N.Y.; Evanston and Oak Park, Ill.; and Brantford and Sarnia, Ontario. The first city in each regional pair got fluoride in its water, while the second city was an unfluoridated control.

The field study's results were promising, and the push to add fluoride to water supplies and dental products throughout the country was on. According to the Centers for Disease Control & Prevention (CDC), by 2000 about 162 million people in the U.S. got their water from a fluoridated supply. That's roughly two-thirds of the population served by public water systems. With the exception of a few boutique brands, most toothpastes contain fluoride.

Even though 60 years have passed since America's first drops of fluoridated water flowed into taps in Grand Rapids, the practice of adding fluoride to water supplies remains controversial. Decades of arguing have polarized the discussion into shrill talking points.

Antifluoridationists claim that adding the chemical to drinking water is forced medication. They say the practice is based on old, flawed studies, and even at low concentrations, they contend, fluoride may actually lead to a host of ailments. Furthermore, they argue that fluoridation's actual benefits are minimal, pointing out that industrialized nations that don't fluoridate their water have seen comparable improvements in dental health.

Those in the profluoridation camp counter that these claims are quackery. They argue that fluoridating water supplies is an easy and inexpensive way to provide cavity protection, especially to people who can't afford regular dental treatment. Profluoridationists have endorsements from the American Medical Association and the American Dental Association to bolster their position. And CDC hailed water fluoridation as one of the "Ten Great Public Health Achievements in the 20th Century."

Antifluoride advocates also have scientists on their side, albeit in fewer numbers.

The polarization that surrounds the issue demonstrates that in matters of personal health, it takes more than endorsements from the scientific establishment to sway voters. Profluoridationists are as likely to lose fluoridation initiatives as they are to win. In April, Missouri voters in the town of Carl Junction overwhelmingly approved a fluoridation measure. Thirty-five miles away, on the same day, Show-me Staters in Neosho crushed a similar proposal to add fluoride to their water supply.

This year alone, proposals to either add or remove fluoride from the water supply have prompted passionate responses--both pro- and antifluoride--from people in Arkansas, Tennessee, Oregon, and Massachusetts, as well as in Ireland, Wales, and Australia, among other locations.

Why, after 60 years of fluoridation and support from the U.S.'s most respected medical associations, are citizens still arguing over fluoride in the water supply? Perhaps the editors at Fort Collins newspaper the Coloradoan put it best when making their endorsements in an April referendum on fluoridation: "The proposal to remove fluoride from the city of Fort Collins' water system is a textbook illustration that supporters and opponents of any issue can find some sort of science to support their viewpoints."—BETHANY HALFORD


The Top Pharmaceuticals
That Changed The World
Vol. 83, Issue 25 (6/20/05)
Table Of Contents


CAS Registry

  • 169-48-8


  • In toothpaste, fluoride comes from stannous fluoride, sodium fluoride, or sodium monofluorophosphate--all are derived from hydrofluoric acid. The principal reagents for fluoridating water are hydrofluorosilicic acid or its sodium salt, sodium silicofluoride. In some countries, sodium fluoride is also added to table salt.

Did you know that the National Research Council's Committee on Toxicology is currently undertaking a 39-month project to review toxicologic, epidemiologic, and clinical and exposure data on orally ingested fluoride?