The Myth of Financial Savings from Fluoridation

John R. Lee, MD, 9620 Bodega Highway, Sebastopol, CA 95472

May 6, 1995

Does fluoridation save money? This is one of the many spurious claims made by fluoridation exponents. One would think that the parties making such a claim would be obliged to back it up with adequate proof. The fact is, they can't. Numerous reviews have attempted to find evidence of financial savings and all have turned up empty. Several examples follow.

  1. Douglas et al. Impact of water fluoridation on dental practice and dental manpower. JADA 1972;84:355-67. This is the only direct comparison of dental practice and costs in fluoridated and unfluoridated communities reported in the dental literature. It showed no significant differences in the cost and nature of dental care relative to fluoridation. In fact, dentist's income in fluoridated communities was slightly higher.

  2. Colquhoun J. Is there a dental benefit from water fluoridation? Fluoride 1994;27(1):13-21. Dr. Colquhoun, previously the chief public health dental officer in Auckland, New Zealand and present Honorary Research Fellow at the University of Auckland, examined the extensive dental records of all school children in New Zealand from 1980 through 1990 and found no benefit from fluoridation. In addition, he examined world-wide and US studies including the Grand Rapids-Muskegon study and again found no benefit from fluoridation. Instead he found serious errors in study design and outright fabrication of data in the pro-fluoridation reports.

  3. Rand corporation report, N-1732-RWJF of December 1981, The costs, effects, and benefits of preventive dental care: a literature review, found that claims of fluoride benefit rested on poor experimental design and hypothetical "cost-effectiveness ratios" that have "no relevance to any criterion of public policymaking." The Rand study concluded that extrapolation of such results, "as widely practiced in the literature, is simply not warranted by available evidence."

    The National Dental Caries Prevalence Survey of 1979-80 (NIH Pub. 82-2245) failed to demonstrate any advantage of artificial fluoridation.

  4. The 1986-1987 National Survey of U>S. Schoolchildren (NIDR) results were obtained using the Freedom of Information act and reviewed by Dr. Yiamouyiannis. Again, no benefit of fluoridation could be found.

  5. Kumar VK, Green EL, Wallace W, et al. Trends in dental fluorosis and dental caries prevalences in Newburgh and Kingston, NY. AJPH May 1989;79:565-69. This paper reviewed the decline in caries since 1955 in both communities. The decline in caries was essentially identical in comparing fluoridated Newburgh with unfluoridated Kingston. There was, however, more dental fluorosis in fluoridated Newburgh.

  6. Gray AS. Fluoridation: time for a new baseline? J Canadian Dental Assoc. 1987;53:763-5. In comparing dental results in fluoridated and unfluoridated school districts of British Columbia, Dr. Gray found no benefit from fluoridation and questioned the common claims of his own public health department.

  7. My list of fluoridation references, section II, lack of dental benefit. This is but a small sampling of authoritative references showing no significant dental benefit for fluoridation.

Does fluoridation increase medical costs? This question concerns the known toxicity of fluoride. My particular interest is fluoride's effect on bones. It is widely known that fluoride treatments for osteoporosis result in increased incidence of hip fracture. The deleterious effect fluoride on bones is now beyond dispute. The question is, does fluoride at the level of water fluoridation also damage bones?

A 1993 report by the National Research Council claimed claimed to have reviewed the available literature and concluded that, though the results were mixed, there was no reason to change fluoride's present maximum contaminant level (MCL) of 4 mg/L. Among references comparing hip fracture incidence relative to fluoridation status, the NRC reported seven studies showing increased fracture risk, three reporting no difference, and none reporting any benefit. The three references that reported no difference were all small studies of elderly women with only brief exposure (six years or less) to fluoridated water. These are obviously not relevant to the question of life-long fluoridation exposure. That leaves seven much better studies showing an increased risk of hip fracture from fluoridated water.

More recently, a report in the JAMA, 8 March 1995, from the University of Bordeaux compared hip fracture incidence among subjects aged 65 years or older in 75 parishes of southwestern France. The fluoride (natural) level of the community water supplies varied from 0.05 to 1.83 mg/L (ppm), much lower than our MCL for fluoride. After adjustment for a number of other potential variables, it was found that women living in communities having more than 0.11 mg/L (ppm), much lower than our MCL for fluoride. After adjustment for a number of other potential variables, it was found that women living in communities having more than 0.11 mg/L of fluoride in their drinking water were found to have a risk of hip fracture 86% greater than those living in the less fluoridated areas.

Thus, the mass of available and relevant scientific literature indicates that fluoridation increases the risk of hip fracture among the elderly. Treating osteoporotic fractures incurs a cost pf $10 billion per year in the US. The additional cost of rest home and nursing home care that follows is probably much larger, not to mention the cost in terms of human suffering. Surely, this is reason enough to desist in fluoridating our water.

There are still remaining many questions about other toxic effects of fluoride, including the strong evidence that fluoridation increases the incidence of bone cancer (osteosarcoma) among young males. Fluoride is a potent enzyme inhibitor at all detectable levels, more toxic than lead. To put it in drinking water will not serve the health of the public nor will it reduce medical or dental costs.

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