Bill Maas Water Fluoridation

Bill Maas, Advisor, Pew Children's Dental Campaign  

The Centers for Disease Control and Prevention calls community water fluoridation one of the 10 “great public health achievements of the 20th century.” It is one of the most cost-effective strategies for improving dental health, yet some communities are still debating whether to start or stop fluoridating their water.

Dr. Bill Maas, a dental policy expert and advisor to Pew on children's dental policy, talks about how fluoride helps improve dental health and what’s at stake.

Q: In November, the drinking water provider for San Jose and neighboring communities voted to fluoridate its water supply. What impact does this have?

The Santa Clara Valley Water district’s unanimous vote in favor of water fluoridation means that more than 280,000 Californians will soon have access to fluoridated drinking water. San Jose was the largest city in the nation without this important cavity-fighting tool, which is proven to reduce tooth decay by 18-40%. It’s a significant step for California and for dental health.

Q: Water fluoridation has been in place in some communities for more than 65 years. Why is it in the news again?

While more than seven out of ten people using public water supplies currently drink fluoridated water, there are still tens of millions of Americans who do not have access to fluoridated water.

Pew is involved because community water fluoridation is an effective preventive health intervention that hasn’t reached all the communities it could. A lot of progress has been made over the years in expanding community water fluoridation, but some opponents have attempted to roll this back.

Q: What do opponents say about fluoridation?

There is a lot of misleading information about fluoride out there. Even though fluoride naturally occurs in nearly all water supplies, opponents make it sound like something new is getting added to water. Community water fluoridation efforts adjust fluoride levels in public water supplies to the recommended level for optimal dental health, which is about one part per million.

Some opponents claim that fluoridated water is unsafe and can cause osteosarcoma, a bone cancer. This is not true. Recently, an expert panel of scientists in California carefully reviewed all of the scientific research and determined that the evidence fails to show that fluoride is linked to cancer. There is a wealth of research that shows that fluoride is safe and beneficial to dental health.

Opponents have also raised concerns about community water fluoridation leading to severe cases of dental fluorosis. Fluorosis is a change in appearance of the tooth’s enamel. Nearly all fluorosis in the U.S. is not harmful and results in white streaks on the teeth that are barely noticeable. Severe fluorosis can cause enamel damage and brown spots, but that problem is rare in our country, afflicting only people on private well water.

In 2006, the National Research Council examined water sources with a range of naturally occurring fluoride levels and found that severe fluorosis virtually never occurs in levels below 2 parts per million. Public water systems fluoridate at a concentration that’s well below that level.

Q: Considering the vast majority of Americans brush their teeth with fluoride toothpaste, is it still important for them to drink fluoridated water?

Drinking fluoridated water and brushing with fluoride toothpaste are two important ways to prevent tooth decay. When you brush your teeth with fluoride toothpaste, it increases the amount of fluoride in your mouth for an hour or two. With fluoridated water, you have many more opportunities throughout the day to introduce fluoride into your mouth and strengthen your teeth. Fluoridated water works in a different way for young children. It gets incorporated into developing teeth, making them more resistant to decay before they even become visible in the mouth.

Q: Given how strained state and local budgets are these days, how expensive is it for a community to fluoridate its water?

According to the Centers for Disease Control, fluoridation costs as little as $1 per person per year and saves $38 in dental treatment costs for every $1 invested. But not every community has recognized this opportunity. In October, Pinellas County, Florida voted to stop fluoridating its water in an effort to cut costs. They asked the water operators how much money they would save from stopping fluoridation but nobody asked what the consequences were. The taxpayers will now pay more money to fill cavities that could have been prevented. Even in tough fiscal times, water fluoridation is a smart investment.