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Emails about fluoride

I recently received an email from a student at one of our local community colleges. The student was taking a journalism course and was writing a story about the “controversy over fluoride.

“Hi my name is **** and I’m a Journalism and Emerging Media student at ***** I’m contacting you in regards to an article I’m doing for my newspaper class on the controversy over fluoride. I was just hoping to ask you a couple questions on the subject of fluoride and I’ll leave them below in this email. The basis of my article is to have a fair and balanced debate between those in the Dental community who support the use of fluoride in our hygiene products/water supplies and arguments made by the anti-fluoridation movement that fluoride causes harm to the body (one website I’ve looked at before is www.fluoridealert.org). I haven’t had much luck contacting anyone else who would speak with me about this. 

Questions:

1. Have you heard of the arguments made by anti-fluoridation movement? If so, do you feel they have any merit? If Yes, Why? If No, Why not?

2. Do you have any personal hygiene suggestions for those who would rather not use fluoride based products?

3. As a Dentist do you have patient refusal of fluoride often? If you do, does it change how you approach cleaning their teeth? Or change what products to recommend to them?

4. What advice would you give parents who are worried about their child’s fluoride exposure (regarding hygiene product usage, etc)?

5. Anything else you would like to add?”

Right away my skeptical alert system went off. Lots of peer reviewed research has determined that the use of optimal fluoride concentrations in drinking water is safe and incredibly effective. The CDC called public water fluoridation one of the top 10 public health achievements of the 20th century. By any reasonable standard, there is no scientific controversy about fluoride. I felt it was important that I let this journalism student know what I felt about science journalism and “teaching the controversy” when there isn’t really a controversy.

“Hi *****,

I’m curious about where your research has taken you. I’m wondering what you personally think about fluoride, both systemic and topical. It won’t change how I answer, but it might help me frame where I’m coming from.

A story like this is interesting. Health and science reporting is kind of special. I understand that you want to have a fair and balanced debate. But when you frame it like that, it assumes that both sides of the debate have equal merit. That might work for political stories, or stories about art. It’s not the same for science. Science journalism is special. Often, there aren’t two sides to a story. There’s the side which the science supports and the side of people who don’t like what that science says. These are not viewpoints with equivalent standing. The evidence weight heavily on one side. Unfortunately, people unfamiliar with the scientific process don’t necessarily understand this.

A great example is the “theory of evolution.” The scientific use of “theory” is unfortunate. To lay people, the term “theory” implies that it’s just someone’s best guess of how something happened. That’s not what a scientific theory is. An excellent definition of “scientific theory” is from Wikipedia: ‘A scientific theory is a well-substantiated explanation of some aspect of the natural world that is acquired through the scientific method, and repeatedly confirmed through observationand experimentation.’ In other words, when scientists use the word theory they mean something that is essentially an explanation of something in the natural world that has been tested and confirmed over and over again. Not just some guy’s idea of how something works.

So I guess what I’m saying is that the fluoride “controversy” isn’t really a controversy. There isn’t credible scientific research that suggests systemic (fluoride in the water) fluoride is dangerous and/or toxic. There is lots of evidence suggesting that systemic fluoride is helpful in preventing tooth decay as well as very cost effective. There’s also lots of evidence suggesting that topical fluoride can help with prevention in tooth decay as well as reversing early “precavitated” lesions.

The problem for a journalist is that doesn’t make for much of a story. The recognized science that includes well designed research says fluoride, when used as directed is safe and effective. If those who believe otherwise have properly designed research published in well peer reviewed journals, the scientific consensus will start to change. Up to now, that’s not been the case.

I’m happy to help, but I want to think a little bit about my answers so I’ll get them to you in a day or so.”

I went ahead and answered her original questions. I answered them in the the way that the current science would indicate. I had done my part by standing on my soapbox and yelling about “teaching the controversy” when there really wasn’t a controversy. This was a college student who didn’t realize they had stumbled upon a dyed-in-the-wool skeptic with a tendency toward rambling emails. Then I received a reply about where this student was coming from.

“My main goal for this article is to basically weigh both sides of the issue and let the audience decide what is best for them and their health. I’m just trying to give each side to the debate a chance to voice their opinion on it. As a journalist I am doing my best to be unbiased while reporting. (As far as me personally),I choose not to use fluoride based toothpaste or mouthwash, and I also have a water bottle that filters fluoride among other things out of my water such as: heavy metals like lead, mercury, radiation etc. I have gone on other websites besides the one I mentioned to research the fluoride debate more. I have contacted the media director for the Fluoride Action Network to get their take on why they believe fluoride is toxic and I was able to get in contact with two Dental Hygienists on what they think. At this point in my life I feel I’ve made the best decision (for me) on fluoride. I understand ‘too much’ fluoride can be toxic, but I’m also told a ‘little bit’ helps our teeth. I just want to make sure all those ‘little bits’ don’t turn into something bigger in the future (If that makes any sense). A main concern to me would be fluorosis of the teeth, and to avoid things like using way more than a pea-size amount. I would just like the opportunity through further exploration finding other ‘all natural’ ways of caring for my mouth.”

So there you have it. As much as I want to believe that this is just a mistake of a somewhat naive college student, I think it’s a bit more than that. In many cases, journalism is about generating a story. The “facts” in this case aren’t hard to find with a little looking. I actually have to give credit to our journalism student for being honest about their biases. Most don’t believe that they have biases. Having biases isn’t a problem. It’s actually part of being human. Recognizing them and overcoming them is really difficult, though. I admit that I struggle with this often. Our aspiring journalist admits that they feel that fluoride isn’t for them. Further, they worry about fluorosis and would prefer a more “all natural” way of caring for their mouth.

Our journalism student commits an “appeal to nature” fallacy here, which is so common that it’s probably not worth dissection. Let’s just say that fluoride is natural, as it is naturally found in most water sources and leave it at that. A bigger problem is our journalist’s concern about fluorosis. Dental fluorosis is a developmental problem. Enamel defects can form in developing teeth if a person is exposed to a high level of fluoride during the time that their teeth are developing. However, it doesn’t effect teeth that have already developed (e.g.–in an adult). This is a fact that can be verified on Wikipedia or any other medical website. Yet our journalist who wants to tell both sides of the story didn’t know that and was, in fact, concerned about it for themselves. A science journalist with clear biases that hasn’t done the basic research can do a lot of damage by simply not knowing the truth about their subject.

On the other hand, the “controversy” is much easier to find. Anti-fluoridation groups make up as much of the first page of a Google search for”water fluoridation” as straight up information sources. The movement against water fluoridation is getting its story out very well, while the boring and decades old success story of public water fluoridation doesn’t have that many blogs and websites dedicated to its advancement. The internet has allowed anyone with an idea and a way to get online the chance to disseminate whatever information they like, whether it is accurate or not.

To their credit our hopeful journalist was seeking out a dentist’s input on fluoride. When asked, “have you heard of the arguments made by the anti-fluoridation movement and do you think they have any merit” I answered like this:

“Yes, I have read about some of the arguments made by the anti-fluoride movement. I think it is legitimate to be concerned about ingesting too much fluoride. But I find most of their arguments to be based in emotion and lacking scientific credibility. Fluoride is present in all water sources. ‘Fluoridation’ is actually more ‘fluoride optimization.’ Some communities with public water supplies have optimized the levels of fluoride in the water supply for dental health. In some cases that means removing fluoride and in some cases that means adding it. Much of the concern of those opposed to fluoride in the water is based upon the idea that it is poisonous and damaging. Fluoride is toxic in chronic high doses. It can cause problems in brain development, problems in bone and tooth development, kidney injury and in certain cases thyroid problems. These injuries happen at high doses over a long period of time. Optimal fluoride (1ppm) is well below a dose that could cause these kinds of problems. Much of what the anti-fluoride groups claim is an extrapolation: since fluoride can cause these problems, it is toxic and poisonous at any level. Toxic effects from anything are dose dependent, and thus optimal fluoridation is safe.

There is overwhelming evidence that optimal fluoride reduces dental disease in a population. Occasionally the anti-fluoride movement will point to research that questions this, but the studies that they tout are usually questionable in their design or interpretation. There is overwhelming scientific support for the use of fluoride in the water supply as safe and effective as well as cost effective on a community wide basis.”

You cannot give “both sides” of a story like this without at least a cursory review of the scientific literature. The water fluoridation issue reminds me a lot of the vaccination issue. For some, the public health gains we’ve achieved with vaccinations are only now being appreciated by people for the fact that many vaccine preventable illnesses are coming back with a vengeance. I only hope that’s not how it goes with public water fluoridation.

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12 Comments

  1. First, I’m glad to see you’re writing again. Second, you’ve published a thoughtful and outstanding response to the student’s questions.

    The fluoride debate is unfortunate, but it’s difficult to educate or persuade the skeptics when television and the internet have more authority over that “facts” than scientific journals.

    Thanks again for sharing.

  2. Actually, the science supporting fluoridation is very weak. See: York Review “What we Really Found” http://www.york.ac.uk/inst/crd/fluoridnew.htm

    Also,National Institutes of Health NIH Consensus Statement on Diagnosis and Management of Dental Caries Throughout Life (2001) – “… the (NIH) panel was disappointed in the overall quality of the clinical data that it reviewed. According to the panel, far too many studies were small, poorly described, or otherwise methodologically flawed” (over 560 studies evaluated fluoride use).

  3. This is a great summary of scientific facts about fluoride—one that I wish everyone would read. Anything can be harmful in a high enough concentration, but the amount in our drinking water is both safe and beneficial for our oral health. It’s sad when people disseminate false information just to cause a stir. When in doubt, ask your dentist, orthodontist, and family doctor if you have concerns!

  4. Hi,
    Really enjoyed reading it, a unique content about some social issue, we must check the content of fluoride to avoid various oral problem and must need a awareness among the people about the effect of fluoride on our health.
    Thanks

  5. Great post Alan. Dose means everything. There’s a cost/benefit ratio to nearly everything we do. I find it interesting that I rarely hear anti-fluoride groups proposing the removal of all natural occurring fluoride from all public water supplies.

  6. Great to see that you’re responding to public emails and publishing positive response on your blog.
    Its quite important to spread awareness about how fluoride fight against decaying of teeth, as its not that easy.