Historic Early Endorsement of Community Water Fluoridation

Carstairs’ review of the history of community water fluoridation (CWF) prior to 1964, argues that “some early concerns about the toxicity of fluoride were put aside as evidence,”^1(p1559) and that proponents of CWF were “too hasty in declaring that water fluoridation was the best (or only) solution for dental decay.”^1(p1567)

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Carstairs’ evidence about toxicity is based on opinions of Alfred Taylor, Margaret and H. V. Smith, and Robert Harris, who testified before the Delaney Committee in 1952.² Alfred Taylor reported a higher mortality of rats that were fed fluoride.³ His work was considered by both Trendley Dean, from the National Institute of Dental Research, and Howard Andervont, from the National Cancer Institute, who went to Texas, looked at Taylor’s data, and found that he was feeding rats extremely high amounts of fluoride, unrelated to use in CWF (one ppm), invalidating his conclusions.

Smith and Smith focused on the risk of enamel fluorosis (mottling), influenced by their experience in Arizona with localities where water contains in excess of optimal fluoride levels and high average daily temperatures.² These concerns were not ignored; the US Environmental Protection Agency’s guidelines for optimal level of fluoride in drinking water took temperature into consideration.

Harris conceded that community water fluoridation reduced dental caries but questioned the safety of long-term ingestion of fluoride at one part per million.² Harris ignored published findings about health and morbidity of populations who had lifelong exposure to natural fluoride⁴ or the health of children growing up in the CWF city of Newburgh, New York.⁵

Carstairs believes that the US Public Health Service (PHS) was “too hasty” and should not have endorsed water fluoridation in 1950. The PHS decision to endorse CWF after five years of testing, rather than waiting for the 10-year data, saved thousands of teeth from extraction. At that time, no fluoride dentifrices were available, and caries accounted for frequent tooth loss. Long-term safety data existed from naturally fluoridated communities; PHS action was hardly precipitous. A long-term pediatric health study found no difference in the children in fluoridated Newburgh and nonfluoridated Kingston, New York, including height and weight measurements, urinary and blood analyses, x-rays for skeletal maturation, and ophthalmological and otological examinations.⁶ (Note that although this chapter was published in 1954, the data were presented at the American Association for the Advancement of Science meeting in December 1951 and were available at the time the PHS endorsed water fluoridation, albeit before the 10-year study was finished.)

By Carstairs’ reasoning, penicillin would not have been used by the military in the early 1940s on soldiers in WWII because of limited testing, although it saved thousands of lives.

In summary, the only question concerning fluoride toxicity at optimal levels for CWF relates to a small portion of the population—at that time about ten percent—developing questionable or very mild enamel fluorosis, a cosmetic issue and not an adverse health effect.