OPINION – November 28, 2012 -- I have been a general dentist for 36 years, graduating from Northwestern University Dental School in the fluoridated city of Chicago. I practiced in Chicago for 4 years before moving to Portland in 1980. I retired from my clinical practice at the end of 2008 and now devote my time volunteering my dental skills to low-income children and adults.
Part of my time in Chicago was devoted to treating the poorest of the poor citizens. I was somewhat ambivalent about fluoridation, because, guess what, poor people got the most cavities. It wasn't until I relocated to Portland that I realized first-hand that fluoridation made a difference. I saw more cavities and fillings in adults and more early childhood cavities in children. For the first time in my career I saw a 20 year old in a full denture.
Cavities are a preventable disease, but to have good oral health, one needs education, prevention, and access to care. If one has all three factors, there is an excellent chance that one will grow up with excellent oral health. I have raised 2 daughters, now age 29 and 25, in non-fluoridated Portland, and they have had one cavity between them. But the low-income children I see today, who did not choose their parents or what socio-economic class they were born into, suffer disproportionately.
Fluoridation is a 20th Century adaptation of a naturally occurring process. Fluoride is the 13th most common element in the Earth's crust, and all water has some fluoride in it, even Bull Run (0.1 parts per million- ppm). It has never been stated that fluoridation is the sole cure for oral disease, but rather the "foundation" of a sound dental public health policy. What so many people in our community want to do is to adjust the level upwards to 0.7 ppm, the optimal level for oral health.
Public health has the goal of improving the health of a population, not of a specific individual. It values the collective good of society. There are three criteria to justify a public health measure: 1) reduction of ill health; 2) reduction of health disparities; and 3) concern for children who constitute a vulnerable group. What makes fluoridation an ideal public health measure is that it reaches all members of society, regardless of age, race, nationality, sex, and socio-economic class.
Yes, there are other vehicles to deliver fluoride to an individual: toothpaste, rinses, varnish, supplements, but they all require compliance. I promote the judicious use of them all, especially supplements for my low-income school children patients in Portland Public Schools. However, the fluoride supplement program is only from K-5th grade, and I hear feedback from children that teachers forget, some kids hide them or throw them away. Parents have to sign a permission slip at the beginning of the year. Yet, in some low-income schools, class turnover can be upwards of 33%, and their permission slips do not transfer to the new school. The school supplement program also misses the summer months, pre-school, middle school, and high school when oral health is critical in determining one's oral health status into their adult years.
For the past 13 years, I have been studying the science, the politics (yes, politics), and the arguments made by fluoridation opponents. Their goal is to create fear and doubt in the general public whenever fluoridation is recommended in a community. Their allegations change from year to year, they are disproved by medical and scientific experts, they disappear, only to get recycled years down the road.
Opponents of fluoridation say it violates their personal freedom and doesn't give them the choice on whether fluoride is in their water. I respond to that accusation by sharing a quote by Dr. John Harris of the Department of Ethics and Social Policy at the University of Manchester:
“We should ask not are we entitled to impose fluoridation on unwilling people, but are the unwilling people entitled to impose the risks, damage & costs of the failure to fluoridate on the community at large? When we compare the freedoms at stake, the most crucial is surely the one which involves liberation from pain and disease.”
67 years of practical experience and over 3000 studies have demonstrated that fluoridation is safe, effective, and socially equitable. It will help remove the environmental stress caused by oral disease for those low-income children so that they, too, can have the opportunities to enjoy the American dream. More importantly, fluoridation will benefit everyone, not just children.
Today, 204 million Americans enjoy the public health benefit of fluoridation. It's time to see Portland join the rest of the U.S. and move forward with implementing water fluoridation.
Dr. Ferré volunteers weekly on a Medical Teams International mobile dental unit and is the volunteer dental director and president of the board for the Creston Children's Dental Clinic in SE Portland.