Don't take fluoride out of the water

It was in the early 1900s in the American Southwest that fluoride in the water was first identified as greatly reducing dental decay. Unfortunately, most areas of the country don't have naturally occurring fluoride and have to add it to the water.

In Lee County, our naturally occurring fluoride has decreased as we have had to dig deeper to get our water. We have had to add fluoride to the water.

The benefits of adding fluoride to the water are clear. There is a 20-40 percent reduction in cavities, a statistical result that has been demonstrated in multiple scientific studies done over the last 50 years. It is no surprise that the toothpaste you buy at the supermarket has fluoride in it. The American Academy of Pediatrics and the American Dental Association even recommend supplementing fluoride for children who may live on well water or in areas where there is inadequate fluoride in the water.

Adding fluoride in the water is a simple no-brainer, which makes it interesting that it has also been the cause of so much debate. Portland's City Council, with the support of every major medical and public health group in their area, voted in 2012 to add fluoride to the city's water.

Unfortunately, in 2013 anti-fluoride activists forced a public referendum and the voters decided not to fluoridate the city's water.

The Bonita Springs water board last year quietly voted to remove fluoride from the water, going so far as to politely decline multiple offers from the Lee County Dental Association to provide board members with data on the benefits of fluoridation. Pinellas County voted in 2011 to remove the fluoride from the water, and then did an about face in 2013. Nationwide, between 60-80 percent of the U.S. population drinks fluoridated water.

Here in Lee County, we've been adding small amounts of fluoride to the water for years, as the naturally occurring fluoride has decreased with the need for deeper and deeper wells. The deeper water requires more filtration to remove salt and other contaminants, removing fluoride as well.

There is a rumor afoot of an effort to try to convince our good county commissioners to remove fluoride from our drinking water. This would be a huge mistake!

Oral bacteria eat sugars and other carbohydrates, producing acid. There is an ongoing battle in your mouth right now between the de-mineralization of your teeth by acids, and the re-mineralization of your teeth as they try to repair themselves. Cavities occur when the de-mineralization occurs more quickly.

Fluoride in the water results in low levels of fluoride ions in the mouth that form an acid resistant surface on the teeth. The most important time for fluoride's effects is when the teeth are developing and coming in during childhood, although the continued exposure to low amounts of fluoride is important throughout adulthood. A rough estimate nationwide is that the average adult ingests about 0.6 milligrams per day of fluoride naturally, and in areas of water fluoridation that goes up to 2 milligrams per day — such a small difference that results in 20-40 percent reduction in dental cavities, pretty impressive.

Dental cavities disproportionately affect the children and the poor. If I don't want fluoride in my water, I can always buy a simple filter in my home. However, if fluoride is removed from the water in Lee County, those most in need will be the least likely to participate in the political process or be able to afford fluoride supplementation.

True, too much fluoride in the water during early childhood can result in staining of the teeth. If you're interested in the details, the optimal concentration of fluoride is 0.7 to 1.2 parts per million. The equipment used by Lee County Utilities controls that level very carefully.

More serious claims argue that fluoridation can result in lower intelligence levels or even cancer. Studies from Australia, Europe, and the Americas have failed to show any consistent basis for these claims. Unfortunately, even in our own media, there is a tendency to highlight controversial claims rather then the basic scientific facts.

Unfortunately, the largest threat to the continued fluoridation of our water in Lee County may be the lack of interest by the general public. So ask your dentist, ask your physician, and stay informed.

— Andy Oakes-Lottridge, MD, FAAFP, with Private Physicians of South-West Florida. The first concierge medicine practice in Florida, est. 1998. E-mail: DrAndy@PvtMD.com or call 239-415-1111.