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More Americans Drinking Fluoridated Water

Rates up slightly, but U.S. finds some states lagging

THURSDAY, Feb. 21, 2002 (HealthDayNews) -- Almost two out of three Americans who drink public water are now getting ample fluoride from the tap.

The Centers for Disease Control and Prevention (CDC) announced the rise today, saying that 162 million Americans who are served by public systems now have the added mineral, which reduces the risk of cavities and other dental problems.

The new report, appearing in the CDC publication Morbidity and Mortality Weekly Report, calls the rise "modest progress." It says 65.8 percent of the population on public systems drink fluoridated water; in 1992, the rate was 62.1 percent. The report doesn't count private sources of water, such as wells.

Although the dental community has long embraced fluoride, which promotes the growth of strong teeth and prevents their decay, some community groups have tried to keep the element out of the water supply. Critics claim fluoride is linked to a range of health problems, from high blood lead levels to early menstruation.

At high doses, fluoride can harm tooth enamel, but most scientists dismiss the more serious claims as fear-mongering. Fluoridation is "eminently safe," says Dr. Herschel Horowitz, a public health dentist in Bethesda, Md., and a spokesman for the American Dental Association.

The new report shows that 26 states and the District of Columbia now meet the government's 2010 guidelines for fluoridation, which call for 75 percent of residents to receive optimal levels of the mineral through public water supplies. Optimal levels range from 0.7 parts per million to 1.2 ppm, depending on how hot the days get in a given area.

Between 1992 and 2000, five states -- Maine, Delaware, Missouri, Nebraska, and Virginia -- reached the 75 percent goal and a sixth state, Oklahoma, came close.

Fluoridation rates in 2000 ranged from 2 percent in Utah to 100 percent in the District of Columbia, where all of the city's 595,000 residents have access to amply fluoridated public water.

Dr. William Maas, head of the CDC's oral health division and a co-author of the new study, says Utah should improve with the next report. Three of the state's largest counties recently approved fluoridation measures and are now hashing out how to implement the policies.

Other laggards include Hawaii, at 9 percent -- down from 13 percent in 1992 -- and New Jersey, at 15.5 percent, off 0.7 percent from the last report.

Maas says states with low coverage may have "incorrect perceptions" that dental caries -- like cavities and tooth decay -- are no longer a problem. They may also be held sway to politics and "unsubstantiated claims" that fluoridated water is harmful, he adds.

However, Maas says, there is "no credible evidence" of any adverse effects from exposure to the mineral in water at levels the government considers safe and therapeutic.

Fluoridation, he adds, is among the most cost-effective ways of reducing the risk of dental caries. The CDC says it costs 72 cents per person a year to fluoridate water, while the average price of a single filling can run $80.

Fluoride opponents railed at the latest findings.

Paul Connett, a chemist at St. Lawrence University in Canton, N.Y., says the guidelines for fluoridating water are based on "outdated" and "outrageously bad science" that ignores the health risks associated with the element.

Connett, founder of Fluoride Action Group, an anti-fluoride coalition, says the government is refusing to acknowledge its error for several reasons, including what he terms the potential liability of having so long recommended a toxic substance. He also says fluoridation is a convenient distraction from the country's real oral health problems: "We're stuffing the sugar down our kids' throats," and poor people have "lousy, lousy dental protection."

But Horowitz dismisses those claims and calls the findings "good news." While "the increase in the last eight years as a percentage isn't great, it's a step in the right direction. It's certainly known that communities benefit from having their water fluoridated."

Dental caries among school children have fallen by more than 60 percent since the early 1970s, before fluoridated public water became widely available, he says. Although some of that gain can be attributed to better brushing habits and the addition of fluoride to toothpaste, much is due to drinking water.

Rather than fret about the alleged risks of fluoridation, dentists are more concerned about the wave of interest in bottled water, little of which contains the tooth-protecting element.

Bottled water consumption in this country has surged from nine gallons per capita in 1990 to more than 18 gallons a head in 2000, the last year for which figures are available, says Stephen Kay, a spokesman for the International Bottled Water Association in Alexandria, Va. Three years ago, there were at least 280 brands of bottled water available in the United States.

Kay says at least 20 brands of bottled water sold in this country contain fluoride, but the group has no breakdown for how much of this is sold each year. The average American drinks 3.6 servings of tap water and 1.7 servings of bottled water a day, Kay says.

What To Do: To find out more about the benefits of fluoride for your teeth, try the American Dental Association or the Centers for Disease Control and Prevention.

SOURCES: Interviews with William Maas, D.D.S, M.P.H., National Center for Chronic Disease Prevention and Health Promotion, Atlanta; Herschel Horowitz, D.D.S., M.P.H., spokesman, American Dental Association, Bethesda, Md.; Stephen Kay, spokesman, International Bottled Water Association, Alexandria, Va.; Paul Connett, Ph.D., professor of chemistry, St. Lawrence University, Canton, N.Y.; Feb. 22, 2002, Morbidity and Mortality Weekly Report
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