‘Healthy Kids, Healthy Portland’ & Fluoride By The Numbers

Healthy Kids, Healthy Portland (HKHP), the group behind the campaign advocating to fluoridate the city of Portland, Oregon’s drinking water, has made a number of claims to justify their cause. Portland is the last major metropolitan city in the US to continually oppose the national trend of water fluoridation. On May 21st, 2013 Portland residents will again be asked to vote on the issue after a contentious decision by Portland’s City Council to fluoridate, with little regard for input from the public, was overturned via referendum last fall.

The issue of water fluoridation has struck a particular nerve with Portland citizens, who pride themselves on having some of the cleanest drinking water in the country. HKHP has based its entire campaign on what they claim is a dental health crisis in Oregon–a crisis that only fluoridation can solve. On the heels of this important decision, Portland residents must seriously assess whether or not the claims made by HKHP are valid.

Their first major claim is that the annual cost per Portland resident to fluoridate its water would be only $0.61. HKHP are pulling this figure directly from estimates provided to Upstream Public Health by the Water Bureau:

“It would cost $575,000 per year in annual costs (or less if different fluoride compounds are chosen). The Water Bureau estimates there are 932,000 water users, so this amounts to $0.61 per person per year.” [1]

What this claim conveniently omits is the estimated cost to the city to construct the fluoride delivery facility, which could reach upwards of $7 million dollars [2]. The City of Portland is still struggling to grapple with its $25 million dollar budget shortfall.

HKHP go on to claim that “35% of Oregon children have untreated tooth decay compared to only 15% of Washington children,” and that “from 2002 to 2007, untreated dental decay in Oregon jumped by 49%.” [3] The statistics for these claims are taken from Oral Health surveys conducted on a statewide level and cataloged nationally by the Centers for Disease Control (CDC) to measure the oral health of children, with participants typically ranging from kindergarten through third grade.

While it is indeed unfortunate that far too many Oregon children suffer from the perfectly preventable affliction of untreated tooth decay, we must be able to accurately identify the reasons for this if we should ever hope to address how to treat it. Pro-fluoride activists would like to insinuate that fluoride chemicals in drinking water, or lack thereof, are a contributing factor to unchecked dental decay, but what do the numbers suggest?

According to the CDC’s compiled data on states that have submitted records for untreated tooth decay in third grade students, Oregon sits fifth from the bottom at 35.4% [4]. Also, according to the CDC’s 2010 Water Fluoridation Statistics, the percentage of persons receiving fluoridated water in Oregon is 22.6%, making Oregon the least fluoridated state in the US that has submitted data on untreated decay [5]. So surely states with worse dental health numbers than Oregon have comparably low rates of fluoridation? Well….

Louisiana, with an untreated decay rate of 42% has 41% of its population drinking fluoridated water. Arizona, with an untreated decay rate of 40% has 57% of its population drinking fluoridated water. New Mexico, with an untreated decay rate of 37% has 77% of its population drinking fluoridated water. And Texas, with the highest untreated decay rate of 43% has 80% of its population drinking fluoridated water. Kentucky, the state who sits just ahead of Oregon in its dental health numbers with an untreated decay rate of 34.6% has a whopping 99.9% of its population drinking fluoridated water! New York, who sits just ahead of them with an untreated decay rate of 33% has 75% of its population drinking fluoridated water. The numbers posted off the CDC’s own website suggest no correlation between the percentage of persons drinking fluoridated water with a lowered rate of untreated dental decay.

Even in states with relatively low rates of untreated dental decay, the individual cities within them, fluoridated or not, do not necessarily reflect the state average. For instance, take the cities of Milwaukee, Wisconsin, and Las Vegas, Nevada, two fluoridated cities that according to 2010 population statistics rank the closest in size to Portland [6]. Wisconsin had an untreated dental decay rate of 20%, with 88% of its population receiving fluoridated water. But statistics from the 2008 Make Your Smile Count survey showed “children in Milwaukee (Wisconsin) to have an untreated decay rate of 37.5 percent, far higher than the state average of 20 percent,” [7] and in 2012 Milwaukee’s City Council actually directed the Milwaukee Water Works to lower the concentration of fluoride in the city’s drinking water [8].

According to the CDC, Nevada’s untreated dental decay rate is 28%, with 73% of its population receiving fluoridated water. But according to a joint United Way and Nevada Community Foundation study, in the city of Las Vegas, Nevada, untreated dental decay among third-graders sits at an alarming 38.9% [9].

And this brings us back to Portland, a city that despite not fluoridating its water has an untreated dental decay rate of 21% [10], a figure that’s lower than the national average of untreated dental decay and a figure that actually brings the statewide average of Oregon down, where Oregon children outside of Portland have a 44% rate of untreated decay [10]. HKHP actually admits to Portland’s low decay rate on their website, but frames it in a wonderfully deceptive way: “In the Tri-County area, 21% of children suffer from untreated dental decay – that’s double the rate of decay right across the river in Vancouver and forty percent more than Seattle.” [11]

Their implication being that fluoridated water is the cause of Washington’s better than average dental health numbers. But again, despite Clark County Washington, where Portland’s closest neighbor city of Vancouver resides, having only 10% untreated decay in its children surveyed [12], 48% of its residents have access to fluoridated water [13], a figure which is lower than Washington’s overall fluoridation average of 64.6%, and dramatically less than the 80% fluoridated King County, the county the city of Seattle resides in, whose decay rate is 15%.

The totality of “evidence” presented in the 2010 King County Smile Survey that focuses on water fluoridation’s role in public health takes up a whole two sentences:

“Children in King County continued to have less dental disease than did children in other areas of Washington State. 80% of King County residents have access to fluoridated water, which probably contributed to the better oral health status of King County children.” [14]

Of course “probably” is not exactly a scientific standard in the strictest sense. One interesting thing to note about the findings in the King County Smile Survey is the rates of Dental Sealants in third grade students remained significantly higher in King County than in the rest of Washington State.

Dental sealants are thin plastic coatings that are applied to the grooves on the chewing surfaces of the back teeth to protect them from tooth decay. Most tooth decay in children and teens occurs on these surfaces. Sealants protect the chewing surfaces from tooth decay by keeping germs and food particles out of these grooves. The rates of dental sealants among third-graders in King County were 63%, as opposed to 51% for Washington State [15]. Incidentally, only 43% of Oregon’s third-graders have these dental sealants [16]. However, more than half of the third-graders surveyed in Portland – 51% – have dental sealants [10].

The sad, yet all too frequent re-occurring theme in every one of the statewide oral health surveys is the fact that children from low-income families, children of color, and children whose primary language is not English have dramatically higher rates of untreated dental decay. Despite being largely fluoridated for decades, Washington State had higher rates of dental disease across the board in 2005 until efforts were made to increase access to care and prevention. Once those measures were put into place, untreated decay rates among low-income preschoolers dropped by 50% within 5 years [17]. The advocates for community water fluoridation, a euphemism they like to substitute for what it should be called–the disposal of industrial waste [18]–seem more intent on dispensing an outdated placebo that modern science has categorically proven poses negative health risks [19], than taking meaningful, evidence-based measures on treating Oregon’s dental health problems.

When it comes to the practice of water fluoridation and the numerous reasons why it needs to be rejected, perhaps the most fundamental reason of them all, a reason that cannot be stressed enough, is the fact that it violates one of the most basic principles of medicine: a patient’s informed consent. The fluoride added to drinking water meets every legal definition of a drug. The fluoride added to dental products is strictly regulated by the Food and Drug Administration, yet what is added to municipal water is not overseen by any regulatory government agency. Fluoride is not a nutrient, it is not an essential mineral, and it is not added to make drinking water potable. Fluoride is added to treat people under the banner of it having a medicinal purpose. All medicines prescribed by doctors have a specific dosage based on the nature of the problem, age, gender, existing medical conditions, treatment, and consent of the patient. Water fluoridation is the mass medication of an entire population without any medical diagnosis whatsoever and without any regard for dosage, consent, or case specifics of the individual.

The precautionary principle states: “If an action or policy has a suspected risk of causing harm to the public or to the environment, in the absence of scientific consensus that the action or policy is harmful, the burden of proof that it is not harmful falls on those taking an act.” [20] Even if one were to shrug off the ethical concerns of water fluoridation and were to believe that the practice has some public health benefit, it would be irresponsible to jeopardize the health of an entire community in the absence of any scientific consensus that the practice is either safe or effective. This is why I am urging all Portland citizens to reject the fluoridation of its water and vote No on Measure 26-151 this May.

Documentation

1. Healthy Kids Healthy Portland
http://healthykidshealthyportland.org/endnotes/#why-fluoride

2. Fluoride would cost $5 million and take 5-plus years: Portland City Hall roundup
http://blog.oregonlive.com/portlandcityhall/2012/08/fluoride_would_cost_5_million.html

3. Healthy Kids Healthy Portland – the crisis
http://healthykidshealthyportland.org/the-crisis/

4. CDC, National Center for Chronic Disease Prevention and Health Promotion – Percentage of 3rd Grade students with untreated tooth decay
http://apps.nccd.cdc.gov/nohss/IndicatorV.asp?Indicator=3

5. CDC – 2010 Water Fluoridation Statistics
http://www.cdc.gov/fluoridation/statistics/2010stats.htm

6. Water Fluoridation Status Of The 50 Largest Cities In The United States

Click to access US-Cities-Fluoridation.pdf

7. Making Milwaukee Smile 2011, p.2

Click to access MMSreport12.11.pdf

8. JSOnline – Council reaches compromise on fluoride issue
http://www.jsonline.com/news/milwaukee/council-reaches-compromise-on-fluoride-issue-hn681rt-163587656.html

9. PR Newswire – At Risk Children Receive Free Dental Services at Communities In Schools Clinic
http://www.prnewswire.com/news-releases/at-risk-children-receive-free-dental-services-at-communities-in-schools-clinic-85004707.html

10. Oregon Smile Survey 2007; p.12

Click to access smile_2007.pdf

11. Healthy Kids Healthy Portland – FAQ
http://healthykidshealthyportland.org/frequently-asked-questions/

12. Smile Survey 2010 The Oral Health Of Children In Clark County, Washington; p. 5

Click to access ClarkCounty2010Report_final.pdf