A Cri De Coeur for Keeping Fluoride in Water

Medscape

2 days ago

In 1728, in 'Le Chirurgien Dentiste' (The Surgeon Dentist), Pierre Fauchard — widely regarded as the father of modern dentistry — referred to significant frustrations from the 'rise of people who without theory or experience' and 'without principles or method' degraded the practice of dentistry.
Today we face similar frustrations as America stands on the precipice of discontinuing water fluoridation. This deconstruction of dental decay prevention will exert a negative effect on the cardiovascular health of our nation. I will make the cardiology case for water fluoridation referencing scientific studies, dental experts, and George Washington's dentures.
George Washington's dentures
Why Cardiologists Should Care About Cavities and Fluoridation
The evidence linking dental maladies to vascular disease is overwhelming to me. Beyond tooth loss, dental pain and the inability to masticate for nutrition, periodontal disease is associated with a 3.5 fold increase in atherosclerosis and an increase in the risk for acute cardiovascular events.
Although far from proof of causality, a study of 101 patients who underwent coronary stenting for myocardial infarction (MI), found concentrations of bacterial DNA were 16 times higher in coronary thrombi than in serum blood samples. And the bacteria were those typical for endodontic infections in 78% of thrombi with other periodontal pathogens detected in 35%. Thirty of these patients underwent panoramic tomography revealing a significant association between the presence of dental abscess at the root of the tooth and DNA-positive thrombi.
Atheroma, plaque rupture, and gum disease share systemic inflammation as a common driver. Periodontal disease is linked to a more atherogenic lipid profile, particularly smaller, denser, LDL cholesterol. There is also a linear association between the severity of periodontal disease and carotid intima media thickness, an accepted predictor of MI and stroke. Conversely, the treatment of severe periodontal disease has been noted to improve lipid profile and endothelial function.
I attended a meeting years ago organized by Bradley Bale, MD, and Amy Doneen, co-authors of 'Beat the Heart Attack Gene'. They described several patients who had an MI despite having few or no known cardiovascular risk factors. Many were found to have severe dental disease. One such patient underwent coronary artery bypass grafting and then, several weeks later, required emergency coronary stenting. Advanced dental imaging revealed teeth in need of extraction. Interestingly, elevated pro-inflammatory markers normalized several weeks post extraction. Bale and Doneen concluded that 'The oral systemic connection is actually even more important than we realized' and suggested that any medical office visit should include a discussion on the importance of good dental health. Perhaps the finding of significant periodontal disease should prompt referrals for coronary screening as well.
Pikes Peaks and The Origins of Water Fluoridation
The story of how fluoride ended up being added to US water supplies begins in the 1800s. This is when Frederick McCay established a dental practice in Colorado Springs where nearly 90% of children exhibited chocolate brown dental staining. Despite the off-putting appearance, those children's teeth rarely developed cavities. McCay suspected the water but it took chemist H.V. Churchill and his new photospectrographic analysis to confirm the cause as high concentrations of fluoride in the drinking water sourced from the Pikes Peak Region and its magma infused granite. By the 1930s it was proven that a fluoride concentration of up to 1.0 part per million (ppm) would not induce changes in the enamel color. In 1945 the fluoridation of water began in Grand Rapids Michigan and after just 10 years it resulted in a 60% reduction in dental cavities among children.
This practice is perhaps our country's best effort to level the playing field in a nation of health disparities. In 1999, the CDC listed water fluoridation as one of the 10 greatest health accomplishments of the 20th century. Just over 70% of the US population have access to fluoridated water, but that is changing. Fluoridation has become a political hot-button topic.
Fluoride in The Firing Line
In April, Health and Human Services Secretary, Robert F. Kennedy Jr, praised Utah 'as the leader in making America healthy again' after it banned water fluoridation. He called fluoride a 'dangerous neurotoxin,' ignoring the fact that neurotoxicity occurs at levels well above current recommendations.
In early May, Florida Governor Ron DeSantis signed a bill into law that bans ' certain additives' in the water system, which would include fluoride — ending a practice that dates back to 1949.
Many cite the US-based study of 220 mother-child pairs, MADRES, to make their antifluoridation case. The study compared maternal spot urine levels of fluoride to child behaviors and found that children were nearly 2-times more likely to show behavioral problems for every additional 0.68 mg/L of fluoride they were exposed to in utero.
However, the behaviors examined were self-reported by parents, and there were potential confounders. Additionally, only a single spot urine was obtained during the third trimester of pregnancy which does not reflect daily changes in dietary intake or exposure. Yet, headlines screamed 'Fluoride levels impact the developing brains of children.'
Proponents of banning fluoride from drinking water also cite a 2024 report by the National Toxicology Program. It summarized studies in Canada, China, India, Iran, Pakistan, and Mexico and concluded that water fluoride levels above 1.5 mg/L were associated with lower IQ in children. There was not enough data to determine if the current recommended maximum level for US community water of 0.7 mg/L has a negative effect on children's IQ.
In response, Mary Beth Giacona, an assistant professor of pediatric dentistry at Rutgers School of Dental Medicine, Newark, New Jersey, told Rutgers Health that 'Most people proclaiming the dangers of fluoride are referring to studies that were done outside the United States, in areas where naturally high levels of fluoride are present in the water people drink.' She pointed out that the US fluoride maximum is even lower than the World Health Organization's recommended maximum of 1.5 ppm.
In a statement from the American Dental Association (ADA), President Linda J Edgar, DDS, noted that 'The scientific weight of sound evidence around the benefit of community water fluoridation is clear and compelling.' In response to 'widespread misinformation circulating online,' the ADA urged its members 'to be cautious of pseudoscientific information.'
Some in the revolt against water fluoridation point to the loss of personal freedom, but many readily available bottled waters do not contain fluoride.
What Happens When Water Fluoridation is Abandoned?
We already know the future of communities without fluoridated water. In 2011, the Canadian city of Calgary stopped adding fluoride to its water. Fast forward to a study of more than 2500 second graders around 7 years after the ban which found that 65% had tooth decay vs 55% of a similar number of kids from Edmonton where fluoridation remained. Predictably, there was also an increase in the number of dental treatments requiring general anesthesia.
The town of Windsor, Ontario also learned the hard way. T he city council voted 8-3 to reinstate fluoridation 5 years after their own fluoride cessation program revealed a 51% increase in tooth decay requiring urgent care among children.
I was raised on a farm in Metcalfe County, Kentucky. Our family had no opportunity for 'city water' until my brother and I were in our teens. My family members have been saddled with a lifetime of dental misery at a cost of thousands of dollars despite many dental trays of grape-flavored gel to try and protect us. My children were raised on fluoridated water and thankfully have never experienced a cavity.
Scott Tomar, DMD, DrPH, a spokesperson for the ADA said by email that 'community water fluoridation benefits everyone – regardless of income, education, race – but especially those without access to regular dental care.'
My parents, my brother, and I sure could have used a generous helping of dental health equity back in the day.
Would George Washington Have Fluoridated the Potomac?
Which brings me to George Washington's dentures. When I first heard of the campaign to remove fluoride, I thought of our first president's fake teeth. I'd seen them in a display case at Mount Vernon. They are fashioned from a combination of animal and human teeth, as well as lead and ivory. Our tour guide mentioned Washington's diary entries of 'aching teeth, lost teeth, inflamed gums and ill-fitting dentures,' maladies that plagued him throughout adulthood. How different his life would have been if he had been blessed with fluoridated water as a child.
If the removal of fluoride from water becomes commonplace, our nation's cardiovascular and dental health will have been sacrificed on the altar of pseudoscience for a vote grab fueled by misinformation.
The aforementioned surgeon dentist, Pierre Fauchard, was said to have 'never departed from good sense and clear judgement.' In America, our teeth and our smiles could last a lifetime if only we would do the same.