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Guest commentary / Dental health

Flouridated water a safe, low-cost public health tool

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By Dr. Gary Goldbaum and Stephen J. Lee, DDS
Opinions about the safety of our community's drinking water were expressed in the March 24 guest commentary, "Fluoridated water supply: Utility should have to prove its safety." We'd like to present the facts.
Twenty years ago this spring, the City of Everett began adding fluoride to its public drinking water. Fluoride exists naturally in virtually all water supplies. Water is "fluoridated" when a public water system adjusts the fluoride to a level known to prevent tooth decay. Fluoridation is simple, safe and inexpensive, and has contributed significantly to the remarkable decline in tooth decay in the United States since the practice began in 1945.
From the early 1970s to the present, the proportion of adolescents with tooth decay has decreased from 90 percent to 60 percent. Among adults the number of teeth with cavities decreased from 18 to 10. Although these are notable declines in tooth decay, it remains the most common chronic disease of childhood.
Even with water fluoridation, 19 percent of Snohomish County children have at least one untreated cavity by age 9 (Snohomish Health District "Smile Survey 2010"). Consider the lifetime effects of cavities: the initial costs of a filling, the cost of repeated and larger fillings required over time and the risks of anesthesia. In an era of reduced severity of tooth decay, we forget that children can die from untreated dental infections and that childhood cavities can have lifelong health impacts and costs.
Improving dental health is the reason Everett water fluoridation began in 1992 after a successful public vote on the issue. The commitment to community health continued when voters soundly defeated a measure by opponents to stop fluoridation. Everett's system is the source of about 75 percent of Snohomish County's drinking water.
The Centers for Disease Control and Prevention named community water fluoridation one of the 10 great public health achievements of the 20th century. Community water fluoridation is currently endorsed by more than 100 health, science and children's organizations including the Environmental Protection Agency, American Academy of Pediatrics, the American Medical Association and the American Dental Association.
Today, Americans have access to more fluoride than they did in the 1940s, which causes some to wonder whether we still need fluoridated water. The answer is yes. Although other fluoride-containing products like toothpaste are available, water fluoridation remains the most cost-effective method of delivering fluoride to all members of a community, regardless of age, educational attainment or income level. It provides the greatest benefit to those who can least afford preventive and restorative dentistry and reduces dental disease, loss of teeth, time away from work or school, and anesthesia-related risks associated with dental treatment.
Affordable dental care was identified as the largest health care need in the 2011 Snohomish County Human Services Needs Assessment. Community water fluoridation costs about $1 per person per year, and saves $38 for every dollar invested.
More than 3,000 scientific studies have proven that appropriate fluoridation strengthens teeth by re-mineralizing them. The result is reduced dental decay -- and mild fluorosis in less than one in four people. The minor changes in the tooth surface caused by fluorosis are not detectable by the average consumer or considered unsightly. Fluorosis is not a health issue, but cavities are!
The City of Everett takes great care to ensure its fluoridated drinking water meets all national health and safety standards as set by the Environmental Protection Agency, Department of Health and Human Services and NSF. Everett follows the American National Standards Institute standards for the purity of fluoride used in our drinking water and there have been several reviews of fluoride safety by the EPA
The benefits of fluoridation are not impacted by short-term interruptions in service. The city of Everett temporarily stopped fluoridation last month as part of planned maintenance. The system will go back online early this month, once again providing Snohomish County residents with a safe, effective and low-cost way to prevent tooth decay .
To learn more about the benefits and safety of public water fluoridation, visit

Dr. Gary Goldbaum is health officer & director of the Snohomish Health District. Stephen J. Lee, DDS, is president of the Snohomish County Dental Society.

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