By Delaine Eastin; Rick Baker, M.D.; Constance J. Caldwell, M.D.; and Bette Hinton, M.D.
Public health work, at its best, goes largely unnoticed; hand-washing campaigns and crusades for more sidewalks do not warrant front-page news coverage.
However, issues occasionally come along that pull public health to the surface. One such issue is coming down the pipeline — our water pipeline, to be precise. Now that the two largest cities in Yolo County, Davis and Woodland, have elected to move forward with a surface water project, the time is right to fluoridate our public water supply. In doing so, we would join the more than 200 million Americans who reap the oral health benefits of drinking fluoridated water.
The positive health effects of fluoride have been recognized since the 1930s. Epidemiologists found that populations with higher concentrations of the naturally occurring mineral in their water had a lower prevalence of tooth decay — more than 50 percent lower, which from a scientific perspective is enormously significant. When case studies soon thereafter provided the causal link between fluoride and good oral health, communities began fluoridating as early as 1951.
It was found that fluoride benefits not only the body, but the budget as well. With respect to cost savings, the intervention is unparalleled: Every $1 invested in fluoridation saves $38 in dental costs. Despite increasingly dilute opposition, fluoridation has garnered a flood of support as a safe and valuable public health measure from scientists and health experts the world over.
Much of the polemic surrounding fluoride is too shallow to encompass the core issue: Fluoridation is clear-cut social justice. Fluoride in the water improves the oral health of everyone with teeth, regardless of age, income or access to dental care. Recent statistics highlighting 26 percent of Yolo County children with untreated dental decay reveal a sizable population among us with mouths less than excited to smile. Many of these children are absent from school and adults with similar afflictions miss work. Extrapolating from national rates, more than 41,000 work hours and 21,000 school hours were lost last year in Yolo County due to oral health issues.
West Sacramento made the decision to fluoridate its water supply in 2008 and, since that time, preschoolers have seen a 17 percent reduction in frequency rates of visible or urgent decay — a faster rate of decline than in any other city in the county. Now that’s something to smile about.
In addition to children, senior citizens present another priority population. As we age, performance of self-care tasks like tooth brushing declines, and receding gums expose more of our tooth surface to the risk for decay. Research validates that fluoride helps to protect the elderly against these demographic-specific risks.
It gets better. Water fluoridation also serves those living in our cities who do brush twice daily, floss regularly and visit the dentist every six months. The American Dental Association cites peer-reviewed studies indicating that water fluoridation contributes to a 20 to 40 percent decline in tooth decay even in populations with widespread exposure to fluoride from other sources. These other sources include fluoride in toothpaste, food and dental varnish.
Yet, not all people brush their teeth equally, have the same diet, can afford to visit the dentist or remember to take prescribed fluoride pills. Because we all must drink, fluoridating a community’s water supply offers the highest level of protection for the largest number of people. All 120,000 residents of Davis and Woodland stand to win.
We are all currently exposed to fluoride because of the naturally occurring fluoride in the existing water supply and foods — but not the optimum amount to prevent cavities. While many would survive comfortably if optimum fluoride remained a privilege of the wealthy, many in our midst would not.
By supporting community water fluoridation, we are not imposing a danger upon unwilling people, as opponents may claim. In 1973, the California Court of Appeals case Beck v. City Council of Beverly Hills concluded that: “Courts through the United States have uniformly held that fluoridation of water is a reasonable and proper exercise of the police power in the interest of public health. The matter is no longer an open question.”
Not only is fluoridation a legal governmental exercise, it is responsible one. Rather, it is by neglecting fluoridation that we are imposing risk and cost on those who can endure it least, such as children of low-income families and seniors. Indeed, of the liberties at stake, the more imperative is surely the emancipation from illness and suffering. The public health community and Supreme Courts have unwaveringly adopted this stance.
To ignore an opportunity as cost-effective, health-protective and scientifically supported as community water fluoridation would be to send a great public health opportunity for Yolo County, quite literally, down the drain.
— Delaine Eastin is a retired California superintendent of public instruction; Rick Baker, M.D., is a First 5 Yolo commissioner; Constance J. Caldwell, M.D., is Yolo County’s current health officer; and Bette Hinton, M.D., is Yolo County’s former health officer.