The “why” behind our fluoride policy

Denver Water’s board decided to continue community water fluoridation by weighing the evidence. Now you can, too.

August 26, 2015 | By: TAP Staff
Denver Board of Water Commissioner members listen to information at the July 2015 fluoride information session.
Denver Board of Water Commissioners listen to information at the July 2015 fluoride information session.

In the end, it came down to the science. And there’s a lot of it.

On Aug. 26, the Denver Board of Water Commissioners voted to continue its practice of community water fluoridation.

That decision was not entirely unexpected. Denver Water has been regulating fluoride in the water since 1953, but board members said they took opposition to the policy seriously and requested a review of the latest science from the foremost national and local authorities to inform our policy.

Fluoride naturally occurs in many of Denver Water’s supply sources. We add fluoride as necessary to achieve an average concentration equal to the target recommended by the U.S. Public Health Service and the Colorado Department of Public Health and Environment.

Earlier this year, opponents of water fluoridation began appearing at Denver Water board meetings, urging commissioners to end the practice. In response, the board held a fluoride information session on July 29 and encouraged public input. Many individuals and organizations submitted comments and reference documents.

“We are just trying to educate people on this issue,” said Greg Gillette, a spokesman for We are Change Colorado, a group urging Denver Water to stop adding fluoride to water. “We hope everybody has an open mind.”

After reviewing the presentations, the extensive research on this issue, and the advice of public health and medical professionals in Colorado, the board announced there would be no change in its water fluoridation policy.

The resolution the board adopted at its meeting stated: “Nothing we heard through the presentations or learned in research would justify ignoring the advice of the public health agencies and medical organizations or deviating from the thoroughly researched and documented recommendation of the U.S. Public Health Service.”

Denver Water Commissioner Greg Austin went on record saying, “After careful consideration of the information put forth by both sides of the fluoridation debate, I am convinced that the community water fluoridation level recommended by the U.S. Public Health Service provides substantial health benefits, and is a safe, cost-effective and common sense contribution to the health of the public.”

The research on fluoridation is quite extensive. Here’s a sample of what board members and Denver Water staff reviewed:

  • The work of the Federal Panel on Community Water Fluoridation. This group of physicians, epidemiologists, environmental health experts, dental professionals, toxicologists, statisticians and economists re-examined water fluoridation levels.
    • In 2011, the U.S. Public Health Service published a proposed recommendation based on the conclusions of that panel.
    • The Public Health Service then received thousands of comments opposing community water fluoridation, raising the same categories of objections as those submitted to Denver Water at our public forum and during the public comment period.
    • The Panel did not identify compelling new information to alter its assessment that fluoride levels of 0.7 milligrams per liter provide the best balance of benefit to potential harm.
    • In May 2015, the Public Health Service issued its final decision document, adopting a recommendation to change to a single target fluoride concentration of 0.7 milligrams per liter.
  • Letters, documentation and personal stories from public and professional health organizations and medical professionals supporting the continuation of community water fluoridation. Notably, every public health agency operating in our service area urged us to continue our practice of managing fluoride concentrations in our drinking water.

Commissioners also noted that if Denver Water stopped managing fluoride levels, our customers would still be drinking fluoridated water.

“But the levels would vary significantly, creating an imbalance throughout our service area,” Denver Water Commissioner Penfield Tate said. “Community water fluoridation provides dental health benefits across all socioeconomic communities in a predictable and uniform manner.”

Filter beds at a Denver Water treatment plant. Fluoride is added after filtration, prior to disinfection. Learn more about the treatment process: denverwater.org/WaterQuality/TreatmentProcess
Filter beds at a Denver Water treatment plant. Fluoride is added after filtration, prior to disinfection.

“Community water fluoridation is a public health action, which by definition protects the health of the population in general, and sometimes conflicts with individual choice,” said Denver Water General Counsel Patricia Wells. “Those who object to fluoridated water do have alternatives, such as nonfluoridated bottled water or in-home filtering systems.”

With their decision, the commissioners said they were relying on experts who bear the responsibility to protect the health of the public. Community water fluoridation provides health benefits to all our customers, at all stages and ages of their lives, regardless of their access to health care or their adherence to healthy living guidelines.

Denver Water consumers can inform themselves about fluoride levels in their water by accessing readily available public information on our website.

8 thoughts on “The “why” behind our fluoride policy”

  1. Thankfully legitimate science prevailed over the fear-mongering and bias-science of fluoridation opponents (FOs) with the Denver Water Board Commissioners decision to continue fluoridation of Denver’s drinking water. The resolution the board adopted at its August 26, 2015 meeting stated: “Nothing has been presented to the Board or learned in our research that would justify ignoring the advice of these public health agencies and medical and community organizations, or deviating from the thoroughly researched and documented recommendation of the U.S. Public Health Service.”, http://www.denverwater.org/WaterQuality/WaterSafety/Fluoride/. That statement is important considering top FO spokesperson, Paul Connett, flew in to give a presentation at the July 29th information session.

    For those who are concerned about fluoridation because of all the complete falsehoods and twisted truths spread by FOs, I put together a web page, http://www.cyber-nook.com/water/fluoridationreferences.htm, to provide evidence in support of the safety and effectiveness of drinking water fluoridation that is conveniently missing from the FOs’ propaganda. Don’t buy into the fear without doing your own research. If there are not enough references to convince you the FOs are distorting the evidence, simply go to the entire body of published evidence at http://www.pubmed.gov/ and do your own study of the research.

    It is very easy to discover where the FOs have distorted the evidence to create fear using studies where the actual conclusions are completely contrary to how they have been presented. The 2012 ‘Harvard IQ’ study by Choi, et al. and the 2015 Cochrane review of water fluoridation are excellent examples.

    Remember, as you examine the evidence, science is a process by which the scientific community reaches a consensus (a communal agreement) about specific issues that is based on a complete evaluation of all the evidence that’s available. The scientific consensus on community water fluoridation for over 70 years has been that it is a safe and effective process for reducing dental caries in a community. All of the so-called evidence used by FOs has been exhaustively analyzed and found to be insufficient to change the consensus.

    The only way FOs can promote their agenda is to try and convince the public that fluoridation is ineffective and harmful to health. And the only way that can be accomplished is to:
    (1) Reference poor quality research that has been dismissed by experts in the field,
    (2) Claim that known detrimental effects of exposure to high levels of fluoride automatically means low level exposure is also harmful,
    (3) Manipulate the conclusions of legitimate research to imply the practice of fluoridation is harmful.
    (4) Use fear instead of valid evidence to try and convince people the FOs’ position is valid.
    (5) Try and suggest that fluoridation is forced medication instead of a beneficial water treatment process – like chlorination and the addition of various other chemicals.
    (6) Try and discredit the respected science and healthcare professionals, and the highly respected science, healthcare, and regulatory organizations supporting fluoridation as being corrupt, inept, conspiracy laden, etc. It is ironic that FOs attempt to use the methods of science to justify their strongly held biases, but the only way that they can do that is to deny one of the key components of the scientific method – Consensus of the experts.

    Check the evidence for yourself. fluoridation supporters are not hiding anything – you will see all the evidence (the good, the bad, and the ugly), and you will discover that a very significant majority of research supports the practice of fluoridation – and has for over 70 years. Dr. Steve Slott and others who contribute to these discussions provide point-by-point rebuttals to claims by the FOs, and you can verify each one of their statements by going to the original evidence.

    Randy Johnson

    1. Consensus has absolutely nothing to do with the scientific method. You are scientifically illiterate. The so-called consensus you refer to is a figment of your imagination anyhow. You also couldn’t be more hypocritical if you tried. You forced-fluoridation freaks never cite a single good-quality original research study which indicates that the forced-fluoridation experiment is anything but harmful and useless, for the simple reason that there are no such studies. It’s all just a big con job perpetrated by human rights abusers.

  2. Anyone who thinks that forced-fluoridation is supported by science is scientifically illiterate. The random dosing of people throughout their lives, without monitoring, is pharmacologically nonsensical. On top of that, there is the fact that there is not a single good quality original research study which indicates that the forced-fluoridation experiment is anything but harmful and useless. It is also a blatant abuse of human rights. You should be ashamed of yourselves.

    I have asked many forced-fluoridation fanatics to tell me how much accumulated fluoride in the body they think is safe. So far not a single one of them has been able to answer the question.
    http://forcedfluoridationfreedomfighters.com/a-preliminary-investigation-into-fluoride-accumulation-in-bone/

  3. There is no credible evidence that fluoridated water has ever prevented a single dental cavity. Here’s some quotes from the 2015 Cochrane review of artificial water fluoridation.
    p 2 “A total of 155 studies met the inclusion criteria; 107 studies provided sufficient data for quantitative synthesis.”
    p 2 “There is insufficient information to determine whether initiation of a water fluoridation programme results in a change in disparities in caries across socioeconomic status (SES) levels.
    There is insufficient information to determine the effect of stopping water fluoridation programmes on caries levels.
    No studies that aimed to determine the effectiveness of water fluoridation for preventing caries in adults met the review’s inclusion criteria.”
    p 3 “Researchers from the Cochrane Oral Health Group reviewed the evidence – up to 19 February 2015 – for the effect of water fluoridation. They identified 155 studies in which children receiving fluoridated water (either natural or artificial) were compared with those receiving water with very low or no fluoride. Twenty studies examined tooth decay, most of which (71%) were conducted prior to 1975. A further 135 studies examined dental fluorosis.”
    p 14 “Five studies were funded by research grants from research organisations, health authorities and government organisations, one study was funded in collaboration with members of the committee pro-fluoridation, while the other studies [on caries] did not state their funding sources.”
    p 17 “We judged that all the 20 studies included for the caries outcome (including disparities in caries) were at high risk of bias overall.”
    p 17 “We found all studies to be at high risk of bias for confounding. We considered confounding factors for this outcome to be sugar consumption/dietary habits, SES, ethnicity and the use of other fluoride sources.”
    p 28 “Whilst these [fluoridated] areas tend to have low to very low DMFT, there are many other parts of the world where fluoridated water is not widespread that also have low caries levels. Equally, there are areas with relatively high distribution of water fluoridation and moderate caries levels (e.g. Brazil).”
    p 30 “The quality of the evidence, when GRADE criteria are applied, is judged to be low.”

  4. They certainly would have a problem if they had decided to end the practice and then turn around and assure everyone that they didn’t need to remove the naturally occurring levels.

    I wonder if the board members will drink the water after looking at all the evidence.

  5. Wow, the misinformation posted here by Germouse is rampant!

    So, let’s see…..

    1. Countless peer-reviewed scientific studies clearly demonstrate the effectiveness of fluoridation in the prevention of dental decay in entire populations. Numerous such studies have been provided to Germouse, repeatedly. His clear denial of science is his problem, not the evidence supporting fluoridation.

    2. The randomly controlled trials for which Germouse mindlessly clamors, having no understanding of even what constitutes such studies, are all but impossible to perform for the population based public health initiative of water fluoridation, and will never be done. The Cochrane Review which Germouse misrepresents here with his out-of-context quotes, fully recognized this fact, as stated in the report:

    “However, there has been much debate around the appropriateness of GRADE when applied to public health interventions, particularly for research questions where evidence from randomised controlled trials is never going to be available due to the unfeasibility of conducting such trials. Community water fluoridation is one such area.”

    And:

    “we accept that the terminology of ‘low quality’ for evidence may appear too judgmental. We acknowledge that studies on water fluoridation, as for many public health interventions, are complex to undertake and that researchers are often constrained in their study design by practical considerations. For many public health interventions, the GRADE framework will always result in a rating of low or very low quality. Decision makers need to recognise that for some areas of research, the quality of the evidence will never be ‘high’ and that, as for any intervention, the recommendation for its use depends not just upon the quality of the evidence but also on factors such as acceptability and cost-effectiveness (Burford 2012).”

    ——Water fluoridation for the prevention of dental caries (Review)
    Iheozor-Ejiofor Z, Worthington HV, Walsh T, O’Malley L, Clarkson JE, Macey R, Alam R,
    Tugwell P, Welch V, Glenny AM
    The Cochrane Collaboration

    3. There is no “random dosing” of anybody in regard to water fluoridation. In making this ridiculous claim, Germouse clearly demonstrates his ignorance of even the basics of the science of fluoridation.

    Simply put, water is fluoridated at 0.7 mg/liter (ppm=mg/liter). Thus, for every liter of fluoridated water consumed, the “dose” of fluoride intake is 0.7 mg. The average daily water consumption by an adult is 2-3 liters per day. So, let’s go to an extreme and double that to an excessive 6 liters of fluoridated water consumption per day. This translates to 4.2 mg “dose” of fluoride intake per day from the water. The CDC estimates that of the total daily intake, or “dose”, of fluoride from all sources including dental products, 75% is from the water. Thus as 4.2 mg is 75% if the total daily intake from all sources, the total daily intake, or “dose” from all sources would be 5.6 mg for an individual who consumed an excessive 6 liters of fluoridated water per day. 

    The Institute of Medicine has established that the daily upper limit for fluoride intake from all sources, for adults, before adverse effects will occur, short or long term, is 10 mg. Thus, even the excessive 6 liter per day consumer of water will still only take in a daily “dose” of fluoride that is slightly more than half the upper limit before adverse effects.

    The range of safety between the miniscule few parts per million fluoride that are added to existing fluoride levels in your water, is so wide that “dose” is not an issue. Before the UL of 10 mg could be reached, water toxicity would be the concern, not fluoride.

    http://iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity%20Files/Nutrition/DRIs/ULs%20for%20Vitamins%20and%20Elements.pdf

    4. In regard to the question Germouse claims no one has been able to answer…..yet another false claim by him. The answer to this question has been repeatedly provided to Germouse. That the answer doesn’t conform to his twisted perspective is a problem with him, not with the answer.

    Yet once again…..The amount of fluoride stored in hard tissues is not a linear constant. It fluctuates in accordance with its equilibrium with plasma levels of fluoride. Plasmas levels are determined by fluoride intake. The US Institute of Medicine has established the daily upper limit of total fluoride intake to be 10 mg before adverse effects will occur short or long term. Below the level of chronic daily fluoride intake of 10 mg, adverse effects will not occur. The first disorder risked by chronic daily intake of 10 mg or more fluoride, is skeletal fluorosis, a disorder so rare in the US as to be nearly non-existent.

    Given that the CDC has estimated 75% of total fluoride intake to be from water and beverages, a simple math equation demonstrates that before the daily upper limit could be attained in association with optimally fluoridated water, water toxicity would be the concern, not fluoride.

    Steven D. Slott, DDS

  6. Dan – Consensus has everything to do with legitimate science. When applied it keeps BiasScience, fear mongers who can’t produce legitimate evidence from influencing public policy as demonstrated in Denver. Anyone who evaluates the evidence for themselves will discover why the scientific consensus continues to support fluoridation after more than 70 years of attempts by FOs to change it. If you have the evidence, the consensus will change – it’s as simple as that. These messages are not for you – it is unlikely your biases will ever allow you to impartially examine the evidence. I provide the information to help people who are confused about fluoridation examine the alternatives to your position.

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