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Monday, June 16, 2014

Put fluoride in our water, or not? Science Cafe will discuss the issue Wednesday

David Brooks

Ancient wisdom isn’t always wise – seen much spontaneous generation lately? – but sometimes it really hits the mark. You don’t get much more mark-hitting than “the dose makes the poison.”

This adage, expressed 500 years ago by a cranky but brilliant Renaissance physician called Paracelus, notes that any substance can be either harmful or harmless, if you adjust the dosage enough. It is the key to understanding all medicine, and also key to understanding the topic of Science Cafe this Wednesday: adding fluoride to public water supplies. ...

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Ancient wisdom isn’t always wise – seen much spontaneous generation lately? – but sometimes it really hits the mark. You don’t get much more mark-hitting than “the dose makes the poison.”

This adage, expressed 500 years ago by a cranky but brilliant Renaissance physician called Paracelus, notes that any substance can be either harmful or harmless, if you adjust the dosage enough. It is the key to understanding all medicine, and also key to understanding the topic of Science Cafe this Wednesday: adding fluoride to public water supplies.

“Fluoride is one of those things where the key part of the sentence is ‘in appropriate amounts’,” said Sarah Finne, a dentist who practiced in Massachusetts and New Hampshire for two decade before going into public health.

Finne will be a panelist at the cafe, starting at 6 p.m. at Killarney’s Irish Pub, along with the head of the Concord Water Treatment plant, which received an EPA award for its fluoridation. As always, the event is free; show up, buy some beverage and food, and ask questions. Eat, drink and be knowledgeable, as we say.

Nobody from Nashua or Milford or Greenville wastewater plants are on the panel because they don’t add fluoride. Manchester is the closest city that does so.

You can see the balance over dosage in materials the New Hampshire Department of Environmental Services, which notes that “fluoride in drinking water is beneficial at low concentrations, but can pose health concerns at higher concentrations.”

In other words, the dose is the poison – although poison is too strong a word with the doses we’re discussing. The concern is that excess fluoride can cause mottled or discolored teeth.

Mixing powdered infant formula with tap water can cause what the CDC calls “the faint, white markings of very mild or mild enamel fluorosis” on their teeth; the center recommends using non-fluoridated water to mix formula for babies under 6 months.

There are plenty of claims that excess fluoride can cause more serious problems, ranging from cancer to osteoporosis, but Finne says science hasn’t validated those concerns.

“Several recent studies have not been able to show a link with any bone diseases ... or with problems such as increased hip fractures in older people. That’s not the case,” she said.

Most of the concern about public fluoridation is more political than scientific – the feeling that the government shouldn’t be medicating people involuntarily, no matter how beneficial – and don’t fall into the purview of Science Cafe New Hampshire, where we have only two rules: No PowerPoint, no politics. Still, this is a potent chemical that deserves our respect.

The federal Department of Health and Human Services in 2011 lowered its recommended level in public water systems by about one-third, from 1.1 milligrams per liter of water (the same as 1 part per million) down to 0.7 milligrams, saying that most Americans get more fluoride in their diet than when the drinking water regulation was established in 1962. The reduction hasn’t been officially adopted by the CDC, however, which just shows how complicated this is.

U.S. cities began fluoridating water in the 1940s – usually by adding sodium fluoride, while other compounds were used later – because of clinical evidence that it reduced tooth decay in children. Today about two-thirds of Americans have access to fluoridated water. The figure in New Hampshire is a little under 50 percent because about two-fifths of the population (including me) gets its water from private wells, plus a number of cities don’t fluoridate their water.

The Centers for Disease Control and Prevention calls water fluoridation one of the top 10 public health achievements of the 20th century, noting that studies show it reduces cavities in adolescents by up to 37 percent, and among adults by up to 40 percent.

Fluroidated water is particularly important for children whose teeth are growing.

“It gets absorbed into the body and incorporated into the matrix of the teeth as they’re developing,” she said.

I had to buy fluoride pills for my kids for years and years, until adolescence rescued us from that cost (while introducing many more, of course).

Adult teeth benefit from topical application of fluoride, either from toothpaste, mouthwash or tap water.

To me, the most interesting aspect of public water fluoridation is its strong support by dentists.

Dentists aren’t merely objective in this matter, they have actual cause to oppose fluoride because it cuts into their business. A dentist supporting fluoridation is like a newspaperman supporting free online news aggregators – it can only be bad for the bottom line.

I guess dentists see enough of the pain and suffering caused by cavities that their medical persona overcomes their business persona. Hats off to them for it.

GraniteGeek appears Mondays in The Telegraph. David Brooks can be reached at 594-6531 or dbrooks@nashuatelegraph.com. Also, follow Brooks on Twitter (@granitegeek).