As expected, we got a response to our post on fluoridation. In the interest of sharing the information and because it provides a leaping off point for some interesting discussion, we’ll share the response we got:

Fluoridation is a dismal failure. In fact, non-fluoridated Rockland, Nassau, and Suffolk counties have among the lowest rates of tooth decay in NYS which is otherwise about 73% fluoridated.

To see how fluoridation has failed, in general. See: Fluoridation Fails as America’s dental health crisis grows

If you look at these posts, you’ll see they’re filled with a cacophonous pile of statistics that are common to anti-fluoridation rants. The statistics are given all out of context, without any attempt to make meaningful comparisons among populations, but they have some merit, especially the one from Fluoride Dangers.

Fluoridation Is not a Panacea

Although it’s likely there were some people who believed that fluoridation would completely eliminate oral decay (they’re probably the same people who believed that the atom would free us all from work and we’d all have robot servants by now), most health officials who have advocated for fluoridation have always done so from the standpoint that it would achieve modest reduction in cavities among the general population and provide an overall savings on oral healthcare compared to the cost of fluoridation. And, really, if we’re totally honest, if dentists thought fluoridation was going to make them completely obsolete, would they advocate it?

As the Fluoride Dangers article points out, however, there are many other factors that influence the rate of cavities that children suffer, including race and class divisions that (sadly) have not been eliminated by fluoridation. Some regions of the country and some populations put more emphasis on oral hygiene than others. Some people are more privileged to be able to see the dentist and receive proper preventive care than others. And some populations are more at risk, either genetically or because of their diet and lifestyle for conditions such as diabetes that can increase the risk of tooth loss.

But, as with so many things in this country, income and race are probably the biggest dividers in oral health, and it’s that which is behind the apparent “failures” of fluoridation that the article promotes.

Comparing Apples to Apples Shows Fluoridation’s Success

The response to our article foregrounds the low cavity rates in Rockland, Nassau, and Suffolk counties, which happen to be among the wealthiest counties in the state, but suspiciously missing from any of the evidence is Westchester County, which has fluoridated water. Probably because it would completely undermine their argument. The cavity rate for Westchester County is 40%, compared to 50% for Nassau County and 54% for Suffolk County. I don’t know, but that sure seems like a big win for fluoridation.

But perhaps it’s not fair to compare Nassau County and Westchester County. What if we compare Nassau County to someplace where fluoridation “failed” according to Fluoride Dangers: Connecticut. In Connecticut, which has a median household income slightly less than Nassau County ($69k to $72k) the childhood cavity rate is 35% for white children and 50% for both African American and Hispanic children. Applying these cavity rates to Nassau County’s demographics (73% white 11% African-American, 7.6% Asian, and 8.4% other, including 14.6% of Hispanic or Latino of any race) putting whites at the same rate as Connecticut and every other race at the African-American and Hispanic rate, Nassau County’s childhood cavity rate should be 39%. Or about what Westchester County has. Using two different comparisons–one from fluoride opponents’ own data–fluoridation leads to about a 20% decrease in childhood cavities.

Before Fluoridation

I’m going to come right out and say it: dentists are probably the most undercelebrated heroes of the 20th century. We have benefited so much from their care and education and expertise that it’s easy now to forget what things were like in the days before fluoridated water and before everyone had access to the care of dentists. It’s hard even to reconstruct it, but we’ll use a couple of examples to make the point. The Fluoride Dangers article waxes hysterical about the 75% of Kentucky 15-year-olds that have cavities, but in 1910 a survey of 447 schoolchildren in Elmyra, NY (all 14 years old or less) showed that 95% of them had cavities. Among these 425 schoolchildren there were a total of 2063 cavities, and 617 teeth that were in such bad shape they needed to be extracted.

Another case in point. When the US entered World War I, the 1A standard of oral health required that a man have a minimum of 12 teeth: six opposable pairs. Men could still be passable (1B) if they had dentures to help them meet this requirement. Even with this low standard, of the men age 18 to 35 who enlisted 24 out of every 1000 men were rejected because they had unfit teeth. Today, the average number of teeth for this age group in this country is 27. Which, considering most of us have our wisdom teeth removed and therefore have only 28 permanent teeth to begin with, is pretty remarkable.

Fluoridation isn’t perfect, and it can’t overcome many of the other problems that lead to poor oral health, but it certainly doesn’t seem to be a failure, and definitely not a “dismal” one.