Facts of Medicine; 6; Fluoridation

This is National Educational Television. A program produced for the Educational Television and Radio Center. The Facts of Medicine, presented by the Harvard Medical School and the Lowell Institute with Dr. David D. Rothstein, Professor of Preventive Medicine, Harvard University and Mr. Parker Wheatley, General Manager of WGBH-TV. The Facts of Medicine is made possible by a grant and aid from the John Hancock Mutual Life Insurance Company and produced in the studios of WGBH TV Boston. Dr. Rothstein, why all the controversy about fluoridation? Mr. Wheatley, I wish I knew. This is a really a very serious question because there are strong feelings about this whole question on both sides really, and perhaps you might ask the question of me at the end of the program after we present the facts. And it will give you tonight, just exactly what we

think [Ah] is available in the medical literature on what happens when you put fluoride into water in terms of possible harm, in terms of the benefits, in terms of how it should be done, if it is desirable to do it. You know, Mr Wheatley, fluoride is a powder. I have some of it right over here, a little bottle. You see it's a white powder. It comes out of rocks. And this white powder is extracted from rock. Or, the fluoride is gotten out and a special salt is made so it can be placed in a water supply. This particular material is just all over. (All over?) It's everywhere. It's in our soil. It's in our rocks, And, uh, we almost can't avoid it. As a matter of fact, if we were to say we would eat no fluoride, it would keep fluoride out of our

mouths completely, we would have to stop eating completely because it is, in fact, all the food that we eat in small amounts. (Small amounts) In small amounts, and we'll talk about the exact amounts. Now, the amount of fluoride that's recommended to be placed in the water supply is one part in one million. And let me show you here. In other words if you took this medicine dropper. And we wanted to put into one million drops of water, which would be the amount in a third of a bathtub, let's say (a big bath tub?) in a big, well, average size home bathtub, this is how much fluoride we put in if we can see this drop. Just that much and no more. That's one part per million. And perhaps we should put this on the board so we can use this as a reference point throughout the rest of the program so we can discuss how much this is, lets put down one P.P.M. One part per million. This is the recommended

concentration, in order to prevent tooth decay. Now before we get too far into this, let's make one other point about the distribution of fluoride around the world, in the United States for example. We will find if we go around from place to place, great differences in the amount of fluoride in water or in food, depending on where the food is grown, in what kind of soil it's grown. And up here on the map, If we go up here on this map we can take a look and for instance if we go to Washington, D.C., Which will be over here, there will be no fluoride in the water at all. If we went to Boulder, Colorado I guess that would be about right here. There would be no fluoride at all. But if we went right near it, to Colorado Springs, there would be a lot. There would be two and a

half parts per million. If we went down here to Bartlett in Texas we would have 8 parts per million in a normal water supply that people drink. Actually there are two areas in the country where the largest concentrations appear all through here in Texas as I mentioned, and up through here there's an area. Then there's one that starts up here in the Dakotas come down here into Iowa over here into Illinois and Indiana. And ?inaudible? here. These are two areas where the fluoride is particularly heavy. So you see we have flouride all over. We have in Massachusetts a few places where the fluoride is more than one part per million. But there are places in the country where there are a lot of places of that sort. And it's interesting that if you drink that nice sparkling well water. The deeper the well is, the more likely it is to contain more fluoride. But of course, in the general surface waters, waters from reservoirs tend to have less fluoride ah- than the waters we get from down deep. The more pure the water tastes the more pure it's likely to have flouride in it. Well

I don't know, I don't know if that's true. I won't- don't quite go that far but at least a lot of sparkling well water has got a lot of fluoride in it. Now as I said if you eat food on the average in your diet every day you have two tenths to three tenths part per million or about one quarter to one third the amount that you would need in order to uh have the recommended amount per day for the prevention in children. Actually there's one food, tea, which has a large amount of fluoride in it, and actually in 10 cups of tea, you'll find 1 milligram of fluorine. So you take in 10 cups of tea per day, you'll take in just the required amount of fluorine that, uh, would- would be needed to do this but after all children don't drink tea, you see, and we don't recommend tea for children. So we have to try to get it to them some other way. But now what about this material is it going to- is it going to harm anybody? Many people think it does. Yes, yes they do. And what I thought we'd do would be to take

particular diseases that are said to be more common or more common a cause of death and show you just what the deaths are like in the sense of numbers in this country in 32 communities where fluoride- and actually it's used now I guess, I guess in 11 hundred and 40-some communities in this country. Making up somewhere around 23 million people are now getting fluoride in the water supply and something of that sort. But let's look a minute here and we see these dark lines represent the death rates for 100,000 population in fluoride cities and the death rates in the cities without fluoride. Uh Thirty two cities that were picked nearby to match the other 32 so that they would be close by geographically but would have no floride in the water. And you see the heart disease here. Deaths are the same, the cancer deaths are the same, the deaths ahead here, we had to use it a short word it means a cerebral hemorrhage, hemorrhage in the

skull, strokes. And you see this is the same. And they talk much about the fact that since fluoride is excreted in the kidney, in the urine, that perhaps the kidney would be damaged and you see here that the kidney's the same and then the few words about liver cirrhosis of the liver and we see this is the same. So I think we can say that as far as these causes of death, that have been so commonly talked about, these causes of death that there is no difference between fluoride cities and cities where no fluoride is used in the water supply or where fluoride is not present naturally in the water supply. So that, I don't think that there is any evidence on the other side, either Mr. Wheatley. I don't think this is an isolated study so to speak I think this represents a very representative sample of what the problem is as far as death rates are concerned. So we can say that as far as deaths are concerned there are no differences. That's the first point. But people have said well maybe it isn't death maybe it's just being sick. Will it affect our children? I think some of our -ah our people who have written into the program have said

well the best answer to that was attained in this excellent study on this whole problem which was done by the New York State Department of Health in ah New York State and 2 2 towns, one called Newburgh, New York. And the other, Kingston, New York. Now they picked these two towns right along the west bank of the Hudson River right over in here the- they're just 30 miles apart on the river here. They're towns that are very much alike, have the same kind of stable population. And way back in 1944 they decided that they would take one of these towns, Newburgh, and the local community cooperated, after much discussion I might say, and Kingston was left to go ahead and not put any fluoride in its water supply. It has no normal fluoride in the supply. With the result is that they have been able since 1944 and now just last December a report was made, December '55, 10 years after the experiment was done, started, to see what would happen to the children in this

community having all been examined at the beginning before the fluoride was put in, and having been examined again and they were examined for the following things; first did they grow in- the children grow in Newburgh the way they grew in Kingston- did fluoride have an effect on cutting down their height or their weight. It did not. Did it have any effect on their eyes and particularly their ears because there's been some talk about the fact that fluoride might cause deafness. There's no evidence of deafness at all. Ah was there any evidence about the question of ah general physical examination. Were they able to pick up any disease? They were not. This is all been carefully written up and documented. So we can say then, as a result of the study, care- very careful study done by comparing two communities - Kingston, New York with no fluoride, Newburgh, New York with flouride over a period of 10 years that there were no differences in the way the children grew or the way they had diseases in the 2 communities. But there was 1 difference. And that had to do with their teeth, and we'll see about that in a moment.

There's a major difference. There's an interesting little story about this, Mr. Wheatley. When they first talked about this in 1944 in Newburgh ah and they thought they would be starting earlier than they were able to start, a great many people in the community thought that they had started. So they immediately start sending in letters to the newspapers about the way pots were being discolored, about the fact that people were having all kinds of symptoms, ah how bad the water tasted. And then it was announced after a great many of these complaints came in that they hadn't started the experiment at all, as a matter of fact they didn't start until 1945. But it- it is a very interesting chapter in this whole story on ah- on the problems of getting fluoride in the water supplies for the prevention of tooth decay. I think it's clearly established, Mr. Wheatley, that this stuff is not harmful. There's been some vague talk about its effect on the bones and a study just published in December

and one of the co-authors of this study it was Dr. Merrill Sosman a professor of radiology at the Harvard Medical School and chief of the X-ray department at the Peter Bent Brigham Hospital. hospital. And this study was done down in Bartlett, Texas. You remember we talked about this little town that had 8 parts per million, which is 8 times the recommended amount. So much of it, they got to deflouridate their supply now to get it down to one which is what they started to do. Down there they studied people over a period of 10 years again exposed to 8 parts per million to see whether any change in the bones of these people over 10 years. They found some increased density of bone but they concluded it by believing that this slight increase in density might even be helpful, because older women, after the menopause, you know, it's- it's very common to have a certain amount of the lime to become out of the bones of older women. And that's one of the reasons why you have these accidents or broken hips and things of that sort when they fall. And it's been shown that in this community, the amount of calcium the amount of lime in the

bones is at a higher level in such women and maybe it might even be a little bit helpful that had that fluoride in the water supply. As far as the bones are concerned. So I think that's another aspect. To the question of teeth. And, uh, when we talk about the problem of teeth, we have a little model over here, which I'd like to show you. you. And in this model, cut in half you see as if it were cut down the middle. We have this outside part which is the part that we see on the outside of a tooth. This is what we try to keep from having any little holes put in it, So the tooth won't decay. This is the material that fastens the root which is in here - the pulp to the enamel the so-called dentine that runs all the way around. Now the- the blood supply comes in from the bottom, and if you put water if the person drinks water, which has fluoride in it, it comes through the blood supply

and this is now in a small child whose tooth is being formed. And as you see these lines show, little molecules will go out all the way through the whole tooth and saturate the whole tooth, even the enamel here that this is the enamel is still in the process of formation, it won't happen after it's formed but- in adults- but while it's still being formed in the process of formation it will- get a deposit of fluoride right into that enamel and if you take a piece of that enamel and measure its hardness you'll find that enamel with flouride in it is much harder than enamel without flouride in it, and this is probably one of the reasons why the stuff works. Now. We can also put fluoride into a tooth, a tooth by applying something on the outside but when you do that all that happens is you get a coating on the outside of the tooth and it doesn't go all the way through, the way I just showed you - the material taken by mouth, the water drunk in small children will make the whole tooth harder rather than just a very

thin coating on the outside when we apply things on the outside in the form of oh you know the dentist doing it or tooth paste, or maybe a lozenge, or maybe chewing gum or what have you. We just put it on the outside. Now, the question is what happens if you live in an area where fluorides are higher in concentration or as high in concentration where the concentration or higher concentration than should be, in order to protect you from getting decayed teeth. I've got a chart here. Shows about- tells us about 2 towns and there's this item decayed, missing or filled teeth. This is the way we measure damage to teeth. It can be damaged any 1 of 3 ways. Either it can be decayed with a hole in it or the tooth can be missing, either fallen out or pulled out, or the tooth could have been repaired, but it means a damaged tooth. Now there are 32 teeth in our mouths, if they're all there, in adults, permanent teeth.

And you see here in Boulder, Colorado with no fluoride in it, in people aged 20 to 24 something like 14 of these 32 teeth in the mouth were either decayed, missing or filled. And you see this gradually goes up as you'd expect as people get older from 20s to the 30s and up to the 40s so that it reaches a level of a little over 20. But in a community like Colorado Springs which is nearby, where they have two and a half parts per million instead of one part per million up here on the board you see that it starts at a much lower level at 6 instead of 14 and it goes to 44 to a level somewhere around 10 or 11 up to about 22 up here. So actually it's cut about 60 percent actually as a figure if you actually calculate it on the average 60 percent of decayed, missing or filled teeth are done away with. 60 percent of the damage is done away with by natural floride. Now what about fluoride that's put into the water? Does it work the same? Well it's pretty much the same kind of stuff and what happens. Well, we have a

chart here, Aurora, Illinois, this is a place where you have natural fluoridination actually 1 point 2 parts per million and you see how low this stays in child 5 to 16. Starts off at 0 here at 5 and maybe runs up to about 4 or 5 at age 16. But up here in Grand Rapids which had none beforehand, it started at the same place but look where it went, up here at about 13 or 14 by the age of 16. Now when they put fluoride into that supply you see the younger children who benefited from the fluoride being in for 9 years, up to age 11, have the same experience as the Aurora people did, but the older children who were there beforehand and who had their teeth formed earlier, they went on and had a worse experience, although they benefited some, they were better than they were before. And finally that nice experiment that we talked about remember in Newburgh and in Kingston. I just got a couple little fractions up here to show this quickly, again decayed

missing or filled permanent teeth, in 6 to 10 year old children, 1 out of every 10 in Newburgh at the end of 8 years of fluoridation - 1953. From '45 to '53. 1 out of 10 had, as 1 out of 10 teeth in the mouth of these children whether decayed, missing or filled, but 1 out of 4 in Kingston already at the age of 10 years from 6 to 10 years one quarter of the teeth were either decayed missing or filled, you see. That's really a very serious problem. And the putting fluoride in the water is not something one does for the joke of it but this is a really a serious problem that you can do something about if flouride is put into the water supply. Now. I think Mr. Wheatley we've demonstrated that the material is not harmful in the amounts recommended, although in very much larger amounts it might very well be toxic as many substances are. And also that it's helpful, that it cuts down decay 60 percent, cuts down the number of decayed, missing or filled teeth

about 60 percent. If it's given so the children can get it in the water supply while their teeth are still being formed, that means that their baby teeth and their permanent teeth, and it's important for both because if the baby teeth are kept in the mouth, the shape of the jaw is preserved, if they're kept in for a longer period of time until the permanent teeth have a chance to come in and frame out the jaw. How are we going to do this, how are we going to get this water in to how are you going to get the flouride into the water supply? How is it usually done? People want to know, one of the first questions no one knows whether or not this material can be tasted in the water. Bottles over here Mr Wheatley. I've got two glasses for you. For me? For you. And I've got a bottle here of some, some uh water from down in Hingham, where they flouridate their supply. And down there I got

some water before they put the fluoride in. I got some of the same water after they put the fluoride in and I want you to taste them and tell me how the fluoride tastes. Try this? I avoided reading which label was on which bottle. Well it doesn't make any difference. You go tell me which one tastes better. I don't want any suggestion here. Just tell me which one tastes better. I may not have the right answer. I like this one. You do? Yes.

That was the one without the flouride in it. Without the flouride? Yes. You think you can taste it. I don't think so, really. You don't think so? I don't. Well I just had some, it tastes to me like ordinary water but I would recommend that anyone would like to try this I recommend they get some and get some water. I can't really tell. Or go to any Community around the country where they might have flouride in the water supply. Well in any event, uh many tests have been done and you can't taste it until it gets way up into the hundreds of parts per million, until you can begin to taste it and uh it's also colorless as you see, it's perfectly sparkling, both glasses. Now if you have a water supply, this is the best way of doing it. Putting the fluoride in the supply because we know the dosage. We know that in Newburgh over a period of 10 years with the amount of cavities was cut down. Same kind of thing happened in Branford, Ontario, Grand Rapids.

One chart you saw there, um so that we know the dosage approximately how much people drink per day and the range of drinking that is every child doesn't drink the same as every other child even within the range of drinking within a climate like upper New York State. uh. It's perfectly satisfactory the range is not toxic it's not poisonous and seems to be quite effective. Of course in southern United States, in hot weather you would have to have lower concentrations and actually in uh Charlotte, North Carolina they are adjusting the level of the fluoride in the water supply of the community so that it's lower in the hot weather when people drink more water to keep the amount taken in per day about the same, you see. Well now, other things have been recommended besides water and of course many of you may not have a water supply and may- you may have your own well. If you have a deep well, you may have some flouride in your well. But, you'll have to find your- find your fluoride another ways. You get some in your food as I showed you. But probably the best thing to do for your children is to have

them go to a dentist and uh about the age of 3 years and again at the age of 7 and about 12 and uh maybe about 15 and have it applied by the dentist in the form of a solution. I have a solution here of a 2 percent solution of this material. This is the stuff that the dentist use- uses and this material actually when the dentist puts it on he puts pads all around the teeth so the stuff can't get into your mouth. But it - you see it's a perfectly clear solution and uh this is the ordinary material used. What ages? Age 3 first and then age about 6 and somewhere about 9, 12, 15, something like that. Only if it isn't in the water supply? Only if it isn't in the water supply, that's right. Other ways of getting it, recently recommended of course, are things like toothpaste. And some people have suggested chewing gum and lozenges. The difficulty with getting fluoride this way is that we know nothing about the dosage. There is one experiment that shows that

fluoride in toothpaste does cause a decrease in decay. But the dosage is so irregular, it's only been one study and if you take toothpaste one day and take some fluoride in your water supply and that vary may from place to place and if you take chewing gum, or take some uh lozenges, more than that, the law, at the present, uh the federal- er federal Food and Drug Law does not require the manufacturer to put the amount of fluoride on the toothpaste tube and you'll see if you look on toothpaste tubes that it's supposed to have fluoride in them, but that no amount is specified. So that uh matter of fact the law only requires that the manufacturer guarantee that the amount be safe and not be harmful. So that we can't tell what the dosage is until we have much more information about dosage b- through toothpaste, that will only then coat just the outside of the tooth now. Coming back to our model here a minute. It'll only coat the outside of the tooth anyway, it wouldn't go all the way through, would only be used

in places where you wouldn't have a water supply but probably best given by the dentist because he knows how much he can, how much to apply and knows the exact dose or perhaps by a dental hygienist in school that's been done it's something you can do. It's useful, if you have tropical flouride. We need more information about it, we can make no recommendations at the moment. No recommendations? In favor of it at the moment, no strong recommendations except in those areas where no fluoride in the water supply and there we recommend topical application by the dentist as the first choice. This is where we stand. Is there any evidence now about the use of any of these other means - toothpaste, lozenges and so on for adults. This would only be for adults and we have no evidence that such uh treatment of adults really makes very much difference Does the water supply being treated with fluoride. We have no evidence about that either really we only know that if people stay in the community as you saw in this chart with Boulder, Colorado, that they apparently preserve their ability. Well now Mr. Wheatley, we I think have gone through this story. We'll come

back to your first question and that is- why is there so much opposition. And the answer is, I don't know unless it has to do with the fact that anything new is introduced and put into some of our food that we don't know anything about, that the unknown scares us. And that being the case, perhaps a lot of people are just fearful. But I think people should look the facts squarely, look squarely at these facts and then try to see whether or not you wouldn't reali- really appreciate having fluoride in your supply because when you think of all the dentures. And I think of my fillings in my teeth and I think tooth extractions I've had, and think that that can be cut 60 percent for my children and for your children. I really think it's worthwhile. Thank you very much. Dr. Rutstein, this evidence in favor of fluoridation is about as complete as you can have scientific evidence be complete? I would think so. For water supply for children.

We don't have the evidence yet on the adults, we'll get that as we get more information about applying it from the outside. But as far as children are concerned, as far as putting in the water supply during the period of formation. I don't see how you can have better evidence. Thank you very much Dr. Rutstein. The facts of medicine has been presented by the Harvard Medical School and the Lowell Institute, with Dr. David D. Rutstein professor of preventive medicine Harvard University, and Mr. Parker Wheatley, general manager of WGBH TV. The Facts of Medicine is made possible by a grant and aid from the John Hancock Mutual Life Insurance Company. It's directed by Paul Rader, and produced in the studios of WGBH TV Boston. The preceding program was produced for the Educational Television and Radio Center. This is National Educational Television.