34.  Is water fluoridation a valuable public health measure?

Yes. Fluoridation is a public health program that benefits people of all ages, is safe and is cost effective because it saves money.

Water fluoridation has been landed as one of the most economical preventive values in the nation.
 (US Department of Health and Human Services. For a healthy nation: returns on investment in public health.  Washington, DC: US Government Printing Office; August 1994.) and today still has the greatest dental public health impact. (Selwitz RH, Nowjack-Raymer RE, Kingman A, Driscoll WS.  Dental caries and dental fluorosis among schoolchildren who were lifelong residents of communities having either low or optimal levels of fluoride in drinking water.  J Public Health Dent
1998;58(1):28-35.)

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35.  Has the legality of water fluoridation been upheld by the courts?

Yes. Fluoridation has been thoroughly tested in the United States' court system, and found to be a proper means of furthering public health and welfare. No court of last resort has ever determined fluoridation to be unlawful.  Moreover, fluoridation has been clearly held not to be an unconstitutional invasion of religious freedom or other individual rights guaranteed by the U.S. Constitution.

It has been the position of the american courts that a significant government interest in health and welfare of the public generally overrides individual objections to public health regulation.
(Block LE. Antifluoridationists persist: the constitutional basis for fluoridation. J Public Health Dent 1986;46(4):188-98.)

Consequently, the courts have rejected the contention that fluoridation ordinances are a deprivation of religious or individual freedoms guaranteed under the constitution.
(McMenamin JP. Fluoridation of water in Virginia: the tempest in the teapot. J Law Ethics Dent 1988;1(1):42-6.)

In reviewing the legal aspects of fluoridation, the courts have dealt with this concern by ruling that:  (1) fluoride is a nutrient, not a medication, and is present naturally in the environment;   (2) no one is forced to drink fluoridated water as alternative sources are available; and (3) in cases where a person believes that fluoridation interferes with religious beliefs, there is a difference between the freedom to believe, which is absolute, and the freedom to practice beliefs, which may be restricted in the public's interest.
(Roemer R. Water fluoridation: public health responsibility and the democratic process.  Am J Public Health 1965;55(9):1337-48;  Strong GA. Liberty, religion and fluoridation.  J Am Dent Assoc 1968;76:1398-1409.)

Water that has been fortified with fluoride is similar to fortifying salt with iodine, milk with vitamin D and orange juice with vitamin C.

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36.  Why does opposition to community water fluoridation continue?

Fluoridation is considered beneficial by the overwhelming majority of the health and scientific communities as well as the general public.  However, a vocal minority continues to speak out against fluoridation of municipal water supplies. Some individuals may view fluoridation of public water as limiting their freedom of choice; other opposition can stem from misinterpretations or inappropriate extrapolations of the science behind the fluoridation issue.

Of the small fraction that opposes water fluoridation for philosophical reasons, freedom of choice probably stands out as the most important single issue.
(Newbrun E.  The fluoridation war: a scientific dispute or a religious argument? J Public Health Dent 1996;56(5 Spec No):246-52.)

Some individuals are opposed to community action on any health issue, others because of environmental or economic arguments and some because they are misinformed.

Opinions are seldom unanimous on any scientific subject. In fact, there may be no such thing as "final knowledge", since new information is continuously emerging and being disseminated. As such, the benefit evidence must be continually weighed against risk evidence. Health professionals, decision makers, and the public should be cooperating partners in the quest for that accountability.
(Park B, Smith K, Malvitz D, Furman L. Hazard vs outrage: public perception of fluoridation risks. J Public Health Dent 1990;50(4):285-7.)

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37.  Where can reliable information about water fluoridation be found on the Internet and World Wide Web?

The American Dental Association , The Center for Disease and Control, as well as other reputable health and science organizations, and government agencies have sites on the Internet/Web which provide information on fluorides and fluoridation.  These sites provide information that is consistent with generally accepted scientific knowledge.

Searching the Internet for "fluoride" or "water fluoridation" directs individuals to a number of Web sites.  Some of the content found in the sites is scientifically sound.  Other less scientific sites may look highly technical, but contain information based on science that is unconfirmed or has not gained widespread acceptance. Commercial interests, such as the sale of water filters, may also be promoted.

One of the most widely respected sources for information regarding fluoridation and fluorides is the American Dental Association (ADA) Website Home Page. From the ADA Website individuals can make contact with other Web sites for more information about fluoride.

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38.  Why does community water fluoridation sometimes lose when it is put to a public vote?

Voter apathy, blurring of scientific issues, lack of leadership by elected officials, and a lack of political campaign skills among health professionals are some of the reasons fluoridation votes are sometimes unsuccessful.

Clever use of emotionally charged "scare" propaganda by fluoride opponents creates fear, confusion, and doubt within a community when voters consider the use of fluoridation.
(Frazier PJ. Priorities to preserve fluoride uses: rationales and strategies.  J Public Health Dent 1985;45(3):149-65;   Frazier PJ Fluoridation: a review of social research.  J Public Health Dent 1980;40(3):214-33.)

Defeats of referenda or the discontinuance of fluoridation have occurred most often when a small, vocal, and well-organized group has used a barrage of fear-inspiring allegations designed to confuse the electorate. In addition to attempts to influence voters, opponents have also threatened community leaders with personal litigation.
(Easley MW.  The new antifluoridationists: who are they and how do they operate? J Public Health Dent 1985;4593):133-41.)

Adoption of fluoridation is ultimately a decision of state and local decision makers, whether determined by elected officials, health officers, or of the voting public. Fluoridation can be enacted through state legislation, administrative regulation, or a public referendum.  From 1989-94, 318 communities authorized fluoridation by administrative governmental action.

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39.  Is community water fluoridation accepted by other countries?

Yes. Water fluoridation is practiced in approximately 60 countries benefitting over 360,000,000 (three hundred sixty million) people. 
(British Fluoridation Society. Optimal water fluoridation: status worldwide.  Liverpool; May 1998.)

The value of water fluoridation is recognized internationally. Countries and geographic regions with extensive fluoridation include the U.S., Australia, Brazil, Canada, Hong Kong, Malaysia, United Kingdom, Singapore, Chile, New Zealand, Israel, Columbia, Costa Rica and Ireland. (Federation Dentaire International. World fluoridation status. Basic Facts 1990.) The most recent county-wide decision for fluoridated drinking water occurred in South Africia..  (FDI World. South Africa to fluoridate.  FDI World 1997;6(6):7.)

The World Health Organization (WHO) and the Pan American Health Organization have endorsed the practice of water fluoridation since 1964. In 1994, an expert committee of WHO published a report which reaffirmed its support of fluoridation as being safe and effective in the prevention of tooth decay, and stated that provided a community has a piped water supply, water fluoridation is the most effective method of reaching the whole population, so that all social classes benefit without the need for active participation on the part of individuals.
(World Health Organization.  Fluorides and oral health.  Report of a WHO Expert Committee on Oral Health Status and Fluoride use.  WHO Technical Report Series 846. Geneva;1994.)

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40.  Is community water fluoridation banned in Europe?

No country in Europe has banned community water fluoridation.
(Jones S Water fluoridation in Europe. Paper presented to the British Association for the Study of Community Dentistry; 1996 Spring Scientific Meeting. Dundee, Scotland.)

The claim that fluoridation is banned in Europe is frequently used by fluoridation opponents.  In truth, European countries construct their own water quality regulations within the framework of the 1980 European Water Quality Directive. The directive provides maximum admissible concentrations for many substances, one of which is fluoride. The directive does not require or prohibit fluoridation, it merely requires that the fluoride concentration in water does not exceed the maximum permissible concentration.

Many fluoridation systems which used to operate in Eastern and Central Europe did not function properly and, when the ron Curtain fell in 1989-90, shut down because of obsolute technical equipment and lack of knowledge as to the benefits of fluoridated water.
(Marthaler TM.  Water fluoridation results in Basel since 1962: health and political implications.  J Public Health Dent 1996;56(5 Spec No):265-70.) 

Water fluoridation is not practical in many European countries because of complex water systems with numerous water sources. As an alternative to water fluoridation, many European countries have opted for "alt fluoridation", in addition to the use of fluoride toothpaste for topical benefits, as a means of bringing the protective benefits of fluoride to the public.

Again, no european country has specifically imposed a "ban" on fluoridation, it has simply not been implemented for a variety of technical or political reasons.

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