Most public water supplies are fluoridated, especially in larger cities, with about 64 percent of Americans drinking treated water. Maryland is the most fluoridated state, Hawaii the least. MSNBC claimed that "drinking water patterns have changed over time," causing a change in fluoride consumption and a corresponding increase in a condition called fluorosis, mostly in adolescents.
A government study showed an increase in tooth spotting or streaking — in extreme cases even pitting, which is often so mild only dentists notice it, and they may not inform unknowing patients. Fluorosis has become much more common since the 1980s, increasing in adolescents from 21 percent to 43 percent.
But there’s more to the fluoride issue than how much is administered or its consequences. Ever since fluoridating water became public policy, many quick-thinking groups have opposed it as mass medication of the public. In 1951 fluoridation became an official policy of the U.S. Public Health Service, and by 1960 treatment of public water supplies was widespread.
Some communities have successfully opposed the practice. Voters in Springfield, Ohio, near Dayton, turned down the measure 57 to 43 percent in 2005, after also rejecting the idea in the 1970s.
Deborah Catrow successfully fought the 2005 ballot proposal that would have fluoridated Springfield’s drinking water, and thinks reducing fluoride would be a good start, but hopes it will be eliminated altogether from municipal water supplies. When MSNBC asked her about her opposition, Catrow claimed that it was hard fighting city hall, the American Dental Association (ADA), and the state health department, adding,
It's amazing that people have been so convinced that this is an OK thing to do…. Anybody who was anti-fluoride was considered crazy at the time.
Surprisingly, most European water supplies are not fluoridated. In countries that usually welcome government solutions, most communities have resisted it. The UK has tried introducing fluoridation but still finds considerable opposition. British critics, like their American counterparts, argue that people shouldn't be compelled to have "medical treatment" forced on them.
The official government attitude is reflected in MSNBC’s article, in which it asserts that health officials consider fluorosis to be a welcome trade-off for protection against cavities, and label water fluoridation one of the 10 greatest public health accomplishments of the last century.
Health and Human Services Assistant Secretary for Health Dr. Howard Koh declared:
One of water fluoridation's biggest advantages is that it benefits all residents of a community — at home, work, school, or play. And fluoridation's effectiveness in preventing tooth decay is not limited to children, but extends throughout life, resulting in improved oral health.
The American Dental Association also comes down on the side of government. President Raymond F. Gist, DDS, chimed in:
This is a superb example of a government agency fulfilling its mission to protect and enhance the health of the American people.
But those opposed to fluoridation claim that is the very idea they oppose — the idea that it’s the "mission of the federal government to protect and enhance the health of the American people" or to mandate their health decisions. Such federal agencies as Health and Human Services have no constitutional basis for their existence, they say — and serve only to increase the reach of the nanny state.
Other arguments against fluoridation include its dubious efficacy, the inability to accurately control fluoride levels or monitor responses, and most importantly — the impossibility of obtaining the consent of all water users.
In November, the American Public Health Association adopted a resolution that coordinated programs be established at public health, dental and medical clinics to offer fluoride varnish — a highly concentrated lacquer painted on teeth to prevent cavities. According to an administration official, Health and Human Services Secretary Kathleen Sebelius could decide this issue within a few months.
Mass medication has long been a concern of scholars and constitutionalists, at least at the basic level because it undermines individual liberty and choice, and at worst because of its potential as a control mechanism.
Responsible consumers will continue to investigate their choices.