Despite hopes to the contrary, magic bullets are few in the world of medical science. The exception may be fluoride. It is credited with being the primary factor in a dramatic reduction in dental caries in the last twenty years.
Fluoride is a natural component of minerals in rocks and soils. All water contains fluoride, but it is sometimes necessary to add it to some public supplies to attain the optimal amount for dental health.
The story of how fluoride came to have an essential role in the effort to achieve a cavity-free generation is not one of laboratory science. Rather it is one of careful scientific observation of a naturally occurring phenomenon, followed by wide experimentation. First noticed in the early part of this century when researchers observed that persons with "mottled teeth" experienced fewer dental caries than those without the discoloration. The phenomenon was traced to high amounts of naturally occurring fluoride in their drinking water. "Mottled teeth" is also known as fluorosis, a cosmetic defect characterized by white flecks, or in some severe cases, stained teeth.
Fluoride was first introduced into the drinking water of Grand Rapids, Michigan as part of a two-city community trial in 1945. The Grand Rapids undertaking was so successful that the control city of Muskegon soon insisted on fluoridating its water.
Since then, literally thousands of studies on fluorides and fluoridation have been completed, and more than 3,700 studies have been conducted since 1970 alone. The most recent national study on children conducted from 1986-1987 by the National Institute of Dental Research found "a clear and continuing benefit of community water fluoridation in preventing tooth decay."
The fluoridation of drinking water has expanded steadily, as has the use of fluorides in other ways. "Originally viewed as beneficial primarily for children, fluoride agents are now recognized as effective for all ages and of increasing importance in an aging population," according to Irwin Mandel, D.D.S., professor emeritus, Columbia University School of Dental and Oral Surgery. Virtually all toothpaste used in the United States contains fluoride. Fluoride mouthwashes and tablets are used in schools and homes, and topical fluorides are applied in dental offices. Around the world, where fluoridation of water supplies may not be realistic, fluoride-containing toothpaste is used. Unfortunately, those who consume high amounts of bottled water in place of fluoridated tap water may not be receiving its oral health benefits.
Fluoride has not achieved its fame nor results without its share of critics. It has been accused of being illegal, a communist plot, immoral and unconstitutional. It has been blamed for everything from cancer and birth defects to premature aging and, more recently, Alzheimer's disease and AIDS.
However, according to the American Dental Association, "The simple fact remains that there has never been a single valid, peer-reviewed laboratory, clinical or epidemiological study that showed that drinking water with fluoride at optimal levels caused cancer, heart disease or any other multitude of diseases of which it has been accused."
Based on the findings from hundreds of studies, both the National Institute of Dental Research and the U.S. Public Health Service support fluoridation as a safe, effective, equitable means of controlling dental caries.