Bethany Beach's water to be fluoridated

Bethany Beach residents will get something new in their water this week: a small amount of fluoride.

Despite a decided lack of support from town council members for fluoridation of the town’s water supply, the town makes the move this week under pressure to conform to Delaware Division of Public Health and federal Safe Drinking Water Act (SDWA) requirements mandating fluoridation of public water supplies in Delaware.

Beginning Monday, Oct. 31 — just in time to potentially counter some cavities from Halloween candy — the town will add fluoride to its water, maintaining a level of approximately 1 milligram per liter (the nationally recommended median amount).

Town officials had to be asked to provide enough yea votes on fluoridation to make the move official, with the bulk of council members choosing to abstain from voting at the most recent consideration of the issue Sept. 16. (Council Member Tony McClenny has been the staunchest supporter of the concept.)

The council as a whole would likely have voted against fluoridation once again in September, based on their rejection of the process earlier this year. But Town Manager Cliff Graviet informed them that on a recent visit, a representative of the state Division of Drinking Water had advised the town it was “no longer taking a passive approach” toward the issue and would now be mandating — and enforcing — fluoridation for the town’s water supply.

While some Sussex County towns have long been on the fluoridation bandwagon (Selbyville — 1956, Lewes — 1965, Georgetown — 1993 and South Bethany — 2000), Bethany Beach is not the only town that has resisted using the process.

Dewey Beach, Frankford, Millsboro and Rehoboth Beach were all listed by the CDC as having no fluoridation in their central water supplies as of this week. (Though that may change due to the statewide crackdown.)

The $5,000 cost for equipment needed for fluoridation in Bethany Beach was to be reimbursed by the state once the process was under way.

According to town officials, the optimal fluoride concentration level is 0.8 to 1.2 milligrams per liter, as recommended by the U.S. Public Health Service (USPHS) for dental disease prevention. Daily sampling and inspection for quality control will assure the consistency of the concentration.

On previous consideration, council members had expressed concern about the safety of fluoride for some, as well as what offsetting degree of benefit it would provide for the town’s predominantly adult population.

And the town’s announcement that fluoridation would commence Oct. 31 was accompanied by the following warning: “If you or anyone in your family is currently taking fluoride supplements, consult your physician or dentist for guidance.”

That warning stems from concerns about possible overdosing of fluoride, one of the risks associated with fluoridated water supplies.

According to the Centers for Disease Control Web site, like most of the neighboring towns in Sussex County, the town’s water supply does not have a significant naturally occurring amount of fluoride.

So the amounts ingested by the town’s residents will come from foods (usually negligible amounts), toothpaste fortified with fluoride and the water itself. Anyone taking an additional supplement will also have to account for that in their total fluoride intake and address it in consultation with a physician.

According to the American Academy of Pediatrics Committee on Nutrition, infants younger than 6 months are recommended not to receive any supplementation of fluoride, while children living in areas where the water supply has amounts less than .6 parts per million are recommended to receive some degree of additional fluoride in a supplement.

Notably, the level now to be in Bethany Beach town water comes in above that 0.6-parts-per-million level and should eliminate the need for additional fluoride supplements in most children.

Of a deeper concern for town council members during consideration of the issue was the possibility of negative affects from either too much fluoride or even the basic level now being added to the town water supply.

Despite wide-ranging endorsements from a variety of U.S. health organizations and governmental agencies, fluoride has come under heavier scrutiny in recent years, as Internet research and select studies have fanned the flames of fears that the naturally-occurring mineral could cause problems ranging from dental fluorosis (a white or brown mottling of the teeth caused by too much fluoride) to cancer.

Most recently, the Oct. 24 issue of Time magazine contained an article describing some elements of the controversy. That included allegations that research from a 2001 doctoral thesis had shown a sevenfold increased risk of bone cancer (osteosarcoma) in preadolescent boys who drank fluoridated water, but that the information had been suppressed.

At the same time, the benefits of fluoridated water have been questioned, with suggestions that fluoride-containing toothpaste may be responsible for much of the statistical improvement in the number of dental caries nationwide. Indeed, a 2001 CDC study found that kids in locations with fluoridated water, by the time they were 12, had only 1.4 fewer cavities than those living where the water was not fluoridated.

Still, the American Dental Association firmly recommends fluoridation and countered the Time article with reassurances about its safety and effectiveness in preventing cavities: “According to Surgeon General Richard H. Carmona, ‘Fluoridation is the single most effective public health measure to prevent tooth decay and improve oral health over a lifetime, for both children and adults.’”

“Even in an era with widespread availability of fluoride from such other sources as toothpaste, studies prove water fluoridation continues to be effective in reducing tooth decay by 20 to 40 percent,” the ADA Web site notes.

And the National Institutes of Health note that fluoride can even reverse tooth decay by enhancing remineralization, the process by which fluoride “rebuilds” tooth enamel that is beginning to decay.

As for the population of Bethany Beach and its predominance of retirees versus children and adolescents, the American Academy of Family Physicians (AAFP) also touts the benefits of fluoridated water for older Americans, saying:

“While the majority of published studies have examined dental health among adolescents, dental decay is also common during the later years of life in the form of root surface caries. Fewer carious lesions have been identified among older persons residing in communities with optimal fluoride levels.”

On that basis, most medical associations continue to recommend fluoridation of water, deeming any risks to be rare. According to the AAFP, the potential risks associated with fluoride include:

• Acute toxicity — occurring at doses of 1-5 mg/kg. Symptoms of toxicity include nausea, vomiting, diarrhea, sialorrhea and abdominal pain, often accompanied by seizures, cardiac arrhythmias, and coma;

• Fluorosis — dental fluorosis occurs from exposure to increased levels of fluoride during tooth formation; generally considered more of a cosmetic problem since it rarely compromises dental or oral function; [the CDC recently announced that 32 percent of American children now have some form of dental fluorosis]; skeletal fluorosis is extremely rare;

• Cancer — a National Toxicology Program study of rodents with life-long fluoride exposures reported an increased incidence of osteosarcomas among male rats ingesting a high fluoride diet. The same study failed to demonstrate differences in cancer occurrence among female rats or among male or female mice.

The report prompted an examination of incidence rates for osteosarcomas, and all bone cancers combined, in fluoridated and non-fluoridated communities, which revealed no significant differences. In addition, total lifetime fluoride exposure was not found to be associated with risk of developing osteosarcoma.

Previous reports which compared cancer mortality in fluoridated and non-fluoridated areas revealed no association with fluoride levels in drinking water. Similarly, studies of cancer incidence in fluoridated and non-fluoridated communities identified no significant differences.

• Bone fractures — Studies of hip fracture rates and fluoridated drinking water supplies have yielded no consistent results. Further studies are needed to resolve these inconsistencies.

Addressing the study by Dr. Elise Beth Bassin that noted the increased risks of adolescent bone cancer in boys, an ADA spokesperson said, “The ADA cautions the dental profession, public health officials and the public against drawing conclusions based on a lone researcher’s unpublished study. Indeed, the student notes in her thesis that there are several limitations to her study and recommends that the findings be confirmed using data from other studies.”

Repeatedly, the ADA statements concerning the safety of fluoridated water focus on the existing body of evidence:

“ADA policies on community water fluoridation are based on the overwhelming weight of credible scientific evidence. That evidence stems from extensive scientific research and has been published in refereed (peer-reviewed) professional journals that are widely circulated. The research concludes that there is no association between cancer rates in humans and optimal levels of fluoride in drinking water.”

Such assurances put some minds at ease while others fear the true level of risk has not yet been fully recognized.

But Bethany Beach residents concerned about fluoridation have limited options now, aside from avoiding ingesting town water in favor of that from non-fluoridated sources.

Additionally, according to the AAFP: “Parents should monitor their children’s use of dentifrices and other dental products that may represent sources of excessive fluoride ingestion. … To minimize the risk of systemic ingestion of topical fluoride agents children should be supervised when using products containing fluoride.

Toothpaste contains fluoride at a level of 1 mg/gram, making it easy for unsupervised children to ingest excessive fluoride. The AAFP notes that a 2-year old, brushing his teeth twice a day, could ingest as much as 0.5 mg a day. And recent recommendations for toothpaste use among young children have reduced the amounts to be used from a pea-sized amount to a match-head-sized amount.

In the end, perhaps the best recommendation for residents of Bethany Beach who may have issues with their newly fluoridated water is the one coming from the town itself — to consult a physician.

10 reasons to fluoridate public water

• Fluoride is nature’s cavity fighter. It is already present in all water sources, even the ocean. Water Fluoridation is the controlled adjustment of the natural fluoride concentration in a public water supply up to the level recommended for preventing tooth decay.

• Fluoridation protects against tooth decay throughout life, benefiting both children and adults. Inadequate exposure to fluoride places children and adults in a high risk category for tooth decay.

• Fluoridation is the single most effective public health measure to prevent tooth decay and to improve oral health for a lifetime, for both children and adults.

• An estimated 51 million school hours are lost each year due to dental-related illness.

• The average cost for a community to fluoridate its water is estimated to range from approximately $0.50 a year per person in large communities to approximately $3.00 a year per person in small communities. The average cost for one dental filling is $101.94.

• 67.3 percent of the population or more than 170 million people on public water systems receive fluoridated public water. The Healthy People 2010 goal is to raise this number to 75 percent by 2010.

• The Centers for Disease Control and Prevention (CDC) has proclaimed community water fluoridation one of 10 greatest public health achievements of the 20th century.

• Studies prove water fluoridation continues to be effective in reducing tooth decay by 20-40 percent, even in an era with widespread availability of fluoride from other sources, such as fluoride toothpaste.

• The American Dental Association (ADA) endorses fluoridation of community water supplies as safe and effective for preventing tooth decay.

— Source: American Dental Association (ADA)