FLUORIDATION IN NEW YORK STATE:
CHALLENGES
MAY 23, 2012
Jay Kumar, DDS, MPH
Fluoridation in New York State





Focus on research and evaluation
Opposition to fluoridation
New York law supports local decision making
Regulations
Efforts to discontinue fluoridation
Objectives

To describe strategies for maintaining
community water fluoridation
 New
York City
 Poughkeepsie
 Plattsburgh


To discuss efforts to support advocates
To assess factors that affect outcome
New York City




Fluoridation started in 1962
A regulation requires 1.0 mg/L Fluoride
Serves over 8.5 million residents
Bills introduced
 Stop
fluoridation
 Lower fluoride level to 0.7 mg/L

Rally last week
 Councilman
Peter Vallone
Proposed bill
Referred to Committee on Health on 6/14/2011
Sponsors: Jumaane Williams, Fernando
Cabrera, Letitia James, and Deborah Rose
“The municipal water supply shall be fluoridated
in the following manner: A fluoride compound
shall be added to the municipal water supply at
an optimum concentration of about 0.7 ppm of
the fluoride ion, provided, however, the
concentration of such ion shall not exceed 1.0
ppm at any time.”
No final action taken yet
Issues




“I have serious questions with using the water
supply to force-medicate,”
Waste of $25 million per year
Causes IQ deficit
Environmental issues
Prominent Dentists Say Drinking NYC's Fluoridated Water is Risky
NEW YORK, Oct. 5, 2011 /PRNewswire-USNewswire/ -- Breaking away from
dental school dogma, more dentists are speaking out against fluoridation
because fluoride chemicals, added to NYC's water supply intending to
reduce tooth decay, are actually a money-wasting health risk, reports the
New York State Coalition Opposed to Fluoridation (NYSCOF).
Seven NYC Council Members sponsored legislation (1) and residents are
petitioning Mayor Bloomberg to stop fluoridation, to preserve money and
health. Join them: http://www.change.org/petitions/stop-fluoridation-in-newyork-city
Hydrofluosilicic acid, a lead- and arsenic-laced chemical (2) left-over from
making phosphate fertilizer (3) is NYC's fluoride chemical of choice. Dentist
Caree Alexander, a former Navy practitioner, then a private practice dentist
for 20 years, says fluoridation is "totally ineffective and actually damaging as
well."(5)
Dr. Alexander says, "When I graduated from University, we weren't given any
information about where [fluoride] came from. We all assumed it was
[pharmaceutical-grade] calcium fluoride."
Prominent NYC dentist and Huffington Post Contributor, Dr. Thomas
Connelly, writes, "I do not see the good in fluoridating our drinking water ... To
me, the 'bad' it can (potentially) do outweighs the good."(6)
Op Ed by Councilman Gennaro:
Beware The Anti-Fluoride Charlatans

By James F. Gennaro
Published in the Feb 17-23, 2011, edition of the Queens Tribune.

Two weeks ago in the Queens Tribune, a City Council colleague of mine wrote a
piece entitled, “Fluoride – If in Doubt, Keep It Out.” And, in the course of trying to
make the case and advance this bill, my colleague has made all kinds of absolutely
preposterous statements – taken right out of the anti-fluoride zealots’ talking points –
about “the government putting toxic chemicals in our water.” Referred to fluoride as a
“poison” and stated that fluoridation is the government “force-medicating” the public,
and “requiring every man, woman and child in America to ingest it (fluoride) borders
on criminal behavior.” I could go on and on, but Ill spare you. You get the idea.
However, I am compelled to set the record straight and give people the correct and
up-to-date information on fluoride.

"Today's announcement is part of our ongoing support of appropriate fluoridation for
community water systems, and its effectiveness in preventing tooth decay throughout
one's lifetime." But go ahead and ask your doctor and dentist – I'm betting they're in
agreement with the CDC, EPA, HHS, and every respected medical and dental
organization in the country on the benefits of fluoride.
Challenges




Regulation needs to be revised
Large system
Lack of oral health infrastructure
Many media outlets
Approaches

Support from advocates
 Dental
Association
 Academic institutions
 Dental clinic directors

Councilman Gennaro said



“city residents should not ask advice regarding
fluoride from elected officials, but rather from medical
professionals whom they trust.”
Letter from Pew
NY Times Editorial
Poughkeepsie



In 2005, fluoridation was stopped thus affecting 80,000
customers
In 2007 the Poughkeepsie Water Treatment Facility
decided to re-fluoridate the municipal water supply.
Efforts to stop fluoridation continued




Letter to Solvay Fluorides, LLC
Letter to Local Health Department requesting answers to
some 25 questions
In January, 2008, the decision was reversed
DOH letter was sent to Poughkeepsie Joint City/Town
Water Board requesting clarification
Questions raised




NRC Report raised questions about thyroid
impairment
New recommendations from ADA for not using
fluoridated water to mix infant formula
A shift in the scientific determination of
mechanism
Unresolved scientific questions about
disassociation of fluosilicic products, questions
of safety and effectiveness
More questions

1a. What are the daily water ingestion rates for adults, including subpopulations with
high intake rates, in Dutchess County (DC)?

1b. What are the daily water ingestion rates for infants and children by age in DC?

2. Are there identifiable ranges of consumption rates, ages, populations, or
subpopulations for which the DCDOH does not believe that the Board has a
responsibility to provide safe water for a lifetime? If so, what/who are they?

3. At what consumption rate, age, population, or subpopulation does the Board’s duty
to provide safe water cease?

4. What is the estimated cost to homeowners to remove fluoride from water supplied
to their home by a public water supply?

8. Given the NRC finding on endocrine effects from optimally fluoridated water, does
the DCDOH or water operator have a duty to inform the public about such risks?
Response
“The Board asked a number of questions about how much fluoride is
ingested by Dutchess County residents from drinking water and other
sources, and the potential for health effects at those fluoride ingestion
rates. Information directly relevant to these questions is contained in a
recent, comprehensive report by the National Research Council on
water fluoridation (NRC, 2006). Based on our review of the data in this
report and other sources, detailed below, we conclude that the existing
national data on water consumption rates and fluoride exposures from
all sources is applicable to Dutchess County residents. The overall
response to the Board’s questions is that the national estimates of the
amount of fluoride exposure for infants and children when drinking
water is fluoridated to about 1 mg/L does not indicate the likelihood of
adverse health effects in Dutchess County residents.”
DOH letter regarding discontinuation
“Since the Board’s authority to discontinue
fluoridation needs to be clarified and it is not
clear that the public health benefits of
fluoridation and options to provide equivalent
protection have been considered, I strongly
urge you to continue fluoridation until such
time as these issues have been thoroughly
examined and addressed.”
Health Board’s Effort Unsuccessful




Amend to the Sanitary Code
Required fluoridation
Held hearings
Not an elected body
Triumph of Science Over the Politics of Fear:
City of Plattsburgh


Fluoridated since 1956
2007 Water Fluoridation Quality Award
 “Plattsburgh
has been heralded for its treatment
program, winning a Water Fluoridation Quality
award from the CDC in 2007.”

Resolution introduced to stop fluoridation
Clinton County Health Department

Trained health department staff

Launched a social media campaign

Fluoridation brochure was distributed by the Childcare Coordinating
Council, the Joint Council on Economic Opportunity and the WIC
program.

Recruited champions

Encouraged local dentists to write letters in support of water
fluoridation to the City Council.

The county Board of Health passed Resolution #27, supporting
community water fluoridation

In November 2009, the city council voted 5-2 to continue the
fluoridation of the city's drinking water.
Determinants of success/failure






Commitment of policy makers
Strong advocacy
Champions
Supporting data
Resources
Local media
Strategies


Build support - Internal & External
Engage partners and stakeholders
State Oral Health Coalition
 Rural Water Association
 Local Health Departments
 State Dental Association




Develop resources
Provide training
Advocate for investment
Resources





DOH Website
Rural Water Association
Technical Assistance Center in Rochester
Oral Health NY Website
Fluoride Science.org Website (testing)
Thank you
jvk01@health.state.ny.us