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30 J.L. Med. & Ethics 117 (2002)
Fluoridation at Fifty: What Have We Learned

handle is hein.journals/medeth30 and id is 475 raw text is: Fluoridation at Fifty: What Have We Learned? Edwin Ted Pratt, Jr., Raymond D. Rawson, Mark Rubin ABSTRACT The question posed by the title of this article encompasses more than just the law and science applied to fluoridation. A review of the history and present status of fluoridation policy development and implementation makes it quickly apparent that the lessons learned are applicable to a wide range of public health policy and that the public health community needs to be very concerned about the status and trends of legal precedent. Indeed, in the context of recent U. S. Supreme Court decisions, the need for a compre- hensive and coordinated effort to educate the public, legislators, and jurists about the safety and efficacy of community water fluoridation is clear. Two fundamental issues are at the core of this article: (1) the use of science in formulating and defending public health policy, and (2) how to connect scientific fact with the legal process in connection with the actual circumstances regarding a community's health status. The opening section of this article presents an analysis of fluoridation's great success in preventing dental caries over the past 50 years, along with a discussion of current data scientifically demonstrating that fluoride is safe when properly utilized. A second section provides an overview of one state's legislative experience in mandating fluoridation and the political challenges encountered. A final section discusses the legal issues associated with fluoridation, including the bases of legal challenges to public laws mandating it. D oes it work? Comparison of four studies (NH1, 1971-1973; NIDR, 1979-1980; NIDR, 1986-1987; and NH III, 1988-1994) shows both an absolute decline in total number of dental caries in all age groups from 5 to 17 years from 1973 to 1994 as well as a dramatic flattening out of the increase from age 5 to age 17. These data demonstrate not only a reduction in dental caries in 17-year-olds by more than 50%, but also a reduction in the rate of increase among children 5 to 17. Current data indicate that 58% of these children are caries-free, 20% have low caries, and 20 % have high caries. The national data on the status and trends of children's oral health indicate significant improvement since the introduction of drinking water fluoridation over 50 years ago. In addition, specific studies support the positive effects of this public health policy. While there are certain- ly deviations from the standard of randomized, controlled, prospective, double-blinded clinical trials used-for example, by the Food and Drug Administration to test new drugs-the studies are sufficiently rigorous to provide effective evi- dence of fluoride's efficacy in preventing dental caries. More specific studies performed by pri- vate industry regarding fluoride toothpaste pro- vide more evidence that fluoride works-800 controlled trials indicated a 15-40% decrease in caries. Further, studies of the effect of discontin- uing fluoride use almost always show an increase in tooth decay. Recent evaluations of the cost-effectiveness of fluoridation demon- strate an annual per-person cost savings to com- munities of $15.95 to $18.62 attributable to obviation of dental treatment.

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