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

Referred to Committee on Health on 6/14/2011Sponsors: 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

Proposed bill

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-new-york-cityHydrofluosilicic 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)

jvk01@health.state.ny.us

Thank you