And, except for Marathon, nobody in Cortland County gets it.
More than 214 million Americans get publicly fluoridated water to protect their teeth — 2 million more since just 2012, said Dr. Johnny Johnson, president of the American Fluoridation Society.
Johnson wants to change that, which is why he appeared Thursday night at Cortland Regional Medical Center to discuss the science behind the health policies that reduce cavities 25 percent.
Johnson came to Cortland courtesy of Cavity-Free Cortland, a partnership of Seven Valleys Health Coalition and the hospital. He spoke to about 30 people, many of them health professionals, but some fluoride opponents, too, and Mayors Brian Tobin and Genevieve Suits, of Cortland and Homer.
The science he cited has been in the public domain, even in Cortland, since Cavity-Free Cortland began a campaign earlier this year to persuade the city to begin adding fluoride to its water:
• Properly fluoridated water, 0.7 parts per million, reduces cavities 25 percent even in populations with access to good dental care, and up to 50 to 60 percent in other groups.
• Every $1 spent on fluoridation saves $43 in dental care, plus the costs of decreased productivity and poorer school performance.
• Except for mild fluorosis, a slight discoloration of the teeth, no damaging effects have been proven.
“As a dentist, I’ll tell you I’d rather my kids have a few little white spots than anything else,” Johnson said.
But as much as Johnson put forward fact and science, opponents countered.
The problem is the lack of informed consent, said Donna Lieberman of Cortland, after pointed questions about the chemical processes used to split the fluoride ion from the hexafluorosilicic acid from which it is commonly derived.
Johnson, who has a degree in chemistry, explained the process and result. Lieberman pushed the idea that fluoride was medication and that requires informed consent to administer. Johnson responded that court rulings label fluoride a water additive, like chlorine, not a medicine.
“I’ve never seen a child overdrinking water,” said pediatrician Dr. Mohammad Djafari. “I’ve seen them overdrink Kool-aid.”
“You would die of water toxicity before you would have an issue with fluoride,” Johnson added.
“Are we getting great teeth at the risk of neurotoxicity — and the answer is we don’t know,” said Otto Janke of Cortland. “I want to save the brains of kids.”
A handful out of more than 300 studies suggested a link between fluoride exposure and intelligence, but many were flawed, say both proponents and opponents of fluoride. Some didn’t correct for the presence of other substances such as lead or arsenic; others didn’t balance for other sources of fluoride exposure or different sensitivities to it. It’s difficult because large epidemiological studies can’t control for many environmental differences and smaller studies can’t correct for human genetic, behavioral and socio-economic variation.
“Not a single scientific group in the world opposes fluoridation,” Johnson said.
After the session, the fluoride opponents clustered to talk in one corner of the room, the health professionals in another. Johnson and Djafari traded notes in a third.
“We don’t withhold a vaccine or antibiotic if it fights a disease,” said county Health Director Catherine Feuerherm, and dental disease is both preventable and spreadable.
Johnson will continue to fight the opposition using science — he’ll be back in Cortland on Sept. 8 for a panel discussion pairing fluoride proponents and opponents — but he’s using science to argue what is an emotional and political issue.
“It is an elected official’s duty to make the hard decisions — and this decision isn’t that hard,” he said, adding that 65 to 70 percent of residents in most communities support fluoride, a picture politicians don’t always see. “They know their communities by their in-boxes.”
Djafari concedes that fighting fear with facts isn’t easy. “But people can still change. We’ll continue to do the grassroots efforts,” he said. “We never give up.”