By Michael Strand

The Salina Journal

In the first years of the 20th Century, when Frederick McKay moved to Colorado Springs to open a dental practice, he was appalled at the condition of teeth there, which were often mottled the color of chocolate.

After nearly a decade of research, he concluded that what had come to be called "Colorado Brown Stain" had an interesting side effect; those black-and-brown teeth had very few cavities.


Group concerned about fluoride from china.

Read the story:


In 2005, the United States Department of Agriculture compiled a list of common foods and their fluoride content. Among the findings:

-- Chicken broth, 0.61 ppm

-- Root beer, 0.73 ppm, and cranberry juice cocktail, 0.71 ppm, both about the same as in Salina's water.

-- Red wine, 1.05 ppm, about the same as Salina's water a few years ago.

-- White wine, 2.02 ppm

-- White grape juice, 2.13 ppm -- roughly three times what's currently in Salina's water.

-- Raisins, 2.34 ppm

-- Brewed black tea, from 2.5 to nearly 4 ppm -- approaching the EPA's maximum allowed in drinking water.

Source: USDA

By the early 1930s, research by McKay and others had linked the lack of cavities and the brown teeth to naturally occurring fluoride in the water -- and Colorado Brown Stain came to be known as dental fluorosis.

A few years after that, researchers had found that fluoride concentrations up to 1 part per million in water were high enough to prevent cavities, but low enough to cause little fluorosis.

In 1945, Grand Rapids, Mich., became the world's first city to add fluoride to its water supply. A 15-year study showed a 60 percent reduction in cavities among children there, and fluoridation swept the nation.

Salina began adding fluoride to its water in 1969.

On Nov. 4, city voters will decide whether to continue that practice, after a group called Salina Cares organized a petition drive earlier this year to put the issue to a vote.

A "yes" vote on the ballot is to remove fluoride from the water. A "no" vote is to continue fluoridation.

Why end fluoridation?

Lou Tryon is the driving force behind Salina Cares, and her group has compiled a long list of reasons they say justify ending fluoridation: Broadly, they say fluoride isn't effective at fighting cavities, and has long-term effects on people's health, including fluorosis, lower IQs, hip fractures among the elderly and others.

More specifically, Tryon questions why Salina is buying its fluoride from China and worries about its purity.

Dentists and doctors in the area support continuing fluoridation, and are planning a major profluoride push before the election.

What happens in Salina could have far-reaching consequences, says John Adams, who has been practicing dentistry here since 1975.

Adams notes that last year Portland, Ore., voters rejected fluoridation, Wichita voters rejected fluoridation earlier this year, and fluoridation is on the ballot this fall in Wellington in south-central Kansas.

Each vote against fluoridation, Adams says, adds momentum to the cause.

"It makes people wonder 'Maybe those people in Portand know something,' " he said.

Tryon agrees Salina is being watched by both sides nationally.

Salina Cares already has several hundred yard signs posted throughout the city, and Tryon says more are on the way.

Signs supporting fluoridation started showing up around town this past Monday, and medical and dental offices around the city have started distributing information to patients.

It's a lifetime benefit

Salina dentist Allison Lesko is president of the Salina Dental Society and a leader of a group of dentists, doctors and nurses campaigning to keep fluoride in the city's water.

She explains that fluoride is chemically attracted to calcium in teeth and bones, and helps fill holes in the crystal lattice, making teeth and bones stronger and preventing tiny holes that lead to cavities.

It used to be thought that fluoride in water was effective throughout a person's life, Lesko said, but research in the past few years has shown the major effect is when teeth are forming.

While the concentrations in Salina's drinking water -- around 0.6 parts per million -- don't provide a benefit for adults, Lesko said, it does help children build strong teeth.

"It helps both baby teeth and adult teeth before they erupt, and provides a lifetime benefit," she said.

Need to keep applying it

Topical fluoride -- such as found in toothpaste, dental rinses and the fluoride treatments dentists provide -- has a much shorter-term benefit.

"The fluoride will fill the holes, but it's like putting on lotion -- the next day your skin is dry again," Lesko said.

Just as with fluoride that's ingested, Lesko said, topical fluoride is attracted to the calcium in teeth, and helps fill any tiny holes -- and once on the tooth, the fluoride in turn attracts additional calcium, further helping repair teeth.

The effect lasts for a few months, and then needs to be reapplied.

'Amazingly better' teeth

Tryon disputes the effectiveness of fluoridated water, saying other factors can explain the decline in cavities since the 1950s, including fluoridated toothpaste, and an overall greater emphasis on oral hygiene.

Lesko and Adams acknowledge many variables are involved, but numerous studies show the effectiveness of fluoridation.

"There are thousands of studies ... and I can argue what I've seen in my 39 years of practice," Adams said.

"When I came to Salina, I became kind of the resident children's dentist," Adams said. "I'd see six to eight kids a month, from places like Minneapolis and Beloit, that we'd have to take to the hospital and spend a Friday rebuilding their mouth -- they needed the kind of work you couldn't do in a dentist office.

"The kids who were brought up in Salina generally had amazingly much better teeth," he said.

What the science says

Among those thousands of studies Adams cites is one from Korea published earlier this year.

In that study, researchers looked at children of different age groups in two Korean cities, one of which never had fluoridated water, and one that quit fluoridating its water seven years earlier.

That study showed that 11-year-olds in the city that had stopped fluoridating had significantly fewer cavities than in the city that never had fluoridated water.

The researchers found "no significant difference" in cavity rates between eight-year-olds in the two cities.

"That's a good study, that shows what fluoride does, and what happens if you stop," Adams said.

Can't get away from it

Tryon shows a World Health Organization study that shows cavity rates declining at roughly the same pace both in countries that fluoridate their water and those that don't.

She acknowledges that in many of those countries, fluoride is added to milk or table salt instead, much as iodine is added to salt in the United States.

But there's a difference, she says.

"You can not buy the fluoridated salt, or the milk," she said. "You can't get away from fluoridated water -- I'd like to just be able to go out and have coffee with my friends without getting fluoride."

The 'Harvard study'

Tryon and other fluoridation opponents also cite what's called the "Harvard study," as evidence of fluoride's adverse effects.

The Harvard study was released in July of 2012. In it, researchers from Harvard School of Public Health and China Medical University in Shenyang analyzed 27 previous studies of fluoridation and IQ conducted in China, Mongolia and Iran and determined fluoridation lowered IQ by seven points.

But a read of the entire study shows that its authors recognized its shortcomings.

They noted, for example, that "each of the [studies] reviewed had deficiencies, in some cases rather serious, which limit the conclusions that can be drawn," and that the IQ difference was within the margin of error of the tests.

Critics noted that in many cases, the water in the areas studied had naturally occurring fluoride concentrations more than 10 times what's in city water supplies in the United States.

Drink 18 gallons a day

Lesko has read not only the "Harvard study," but also the individual studies it compiled -- except for the half-dozen that haven't been translated into English.

In many parts of China, fluoride isn't just in the water, but in the air -- from burning coal with high fluoride levels -- and in the soil and vegetation, including food.

"There's no way of knowing how much their total exposure was," Lesko said. "And they even said in the study that the results don't translate to the U.S., where fluoride exposure is much lower. To get that much fluoride (from Salina's water) you'd have to drink something like 18 gallons day."

A few months after the study was published, its authors released a short follow-up statement acknowledging some shortcomings, stating "When considering the risks and benefits of fluoride exposure, the level of intake needs to be considered" and that "These results do not allow us to make any judgment regarding possible levels of risk at levels of exposure typical for water fluoridation in the U.S. On the other hand, neither can it be concluded that no risk is present."

What about hip fractures?

Regarding hip fractures, there have been some studies that show slight increases -- and other that show slight decreases after fluoridation.

In 1993, researchers looking at fluoridation and hip fractures in Rochester, Minn., -- home of the Mayo Clinic -- reviewed some of those studies as part of their research.

When fluoride was first being introduced, they wrote, one added benefit of fluoridation was expected to be stronger bones -- and fewer hip fractures.

Results were inconclusive, with some studies showing slight decreases and some showing slight increases after fluoridation.

The study of residents of Rochester, which began fluoridation in 1960, found "no positive association between water fluoridation and hip fracture risk," but that "given the disparate results of this and other ecologic studies, it is apparent that future studies of the association of water fluoridation and hip fracture will need to be conducted..."

Getting too much fluoride

Tryon also points to 2011 decision by the Department of Health and Human Services to reduce the recommended levels of water fluoridation.

For decades, the federal government had recommended fluoridation levels of between 1.2 and 0.7 parts per million, but the new recommendation was that fluoride be limited to 0.7 ppm.

In recommending the lower concentration, the government noted that sources of fluoride have increased over the past few decades, and that during that period, cavity rates have declined -- but dental fluorosis rates have increased.

Studies cited by HHS in recommending the lower fluoride levels pegged fluorosis rates of 23 percent to 41 percent among teenagers; 90 percent of those cases were considered "mild" or "very mild."

Tryon sees that as evidence not just that people are getting enough fluoride from other sources -- but that in many cases, they're getting too much.

"They're struggling to use that as a reason," Adams said. "I can't think of any dentist in town who's ever said they're seeing lots of fluorosis."

Lesko has what she calls "very mild" fluorosis on a couple of her teeth, and dismisses it as "cosmetic."

"I've never seen a severe case except in a book," she said.

It's more than fluoride

And while the name "fluorosis" implies a connection to fluoride, Adams said there are other causes as well.

One other common cause of fluorosis is the antibiotic tetracycline, Adams said, which is often given to teenagers to fight acne.

Lesko said a fever when teeth are forming can also cause fluorosis.

"There are lots of other events that can damage enamel," Adams said. "Even if you see fluorosis, you can't say for sure it's because of fluoride. It's like a headache -- your head hurts, but there could be lots of reasons."

Salina cuts fluoride level

In response to that 2011 federal recommendation, Salina reduced the amount of fluoride in the water.

Lab results from the city show fluoride levels had ranged from 0.7 to 1.2 parts per million in years before the new rule. In 2013, concentrations ranged from 0.54 to 0.64 ppm.

Tryon sees that halving of the city's fluoride levels as a partial victory. Adams says studies show fluoride is still effective at those concentrations.

It's everywhere

With fluoride available in everything from chicken broth and root beer to wine, grape juice and tea, Tryon says this is evidence that people can get plenty of fluoride without government having to "mass medicate all of us." Tryon said. This is especially true given that toothpastes contain fluoride, and fluoride rinses are available in grocery stores.

"We don't have any objection to people using fluoride if they want to," she said. "We don't think it does any good -- and we don't want it in our water."

Adams agrees that fluoride is now widely available -- but that the people who need it the most are the least likely to get it from other sources if it's taken out of the water.

Affect on low-income kids

"There are so many sources now," he said. "If you take it out of the water, it wouldn't affect adults. Kids are a different matter. If they're going to the dentist every six months, they'll probably be OK. The kids who never see a dentist are the ones who would be affected."

Adams does lots of volunteer dentistry around Salina, including treating low-income children in the Head Start program.

"Demographically, the people who don't take their kids to the dentist are also the ones who don't encourage tooth-brushing, and are more likely to give their kids candy," he said. "Those are the ones helped the most by fluoride in the water."

Tryon sees it differently.

"They want us to sacrifice, to get sick, so kids don't have to brush their teeth," she said.

(c)2014 The Salina Journal