In 2007, the Alaskan capital decided to remove fluorine from drinking water, now we know it was not a good idea
In Spain, according to Luis Coloma, the little mouse Pérez lived at number 8 on Madrid's Calle del Arenal, inside a box of cookies from the Prast confectionery. From there, using the city's pipes, this Perez set up an enamel traffic network that, today, is present throughout Latin America. Luckily, it has competition.
And it is that, with that or another name, the popular imagination has created myths about children's teeth throughout the history of humanity, giving us to understand that teeth are important. So when scientists discovered that small amounts of fluoride could protect us from cavities in the 1930s, the idea of adding it to drinking water seemed natural.
80 years later, to my surprise, the fluoride debate is still alive in many parts of the world. And we already know what happens if you remove fluoride from a city and fluoride from running water.
A very brief history of fluoride in water
Actually, in addition to the prophylactic effect of fluorine, what was discovered during the 1930s is that naturally formed water can have small amounts of fluoride. Therefore, the idea of adding it artificially where it had not seemed natural to them. Over the next two decades, researchers tried to find out if that could have ill effects.
By the 1950s, Dental and Medical Societies had become convinced that the possibility of harm was small and they joined a campaign to implement artificial fluoridation of water worldwide. Although according to historians at the time, evidence on the effectiveness and safety of the measure was deliberately ignored, the truth is that it was successful.
Today, it is still accepted that water fluoridation is the best public health measure for collective prophylaxis of dental caries. Although, yes, it is not without controversy. Recurrently, news comes from cities and regions around the world that decide to remove fluorine from their pipes.
Why would anyone want to remove fluoride from the water?
In recent years, studies have been appearing that, in one way or another, indicated black dots in the very clear history of fluoridated water. However, we do not have to go into this debate (which is still alive in the academy) to understand the main argument of those who oppose it: dental fluorosis.
Dental fluorosis is a problem that occurs when teeth are exposed to too much fluoride during their formation. It is an aesthetic problem, they are filled with white spots, but it is also a health problem that can lead to calcifying parts of the tooth and end up making it more sensitive to the same cavities that we wanted to avoid.
The solution to this is simple: adjust the amount of fluorine that we pass in the waters for public consumption. In Spain, for example, in 1962 the recommended amount was below 1.2 mg / l, today the recommendation sets a limit of 0.7 mg / l. In addition, the European Union prohibits the marketing of toothpastes with very high concentrations.
However, against the criteria of all medical and dental societies, there are those who maintain that, although key water fluoridation when there is a high prevalence of dental caries, in populations with low prevalence, supplementing the entire population may not be the better idea. The result is that some cities, disregarding the sanitary consensus, have decided to remove fluorine from the water.
The Juneau case
That is the case of Juneau, the capital of Alaska. In 2003, and without telling anyone, the city's Public Works Department stopped fluoridating drinking water. When it came to light, there was a scandal at the American level and many dentists urged the city to return fluoride to the water.
The problem is that the neighbors were not clear on what to do. Finally, a six-person commission was created that worked for two years and was unable to reach a conclusion: the vote on the final report was resolved with three votes in favor and three against.
Given that, the Juneau City Council finally decided to keep the fluorine out of the water. That could be a problem for the people of Juneau, but it gave us a historic opportunity: to be able to compare what happened to the teeth when the fluoride was removed.
Jennifer Meyer of the University of Alaska Anchorage became aware of this and analyzed the medical records of two groups of children of similar socioeconomic levels before and after fluoride removal. The first group were 853 non-adult patients who had received the "optimal exposure to fluoridation in water" before 2003; the second were 1,052 non-adult patients almost a decade later, in 2012.
The results are striking: Children who had formed their teeth after 2003 had, on average, one more cavity a year than their pre-fluoride removal counterparts. That, in the North American health system, translated into an extra cost of about 300 euros per patient per year. In other words, the impact is considerable considering how cheap fluoridation is.
It is true that Meyer's work did not study cases of dental fluorosis, but looking at the prevalence of the disease in the general population, it is difficult to argue that artificial fluoridation of water is not the most effective public health measure for this problem. No matter who likes it.