1.

Explain the position of the role you have been assigned documented with

at least one professional and one consumer reference that supports the

position of your role.

The assigned role is a former retired dentist that has been a strong

supporter of school health programs and water fluoridation when he was living in

Michigan. He is currently semi-retired and living in Sonoma. This dentist has

noted a difference in higher caries rate among children in California when

compared to Michigan and is still a strong supporter for water fluoridation among

his retirement community and church.

Fluoride has been a proven and accessible way to prevent tooth decay in

both children and adults. By treating the drinking water with fluoride, data has

shown a dramatic decrease in tooth decay. The mean number of decayed,

missing or filled teeth in 12 year olds went down by two thirds, from 4 teeth in the

1960s to 1.3 in 1988-94, mainly due to fluoridation 1.

Due to misperceptions of the benefits and risks of fluoride, policymakers of

Sonoma have be met with barriers and challenges. Because fluoride is extracted

from the same phosphate rock that is later used to create fertilizer, those that do

not understand tend to think that fluoride came from fertilizer. Some individuals

are afraid that drinking fluoridated water is unsafe when ingested in large

quantities. However, the amount of water you have to drink to have an adverse

effect is 10.0 miligrams which means an adult male would have to consume 12

quarts of fluoridated water. Meaning it is 600% of the recommended intake of

water each day.

 The Sonoma County Department of Health Services representative, Kim

Caldewey supported fluoridation of Sonomas water. She noted that there has

been an increase in dental-related visits to the emergency room for the past few

years and that to be able to support the countys economically disadvantaged

children, the water of Sonoma should be fluoridated 2.

Fernadez, chairman of Redwood Empire Dental society Fluoridation

Committee also made the point that the expense of the fluoride for the water for

an entire household for a year will cost less than a tube of toothpaste, and

reduces dental decay at comparable rates 3. It is a important and significant way

for low-income families to avoid costly dental procedures 5.

Fluoridation advocates say that opponents are misguided and dont realize

that there is a very small amount of fluoride that is added to water such that it

does no harm to people that drink the water4. Fluoridation of community water is

only adjusting the naturally occurring fluoride levels in drinking water to an

optimal level to prevent tooth decay. Water being fortified with fluoride is a similar

concept to fortifying milk with Vitamin D, table salt with iodine, and bread and

cereal with folic acid5.

2. List, describe and critically analyze three reasons that support water

fluoridation. Please include both professional and consumer references

that support the pro -fluoride position for each of the three arguments.

The major benefit of community water fluoridation is that it promotes healthy

dentition by reducing caries and tooth decay actively. The CDC cites studies

showing that water fluoridation can reduce tooth decay by about 25% over a

lifetime; the ADA estimates this number can be even higher in the future, up to a
40% reduction6,. Constant exposure to fluoride helps to prevent breakdown of

enamel and re-mineralize tooth structure fluoridated water is efficient as it

enables frequent contact between teeth and low levels of fluoride throughout the

day. Community water fluoridation is safe and effective. It is the least expensive

way to deliver the benefit of fluoride to all residents of a community7. Although

fluoride can be delivered via toothpaste, mouth rise or professional fluoride

treatments, these methods are a lot more expensive and require an active

participation of the individual. A mother of three from Washington state

mentioned, I am proud of my familys healthy lifestyle and yet my children have

needed a lot of dental work. I grew up in a fluoridated city and never had this kind

of dental decay. All kids need the benefits of fluoridation, no matter where they

live3. As a consumer, this individual knew the difference fluoride has made for

her dental health.

Another benefit of water fluoridation is that it is the ease of access.

Fluoridation is especially helpful in underprivileged communities that cant afford

dental care, as it acts as both a preventative measure as well as a treatment

through re-mineralizing the enamel. In addition, easy accessibility means that

people are more likely to utilize this health resource because it is part of their

daily lives. With drinking of water, you passively are protecting your teeth from

decay. In a way, it even helps children with their education according to a 6th

grade teacher in Seattle, Washington. She mentioned, Kids with poor dental

health miss more school, can be distracted, and can even have speech

problems. As a teacher, I see first-hand how dental health can affect a childs
ability to learn and succeed.9 Fluoridation provides oral health benefits to

everyone regardless of socioeconomic status, age, and lifestyle, so it is therefore

important step towards providing equal healthcare for all.

Finally, having a fluoridated water supply has proven to be very cost-

effective. Fluoridation is one public health program that actually saves money; an

individual can have a lifetime of fluoridated water for less than the cost of one

dental filling. Both the ADA and CDC have pointed out the economic benefits of

implementing fluoridation. The CDC states that water fluoridation costs about 50

cents per person in larger communities, and yields about a $38 savings in

treatment costs5. Providing one person with a fluoridated water supply is cheaper

than professional fluoride treatments at the dentists office or toothpaste and

mouth rinse, not to mention dental procedures such as fillings and root canals.

Therefore, introducing fluoride into the water supplies in Sonoma could help save

both time and money spent on preventative and restorative dental treatment.

3. List, describe and critically analyze three reasons that argue against

water fluoridation. Please include both professional and consumer

references that support the anti -fluoride position for each of the three

arguments.

A large and visibly evident concern in the fluoride debate is that it causes

dental fluorosis in children who ingest too much fluoride. This is a symptom of a
larger problem involving the difficulties of limiting daily ingestion to precisely the

recommended amount. The EPA Headquarters Professionals Union reported on

the Fluoride Action Network that at least 22% of children in America has dental

fluorosis1. This not only creates aesthetic problems and but is also a noticeable

sign of fluoride overconsumption in almost a quarter of the child population,

underlining the struggle to limit fluoride intake to appropriate levels. It is believed

that with fluoride in the water, it is hard to control the amount of fluoride ingested

by each individual.

Moreover, some states that studies on cavity incidence in children show little

difference (only about half a cavity less) between fluoridated/non-fluoridated

communities2. The organization also points out that major cities in the US are still

facing dental health problems despite a history of water fluoridation, and

concludes that better access to healthcare and health prevention education is

most vital to solving any widespread crisis in oral health. This point is further

illustrated by the fact that most of the rest of the world does not fluoridate their

water, and tooth decay rates in many non-fluoridated countries are not

1
2
significantly different than rates in fluoridated ones 3. Therefore, other practices

must be responsible for the state of oral health seen in non-fluoridated countries.

Finally, a major issue specific to Sonoma is the cost of implementing and

maintaining the water fluoridation system. Although the predictions that the cost

will be small, the organization has not yet taken into account all the additional

costs, such as the cost of repairing damage from the corrosive acid additives

used to manipulate fluoride levels in water. Mayor David Cook, questions the

program as a top county priority, he believes that money is better spent going to

schools6. All relevant potential cost estimates should be taken into account

before any decision is made regarding water fluoridation in Sonoma. Dawna

Gallagher-Stroeh, an anti-fluoridation crusader argues that there have been no

studies on the safety of ingesting fluoride and that people should make their own

choices about fluoride6. Therefore, fluoridation of the community water in

Sonoma should not be allowed.

31 http://www.sonoma-
county.org/health/topics/fluoridation.asp2http://www.publicceo.com/2013/12/setback-for-sonoma-
county-fluoridation-plans/
3
http://www.pressdemocrat.com/news/3602729-181/sonoma-opposes-county-plan-to?page=2
4
http://www.pressdemocrat.com/news/local/3187628-181/new-studies-seek-to-bolster?page=2
5
http://www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-fluoridation
6
http://www.sonomanews.com/news/3551531-181/council-delays-stand-on-fluoridation#page=3
7
http://fluoridealert.org/articles/epa-union/
8
http://www.cleanwatersonomamarin.org/news/
9
http://fluoridealert.org/issues/water/