CLASSROOM LAW PROJECT Summer Institute Fluoridation: Yes or No? INTERVIEW ROLE PLAY Practice interview skills. When researching the issue of fluoridation, interviewing stakeholders in the community is an important part of the process. Assume the role of one of the stakeholders and be interviewed by others. After a few minutes, swap roles. Interviewers become stakeholders (in a role not interviewed) and stakeholders become interviewers (interviewing for a different role). ROLES Cut into individual roles and distribute. 1. Dentist Representing the American Dental Association 2. Poor Parent 3. Eco-minded Parent 4. Representative for the Centers for Disease Control and Prevention 5. World Health Organization Representative 6. Sierra Club Representative 7. Child with Cavities 8. Person with Illness/Medication Sensitivity 9. Veterinarian
1. DENTIST As a dentist, I am a steward of oral health. It is my duty to promote proper oral hygiene through proven prevention, diagnosis, and treatment methods. While my academic and professional focus is on oral health, my greater concern as a medical practitioner is the patient s general health. Numerous scientific studies indicate strong associations between oral hygiene and a variety of general health conditions including diabetes and heart disease. So, maintaining healthy oral hygiene is a contributing factor to a healthier life in general. Since exposure to low-levels of fluoride over long periods can strengthen teeth, and strong teeth promote proper oral hygiene, I believe that the fluoridation of public water supplies is the surest step toward better oral hygiene and healthier lives for all. One of the most efficient means of maintaining proper oral hygiene is taking steps to preserve the shield of enamel that protects our teeth. Dental caries, or cavities in layman s terms, are weak spots in the tooth enamel that can progress into decay and infection if left untreated. In severe cases, the decay can lead to drastic consequences such as tooth extraction, loss of work, or the spread of infection to other parts of the body. All these consequences could be avoided through common means of prevention such as periodic check-ups and daily brushing and flossing. Why then do dental caries remain a major health concern for industrialized nations? Tooth decay remains an ongoing problem for the following reasons: most lowincome families can afford neither periodic visits to see a dentist nor fluoridated toothpastes, and preventative education on the proper care of teeth is simply not reaching a wide-enough audience. Therefore, I believe that the surest solution lies in a third approach that does not depend upon income or education levels. To combat tooth decay on a wider front, I believe public water supplies should be fluoridated to the levels prescribed by the scientific and medical community between 0.5-1.0 milligrams per liter of water. Since Grand Rapids, Michigan, became the first metropolis in the U.S. to institute the method 65 years ago, fluoridated water supplies have proven a safe, efficient, and inexpensive means of reducing the incidence of tooth decay on a wide-scale. By simply adding a concentration of 0.7 milligrams of fluoride per liter of water, we could reduce the incidence of tooth decay in both adults and children by 25%. Now, that s progress! As a medical professional, it would be unbecoming to recommend a treatment that I cannot stand behind. But given the overwhelming support of the scientific community, and long history of success, I wholeheartedly endorse the fluoridation of public water supplies within the proscribed concentrations. 2
2. POOR PARENT Should every child have healthy teeth? Or, just those children whose families can afford it? I just signed over my paycheck to fix my son s infected tooth $600! Can you believe it? I am still trying to figure out how I ll make up this month s rent. On top of that hole in my pocketbook, I feel like a bad parent. I would have taken him in sooner, promise. I knew he had been complaining at school about his tooth, but I simply couldn t afford the costly visit because my new employer doesn t have a family dental plan. I am sure that if I was higher on the ladder I d be eligible, but there is only so much you can do with a G.E.D. My son is such a hard worker, just like me. I worked hard in school, too. But, by about the 10 th grade, I was absent a lot with a few bad teeth of my own. See, my parents couldn t afford to take me to the dentist either, and I would get toothaches so bad I couldn t finish my homework or focus in class! By the time 11 th grade rolled around, I didn t have the grades or the patience to finish. Fortunately, I was able to go back for my G.E.D. so I could land a job. I just want a better life for my kids, and for them to not have to worry about the same things I did. It s a hard life, and it isn t any easier when you have bad teeth. Sometimes I am too nervous to smile at new customers, or my supervisors, because I don t want them to see my teeth. That s why I got so upset at what the dentist told me about flouride. To think that all this could be avoided! As I signed the check I mumbled, I wish there was a cheaper solution The dentist commented that my son may not be getting enough exposure to flouride. I know that stuff is in toothpaste and all, but how am I supposed to buy $5.00 tubes of toothpaste when I can t even pay our rent? Sure I was upset, but that wasn t all. He went on to say that fluoride could be put in our water, but our town didn t vote for it last time the issue was raised. If every other major U.S. city has done it, why shouldn t we? Something good must come out of it. That s why I am going to the city council meeting, I want my voice to be heard. I may not be able to say it like I want, but I think fluoride could help my kids and me have a better life. 3
3. ECO-MINDED PARENT If you think fluoride is all your getting, think again. Arsenic, lead, and mercury are just some of the ingredients in hydrofluorosilicic acid, the industrial byproduct of fertilizer manufacturing that is used to fluoridate drinking water. Now, is that something we want to expose our children to? The supporters of fluoridation think that it s such an efficient and inexpensive solution to tooth decay. However, have they considered the long-term costs to our health and the environment? For any short-term gains that might be had, the long-term consequences are just way too costly. I don t want fluoridation chemicals added to my water or the rivers where salmon live. I know there is fluoride in my toothpaste when I brush my teeth, but I spit it out like the directions say. When I turn on my faucet all I want to come out of it is water, clean water. After all, most toothpastes and mouthrinses already have sufficient fluoride in them, and those are topical solutions that are actually effective. Ingesting the fluoride does little to stop tooth decay. The safest and most productive approach to enduring dental health is not a universal contamination of our drinking water and environment with toxic and carcinogenic chemicals. It is ongoing dental health and nutrition education, a lifelong gift for a healthier outcome. Teaching a child these skills early in life with routine dental screening is the healthy and cost effective solution. As a community we owe it to our children to provide safe and healthy drinking water. Cities that have been fluoridated for decades continue to face major dental problems. Fluoridation is an expensive distraction from real solutions, such as decreasing extreme sugar diets, increased access to care and prevention education; none of which cause harm to the environment. If we do not leave clean water and clean rivers for our children we will have little reason to be proud. Without good water we lose our greatest resource, and condemn our environment for posterity. 4
4. REPRESENTATIVE FOR CDC* For over 60 years, CDC has been dedicated to protecting health and promoting quality of life through the prevention and control of disease, injury, and disability. We are committed to programs that reduce the health and economic consequences of the leading causes of death and disability, thereby ensuring a long, productive, healthy life for all people. As a medical professional representing the CDC, we support community water fluoridation. With a 65-year history of success, community water fluoridation has proven a safe and effective means of preventing tooth decay and promoting healthy and productive lives. It is also the least expensive way to deliver the benefits of fluoride to all residents of a community. For larger communities of more than 20,000 people, it costs about 50 cents per person per year to fluoridate the water. It is also cost-effective because every $1 invested in this preventive measure yields approximately $38 savings in dental treatment costs. That s why the American Academy of Pediatrics, along with every other major national and local trusted health care organization agrees: water fluoridation is safe, effective and the right thing to do. I ve heard the arguments opponents make and I ve explored the research. With several decades of comprehensive reviews by federal scientists, no reputable scientific study disputes that water fluoridated at the optimum level helps improve the oral health of everyone in the community. No peer-reviewed federal study concludes that water fluoridated at the proposed standard causes the health issues that opponents claim. Not one. The research does demonstrate that there is a clear link between oral health and general health, no matter your age. Untreated dental decay can lead to severe physical and emotional health complications. The pain of dental decay is distracting, causing loss of sleep and stress. The cosmetic effects can lead to lack of confidence and lack of productivity in the workforce. Decaying teeth can lead to oral infections, which in severe cases can spread to the lungs and heart. For these reasons, we encourage your support of community water fluoridation programs. *Center for Disease Control and Prevention (a federal agency) 5
5. REPRESENTATIVE FOR WORLD HEALTH ORGANIZATION The World Health Organization is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends. With 70% of community water supplies fluoridated (participating?), the U.S. is the leading nation in fluoridation programs. After more than 60 years of use, fluoride has proven effective in reducing tooth decay within the U.S. population. However, other nations without fluoridation programs have also experienced similar patterns of decline of tooth decay within their population (see attached chart). While the WHO does support water fluoridation programs, we do so only for those programs that fall within the proscribed concentration parameters of 0.5 1.5 milligrams per liter of water. Any increase beyond 1.5 mg of fluoride per liter would raise the risk of dental fluorosis. In extreme cases, skeletal fluorosis could result a crippling condition that is life threatening if left untreated. 6
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6. SIERRA CLUB Since our organization was established in 1892, the Sierra Club is a non-profit member-supported, public interest organization that promotes conservation of the natural environment. As a member of the local Oregon chapter, my role is to raise awareness and influence public policy decisions legislative, administrative, legal, and electoral. When I turn on my faucet all I want to come out is water, clean water. While we do need to improve our children s dental health, fluoridating our water supply is a band-aid fix and a wrong-headed idea with long-term implications for the environment. The answer lies in increasing oral hygiene awareness and educational programs. They say that fluoridation is cheap that every $1 invested can save $38 in household dental costs. Did they mention the cost of the facility? With a construction price tag of $7.5 million, and $550K annually for the fluoridation chemicals, you can clearly see the cost-effectiveness of this idea is a misnomer. Those are only the face-value costs of the program; what concerns me more is the long-term environmental impact. All water treatment chemicals, with the exception of fluoride, are added to make drinking water safe and pleasant to consume. Fluoride is the only chemical added to treat people who consume the water, rather than the water itself. Fluoridating water supplies can thus fairly be described as a form of mass medication, which is why most European countries have rejected the practice. And, while humans are the target group, that used water has to go somewhere and it drains directly into our rivers and streams, affecting salmon and other critical species. Supporters of fluoridation would have you think there side has the greatest support, with 65 years of research and experience. However, in the grand scheme, that is a relatively short period and the lasting impact may not be felt yet. Once all those toxins are added to our water supply, how can we reverse the contamination when we learn it was a bad idea? Besides, doctors 60 years ago thought smoking cigarettes had health benefits don t believe everything you hear from so-called medical experts. Help us preserve the integrity of our water systems, and promote the health of both ourselves and the environment by voting against water fluoridation. 8
7. CHILD WITH CAVITIES I had a visit with the dentist today. Not at his office like you d think, but at my school. See, my parents can t afford to take me regularly, so I see a dentist whenever they come to my school. Usually the volunteer dentists come around every year; too bad this time was two years between visits. Maybe I could have kept my tooth if I saw him sooner. I have already had to give up three of my permanent molars, and I only have a few left. That s why I was certainly glad to see him this time, despite the pain of having it pulled. I haven t been able to chew my food on the left side of my mouth for almost a year! Chewing on one side was causing bad headaches because my jaw was grinding. That tooth hurt real bad, some nights I d lose sleep. Other days, I simply couldn t pay attention in school. My teacher got mad at me for not paying attention and I got in trouble at home. I tried to explain why I kept losing focus, and Mom kept promising me she d take me to the dentist. But it costs so much money! While I cried when he took my tooth, I was thankful that it would at least feel better in a few days. Mine hurt, but 2 or three of my classmates had it worse than me one of my friends had to go to the hospital to have his back tooth pulled because his was infected. Maybe I ll still have a few teeth when I get older. I just wish there was a way to avoid all this pain, and that it didn t cost so much to keep my teeth strong and healthy. 9
8. PERSON WITH ILLNESS / MEDICATION SENSITIVITY Prior to my present illness, I was a city councilman who favored fluoridation of our city s water supply. If I could do it over, I would vote in opposition to that decision, as I believe it was a contributing factor to my medical condition arsenic poisoning. A few years ago, I experienced difficulty walking. I went to several specialists to determine the cause, and one cited the problem was the build-up of arsenic in my body. After considering the most up-to-date research, he concluded that the arsenic in my system accrued after the prolonged consumption of fluoride, likely through drinking water. See, what most people don t know is that the fluoride we find in our toothpastes is pharmaceutical grade, while the fluoride used in the fluoridation of water supplies is fluorsilicic acid. Fluorosilicic acid is an industrial byproduct that introduces arsenic, lead, mercury, and other toxic compounds. So, how does it make sense to poison our own water? Supporters of fluoridation should call a spade a spade fluoridating a water supply is medicating, if not poisoning, the public without their consent. Those who rely on tap water as their primary source of water are without a real choice in the matter. It is now well established that fluoride is not an essential nutrient. This means that no human disease including tooth decay will result from a deficiency of fluoride. Fluoridating water supplies is therefore different than adding iodine to salt. Unlike fluoride, iodine is an essential nutrient (the body needs iodine to ensure the proper functioning of the thyroid gland). No such necessity exists for fluoride. 10
8. VETERINARIAN When I became a veterinarian, I took an oath to enter the profession that I would protect animal health and welfare, and not only relieve animal suffering but to prevent it when possible. In that spirit of prevention, I stand strongly against the fluoridation of our water supply because of its negative impact on the animals that rely upon it. Since they can t speak, it is my duty to do so on their behalf. Fluoride is naturally occurring in water, true, but only in trace amounts. And, often in neutral, dissolved compounds. When ingested, fluoride bio-accumulates, meaning that it becomes part of the organism that ingests it rather than becoming excreted waste. For this reason, the cumulative effect of fluoride can be devastating to humans, but perhaps even more for animals. A human might have a choice in how much fluoride they ingest; an animal does not. A concerned human might prevent over-consumption by monitoring labels on their foods and medicines, or drinking purified water from an alternate source. It is impossible for anyone to, with any accuracy, determine the amount of fluoride an animal has ingested because none of the food, bottled water, or medicine labels used by animals list whether fluoride was used in the growing, preparation, or manufacturing of the products. While extensive research has been conducted with regard to its effects on humans, the effects of fluoride ingestion on animals is not given due attention. Consider this the national and world health organizations recommend the 1.5 mg of fluoride per liter of water is tolerable for an adult human being. Will a 4 lb. Chihuahua drinking from a tap water source be affected the same as a 170 lb. adult human? Sure, they may not take in much, but the relative proportion means a greater impact. And, what about a zoo elephant that drinks more than 30 gallons of water a day? The research may be incomplete, but what is clear from the evidence is that animals will be affected by water fluoridation in ways different from humans. Until we have fully researched the long-term impacts of fluoridated water supplies on domesticated animals, perhaps we can stick to alternative solutions fluoridated oral care products, education and awareness, etc. until more is known. 11