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Fluoridation in New York State: Challenges May 23, 2012. Jay Kumar, DDS, MPH. Fluoridation in New York State. Focus on research and evaluation Opposition to fluoridation New York law supports local decision making Regulations Efforts to discontinue fluoridation. Objectives.

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Fluoridation in new york state challenges may 23 2012

Fluoridation in New York State:ChallengesMay 23, 2012

Jay Kumar, DDS, MPH


Fluoridation in new york state
Fluoridation in New York State

  • Focus on research and evaluation

  • Opposition to fluoridation

  • New York law supports local decision making

  • Regulations

  • Efforts to discontinue fluoridation


Objectives
Objectives

  • To describe strategies for maintaining community water fluoridation

    • New York City

    • Poughkeepsie

    • Plattsburgh

  • To discuss efforts to support advocates

  • To assess factors that affect outcome


New york city
New York City

  • Fluoridation started in 1962

  • A regulation requires 1.0 mg/L Fluoride

  • Serves over 8.5 million residents

  • Bills introduced

    • Stop fluoridation

    • Lower fluoride level to 0.7 mg/L

  • Rally last week

    • Councilman Peter Vallone


Proposed bill
Proposed bill

Referred to Committee on Health on 6/14/2011

Sponsors: Jumaane Williams, Fernando Cabrera, Letitia James, and Deborah Rose

“The municipal water supply shall be fluoridated in the following manner: A fluoride compound shall be added to the municipal water supply at an optimum concentration of about 0.7 ppm of the fluoride ion, provided, however, the concentration of such ion shall not exceed 1.0 ppm at any time.”

No final action taken yet


Issues
Issues

  • “I have serious questions with using the water supply to force-medicate,”

  • Waste of $25 million per year

  • Causes IQ deficit

  • Environmental issues


Prominent Dentists Say Drinking NYC's Fluoridated Water is Risky

NEW YORK, Oct. 5, 2011 /PRNewswire-USNewswire/ -- Breaking away from dental school dogma, more dentists are speaking out against fluoridation because fluoride chemicals, added to NYC's water supply intending to reduce tooth decay, are actually a money-wasting health risk, reports the New York State Coalition Opposed to Fluoridation (NYSCOF).

Seven NYC Council Members sponsored legislation (1) and residents are petitioning Mayor Bloomberg to stop fluoridation, to preserve money and health. Join them: http://www.change.org/petitions/stop-fluoridation-in-new-york-city

Hydrofluosilicic acid, a lead- and arsenic-laced chemical (2) left-over from making phosphate fertilizer (3) is NYC's fluoride chemical of choice. Dentist Caree Alexander, a former Navy practitioner, then a private practice dentist for 20 years, says fluoridation is "totally ineffective and actually damaging as well."(5)

Dr. Alexander says, "When I graduated from University, we weren't given any information about where [fluoride] came from. We all assumed it was [pharmaceutical-grade] calcium fluoride."

Prominent NYC dentist and Huffington Post Contributor, Dr. Thomas Connelly, writes, "I do not see the good in fluoridating our drinking water ... To me, the 'bad' it can (potentially) do outweighs the good."(6)


Op ed by councilman gennaro beware the anti fluoride charlatans
Op Ed by Councilman Gennaro: RiskyBeware The Anti-Fluoride Charlatans

  • By James F. GennaroPublished in the Feb 17-23, 2011, edition of the Queens Tribune.

  • Two weeks ago in the Queens Tribune, a City Council colleague of mine wrote a piece entitled, “Fluoride – If in Doubt, Keep It Out.” And, in the course of trying to make the case and advance this bill, my colleague has made all kinds of absolutely preposterous statements – taken right out of the anti-fluoride zealots’ talking points – about “the government putting toxic chemicals in our water.” Referred to fluoride as a “poison” and stated that fluoridation is the government “force-medicating” the public, and “requiring every man, woman and child in America to ingest it (fluoride) borders on criminal behavior.” I could go on and on, but Ill spare you. You get the idea. However, I am compelled to set the record straight and give people the correct and up-to-date information on fluoride.

  • "Today's announcement is part of our ongoing support of appropriate fluoridation for community water systems, and its effectiveness in preventing tooth decay throughout one's lifetime." But go ahead and ask your doctor and dentist – I'm betting they're in agreement with the CDC, EPA, HHS, and every respected medical and dental organization in the country on the benefits of fluoride.


Challenges
Challenges Risky

  • Regulation needs to be revised

  • Large system

  • Lack of oral health infrastructure

  • Many media outlets


Approaches
Approaches Risky

  • Support from advocates

    • Dental Association

    • Academic institutions

    • Dental clinic directors

  • Councilman Gennaro said

    • “city residents should not ask advice regarding fluoride from elected officials, but rather from medical professionals whom they trust.”

  • Letter from Pew

  • NY Times Editorial


Poughkeepsie
Poughkeepsie Risky

  • In 2005, fluoridation was stopped thus affecting 80,000 customers

  • In 2007 the Poughkeepsie Water Treatment Facility decided to re-fluoridate the municipal water supply.

  • Efforts to stop fluoridation continued

    • Letter to Solvay Fluorides, LLC

    • Letter to Local Health Department requesting answers to some 25 questions

  • In January, 2008, the decision was reversed

  • DOH letter was sent to Poughkeepsie Joint City/Town Water Board requesting clarification


Questions raised
Questions raised Risky

  • NRC Report raised questions about thyroid impairment

  • New recommendations from ADA for not using fluoridated water to mix infant formula

  • A shift in the scientific determination of mechanism

  • Unresolved scientific questions about disassociation of fluosilicic products, questions of safety and effectiveness


More questions
More questions Risky

  • 1a. What are the daily water ingestion rates for adults, including subpopulations with high intake rates, in Dutchess County (DC)?

  • 1b. What are the daily water ingestion rates for infants and children by age in DC?

  • 2. Are there identifiable ranges of consumption rates, ages, populations, or subpopulations for which the DCDOH does not believe that the Board has a responsibility to provide safe water for a lifetime? If so, what/who are they?

  • 3. At what consumption rate, age, population, or subpopulation does the Board’s duty to provide safe water cease?

  • 4. What is the estimated cost to homeowners to remove fluoride from water supplied to their home by a public water supply?

  • 8. Given the NRC finding on endocrine effects from optimally fluoridated water, does the DCDOH or water operator have a duty to inform the public about such risks?


Response
Response Risky

“The Board asked a number of questions about how much fluoride is ingested by Dutchess County residents from drinking water and other sources, and the potential for health effects at those fluoride ingestion rates. Information directly relevant to these questions is contained in a recent, comprehensive report by the National Research Council on water fluoridation (NRC, 2006). Based on our review of the data in this report and other sources, detailed below, we conclude that the existing national data on water consumption rates and fluoride exposures from all sources is applicable to Dutchess County residents. The overall response to the Board’s questions is that the national estimates of the amount of fluoride exposure for infants and children when drinking water is fluoridated to about 1 mg/L does not indicate the likelihood of adverse health effects in Dutchess County residents.”


Doh letter regarding discontinuation
DOH letter regarding discontinuation Risky

“Since the Board’s authority to discontinue fluoridation needs to be clarified and it is not clear that the public health benefits of fluoridation and options to provide equivalent protection have been considered, I strongly urge you to continue fluoridation until such time as these issues have been thoroughly examined and addressed.”


Health board s effort unsuccessful
Health Board’s Effort Unsuccessful Risky

  • Amend to the Sanitary Code

  • Required fluoridation

  • Held hearings

  • Not an elected body


Triumph of science over the politics of fear city of plattsburgh
Triumph of Science Over the Politics of Fear: RiskyCity of Plattsburgh

  • Fluoridated since 1956

  • 2007 Water Fluoridation Quality Award

    • “Plattsburgh has been heralded for its treatment program, winning a Water Fluoridation Quality award from the CDC in 2007.”

  • Resolution introduced to stop fluoridation


Clinton county health department
Clinton County Health Department Risky

  • Trained health department staff

  • Launched a social media campaign

  • Fluoridation brochure was distributed by the Childcare Coordinating Council, the Joint Council on Economic Opportunity and the WIC program.

  • Recruited champions

  • Encouraged local dentists to write letters in support of water fluoridation to the City Council.

  • The county Board of Health passed Resolution #27, supporting community water fluoridation  

  • In November 2009, the city council voted 5-2 to continue the fluoridation of the city's drinking water. 


Determinants of success failure
Determinants of success/failure Risky

  • Commitment of policy makers

  • Strong advocacy

  • Champions

  • Supporting data

  • Resources

  • Local media


Strategies
Strategies Risky

  • Build support - Internal & External

  • Engage partners and stakeholders

    • State Oral Health Coalition

    • Rural Water Association

    • Local Health Departments

    • State Dental Association

  • Develop resources

  • Provide training

  • Advocate for investment


Resources
Resources Risky

  • DOH Website

  • Rural Water Association

  • Technical Assistance Center in Rochester

  • Oral Health NY Website

  • Fluoride Science.org Website (testing)



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