This article reviews the findings of a recent study by Drs. Bill Osmunson and Griffin Cole, which provides a comprehensive analysis of the economic cost, benefits, and risks associated with Community Water Fluoridation (CWF).

Community Water Fluoridation has been a common practice for over 70 years, aimed at reducing dental caries (tooth decay). Despite its longstanding implementation, the practice remains controversial, particularly regarding the consideration of potential risks alongside its benefits and costs.

Background and Objectives

The primary objective of the study is to estimate the economic cost-benefit-risk of CWF using 2021 USA dollars per person per year (PPPY). The analysis includes operational costs, benefits in terms of dental caries prevention, and two significant risks: dental fluorosis and developmental neurotoxicity leading to lower IQ and subsequently lower income.

Methodology

The study utilized published operational costs and benefits of CWF. It also incorporated clinical experiences in treating dental fluorosis to estimate treatment costs and evaluated lost wages due to developmental neurotoxicity. The estimates for caries averted were calculated at $8 PPPY. In contrast, the costs associated with dental fluorosis treatment and lower earnings due to presumed developmental neurotoxicity were calculated at $126 PPPY and $438 PPPY, respectively.

Results

The analysis reveals a net loss of $556 PPPY from CWF, suggesting that when the costs of harm are included, CWF is not cost-effective. The key findings include:

  • Caries Prevention: The estimated benefit from caries averted was $8 PPPY.
  • Dental Fluorosis: Treatment costs for perceived dental fluorosis were estimated at $126 PPPY. Dental fluorosis, a condition caused by excessive fluoride intake during tooth development, can lead to cosmetic and functional dental issues.
  • Developmental Neurotoxicity: Lower earnings due to developmental neurotoxicity, measured by a reduction in IQ, were estimated at $438 PPPY. The study referenced numerous studies indicating that fluoride exposure could result in significant IQ reduction, which impacts lifetime earnings.

Discussion

The findings challenge previous economic evaluations of CWF that often omitted potential harm or considered it negligible. The study underscores that including the costs of treating damages changes the economic equation significantly. The potential risks identified include not only dental fluorosis but also broader health concerns such as neurotoxicity, which has implications for cognitive development and economic productivity.

Policy Implications

Based on the study’s findings, the authors advocate for a re-evaluation of CWF policies. They suggest that alternatives to CWF, such as the use of fluoride toothpaste, varnishes, and targeted dental care, should be promoted. These alternatives allow for more controlled and individualized fluoride exposure, minimizing the risks associated with mass fluoridation of public water supplies.

Conclusion

The study concludes that the economic cost-benefit analysis is not favorable when potential harms are included. The estimated net loss from CWF is $556 PPPY, primarily due to the costs associated with treating dental fluorosis and the economic impact of reduced IQ from developmental neurotoxicity. The authors recommend that public health policies should be revisited, taking into account the full spectrum of costs, benefits, and risks associated with fluoride exposure.

The continued practice of CWF needs to be critically assessed, with an emphasis on safer and more effective alternatives for preventing dental caries. Engaging with all stakeholders and considering comprehensive evidence will be crucial in shaping future public health strategies regarding fluoride use.

References

Osmunson, B., & Cole, G. (2024). Community Water Fluoridation: A Cost-Benefit-Risk Consideration.