Which public-health accomplishments in the United States during the twentieth century have had the greatest impact on death, disease, and disability? If we limit our tabulation to those in which drugs have played a major role, we can readily include: eradication or prevention of infectious diseases with vaccines; treatment and cure of infectious diseases with antibiotics and other chemotherapeutic agents; reduction of deaths caused by coronary heart disease and stroke; and family planning with hormonal contraceptives.
A far less obvious inclusion on this list, compiled by the U.S. Centers for Disease Control and Prevention (CDC), is the prevention of tooth decay by the addition of fluorides to drinking water and toothpastes. Since 1945, this measure has safely and very inexpensively reduced tooth decay by 40–70 percent in children and 25–30 percent in adults. Additionally, tooth loss in adults has declined by 40–60 percent. For every dollar spent on fluoridation, an estimated $38 is saved on dental treatment. Fluoridation of drinking water has been most commonly adopted in the United States, Canada, the United Kingdom, and Australia, while fluoridated salt is widely utilized in continental Europe.
When ingested, fluoride is incorporated into the structure of developing teeth and acts on the surface of teeth. It both prevents the acid in plaque from demineralizing tooth enamel and enhances the rate at which teeth repair themselves by remineralization. Fluoride levels of 0.5–1.0 parts per million (ppm) in drinking water generally provide optimal benefits. International medical and dental experts agree that there is only one adverse effect associated with excessive exposure to fluorides. When teeth are developing before the age of eight, dental fluorosis—a discoloration or mottling of permanent teeth—may occur.
PROMOTING PUBLIC HEALTH OR UNDERMINING INDIVIDUAL FREEDOM? Opponents of fluoridation of community drinking water argue that it causes major adverse health problems or that its expense outweighs its benefits. By imposing compulsory mass medication, it violates the individual’s right to choose. As depicted in Stanley Kubrick’s 1964 classic film Dr. Strangelove, during the post-World War II Cold War period, conspiracy theorists argued that it was a Communist plot designed to undermine the public health of Americans.
Noted sociologist and photographer Lewis Hine took this picture of a dentist at work at the Hood Rubber Company Hospital in Cambridge, Massachusetts, in 1917.