Dr. William Bailey, Oral Health Division of the CDC,
Fairbanks, Alaska, March 6, 2008

Comments of William Bailey (DDS, MPH) of the Oral Health Division of the US Centers for Disease Control and Prevention (CDC), with the Fairbanks City Council, Alaska, on March 6, 2008.

On March 10, 2008, the City Council voted against removing fluoride from city water.

Audiotape transcription by FAN

NOTE: There is a 3-part critique of Dr. Bailey's responses at http://fluoridealert.org/bailey1.html

DR. WILLIAM BAILEY (CDC): This is your meeting so I won’t presume… I what I am here for. CDC doesn’t normally get involved with local decisions. I am here to help you make the decision not to try to influence your decision. When there are fluoridation campaigns going on across the country we don’t get involved. When state legislatures ask us to come in and testify on the science we will do that. So that’s my role from CDC – I am here to assist you - help you make your decision.

As far as CDC goes – the CDC as an agency – one of our main roles is to prevent disease and promote healthy behavior and that’s why we promote community water fluoridation as it is one of the two interventions for communities that was recommended by the community guide. The other was community based sealant programs. So those two interventions are what the community guide recommend as the two most effective programs for preventing tooth decay. So the CDC believes that community water fluoridation is safe, healthy and effective and we promote it and that is our role.

I assume you will have questions on different areas.

Community water fluoridation started in 1945 and so it has been around for more than 60 years. Sometimes people will ask us to do some science on community water fluoridation - well there has been 60 years of science. In fact the science began on the natural levels of fluoride in the water before they ever implemented community water fluoridation. They didn’t just say let’s adjust the water to this level. They did lots of interventions and investigations on water systems with naturally occurring fluoride in the water. That’s something we should say too, fluoride is a naturally occurring substance. It is the 13th most abundant element on the earth. There is fluoride in almost all water supplies. The oceans of the earth have fluoride in them at, or levels greater than, the levels we fluoridate our water.

Now the amount that people put in their water is dependent on their climate, so the colder you are the more you put in because it’s based on the theory that people drink less in the colder areas. If you are outside in a warm climate like Southern Florida we put 0.7 ppm – or mg per liter – in the water. If you are up around Fairbanks (Alaska) we put 1 to 1.2 ppm in the water. The amount that we adjust the fluoride to which is optimum for oral health depends on the climate.

As far as why CDC believes that community water fluoridation is a good thing, we base our science on the weight of the evidence. So we base our science on the 60 years of research but also – and possibly even more importantly – the reviews which are done by expert committees and the systematic reviews which are done. You know initially there were only individual studies but after so long you get enough studies that you can do systematic reviews and you can look at the weight of the evidence and the quality of the evidence. There are a number of systematic reviews that are done all the time. The last one came out in the Fall of 2007 from Australia by the National Health and Medical Research Council. These are happening very often throughout the world - systematic reviews on fluoride. So that’s where we take our believe in why fluoridation is safe and effective. It is from the expert committees and the systematic reviews.

Now sometimes people will point to just one study or another and say this study found this and that’s true. They may find something about anything- but if its good science then that study should be able to be replicated- if someone follows the same methodology they should find the same thing and that’s why we look to the weight of the evidence.

Of all the expert committees and all the systematic reviews that have been done, they have all said that water fluoridation is safe and effective and healthy. So that’s the basis of our decision to promote it.

FAIRBANKS COUNCILOR: “Sir, you said that in Fairbanks we do 1 to 1.2 ppm. Could you clarify that? I thought it was more than that.”

DR. WILLIAM BAILEY (CDC): No, I think that should be about the amount but of course your local water authority would be the best source of what they put in but based on what we recommend. And realize that water fluoridation is not a national program at all as you know. It’s your decision. But the safety of water is an EPA function. So the EPA looks at the maximum level contaminant goals and secondary maximum contaminant level goals and so on. They set some of those and those are regulatory in nature. If you exceed those you have to notify the public.

FAIRBANKS COUNCILOR: “The fact that we have 5 ppm naturally occurring, how does that dovetail?”

DR. WILLIAM BAILEY (CDC): I think you have 0.5 ppm.

FAIRBANKS COUNCILOR: “Oh I see. So it’s 0.5 ppm. OK I got it now.”

DR. WILLIAM BAILEY (CDC): You should be fluoridating about double that amount at about 1ppm.

FAIRBANKS COUNCILOR: “I have a question. What is the overall value (total dose, PC)? I mean 60 years ago…when did toothpaste with fluoride come into play?”

DR. WILLIAM BAILEY (CDC): It was approved by the American Dental Association - the seal of approval in 1964. With fluoride. By about 1980 about 90% of the population were using fluoridated toothpaste.

FAIRBANKS COUNCILOR: “Sir, how do you account for studies that have shown that in communities – these are 8 countries which have fluoride and others that don’t – have tracked tooth decay in these countries and they have come together with a tight range - non-fluoridated and non-fluoridated are seeing approximately the same amount of tooth decay?”

DR. WILLIAM BAILEY (CDC): Well some of those countries – all those studies are based on tooth decay in 12-year olds – they don’t look at the whole spectrum of tooth decay. They just look at 12-year olds. And they only look at permanent teeth – you begin your permanent teeth when you are six. Your second molar comes in about the age of 12. That’s not a lot of time for children to get cavities. We know for example that fluoride toothpaste does decrease decay but we also know that with community water fluoridation and toothpaste together decreases tooth decay even more.

There is always a question whether it is just topical – do you just get the benefit from having the fluoride touch the surface of your tooth or do you get any benefit from ingesting the fluoride, especially as your teeth are developing? We believe that there is both a systemic and a topical effect. There is even – research out of Australia as recently as last year that is still showing a systemic and a topical effect. So fluoride benefits you in two ways: one as your teeth are forming and secondly, getting that topical effect.

I should get into a little on how fluoride works. What happens is that your tooth starts getting decay at a very microscopic level and that’s called demineralization and that demineralization can be re-mineralized. What happens when you get demineralized is your the tooth starts getting eaten up by the acid in the bacteria in the plague. So it releases phosphorous, and it releases calcium. The fluoride attacks that and grabs the phosphate and the calcium and brings it back cause it is electronegative and brings it back into the tooth surface and re-mineralizes the surface.

FAIRBANKS COUNCILOR: “Is that systemically or is that topical?”

DR. WILLIAM BAILEY (CDC): That’s topical. The reason fluoride works so well is that the fluoride is held in the plague. The plague serves as a reservoir which is right against your tooth. If you are drinking water throughout the day it helps replenish that reservoir of fluoride in your plague as opposed to brushing your teeth twice a day then you don’t get that replenishment. Systemic fluoride also increases the fluoride in your saliva a bit, but we don’t think that that has a great effect on prevention of tooth decay.

FAIRBANKS COUNCILOR: “ I have another question. You said that you go to professional committees for something I am not familiar with - systematic review - what scientific groups have you gone to that have conducted peer reviewed studies – double blind studies – controlled studies – to evaluate fluoride’s safety?”

DR. WILLIAM BAILEY (CDC): The systematic reviews which I am talking about – the National Health and Medical Research Council – the National Research Council in 2006 – the Agency for Toxic Substance and Disease Registry in 2003 – the Forum on Fluoridation in 2002 in Ireland – the University of York in 2000 and so forth. There’s been many of these throughout the years.

When you ask about blinded studies – where do we go to look for blinded studies? This is also something that comes up a lot. What blinded studies means is that you pick two groups – let’s say that you are in the medical trial – a clinical trial – and so you give somebody a new medicine, and somebody else a placebo. So some people are getting the intervention and some others are not. But nobody knows if they are getting the intervention or if they are getting the placebo. Then when they look at the results then  the examiners are blinded as well. That means that they don’t know who got the intervention and who didn’t. They can be completely objective and say well that this is a better result – I don’t know if they got this or not but this turned out better than this. So that is called blinded studies. The reason that you cannot do blinded studies in fluoridation is that it is impossible. To put fluoride in the public water supply you have to do a public announcement – you just can’t put any in without the public knowing. You can’t do blinded fluoridation on anyone. Also you can’t randomly give fluoride to one house and not to the next – it’s just not possible with the way our water systems work. Third, the way that studies work anymore, we know there is a benefit to water fluoridation so to give it to one group and withhold known benefits from  another group - that’s unethical. So they would never allow that kind of research trial to go forward.

So we really can’t do blinded studies, so what we do instead – there are a couple of ways you can do studies on fluoridation. One is to compare people that have grown up in one community that was fluoridated with a group of people who grew up in a community which wasn’t fluoridated. There are some limitations to that and even though that’s the way to look at it. There are limitations in that people move in and out of communities – they may or may not drink the water – they may or may not have other things which influence their tooth decay and so forth.  Then there is the other way to do it, (which) is to take a group of people and then follow them prospectively through time and see what happens. That’s a real expensive way to do research but that can be done as well.

FAIRBANKS COUNCILOR: “They are recommending now that nursing mothers not drink fluoridated water and that young children not receive fluoridated water. Later in early childhood to have one glass a day. How did we come with these new standards? How did those recommendations come about?”

DR. WILLIAM BAILEY (CDC): What you are talking about is the interim guidance on infant formula which was put out by the American Dental Association. We also have content on this on our web site. And the recommendation isn’t that infants avoid all fluoridated water. What this came from is the fact that the American Dental Association read the NRC report …

FAIRBANKS COUNCILOR: “And the NRC is who?”

DR. WILLIAM BAILEY (CDC): The National Research Council.

FAIRBANKS COUNCILOR: “And they are actually a scientific body? Does scientific studies?”

DR. WILLIAM BAILEY (CDC): They were the group that was hired by the – there the group that works for the National Academies of Science – that gave a report to the Environmental Protection Agency on whether the MCLG was protective. So they were looking at naturally high levels of fluoride in water. This report was in 2006. They were looking to see if levels of fluoride in  water at 4 ppm - or four times what we normally fluoridate the water at – was protective against health effects. So that was what that group was about.”

FAIRBANKS COUNCILOR: “But they were a scientific group? They are scientists?’

DR. WILLIAM BAILEY (CDC): Yes.

FAIRBANKS COUNCILOR: “ OK. Thank you.”

DR. WILLIAM BAILEY (CDC):  So that was a scientific review. It wasn’t a systematic review in that they did not set rules as to what would be entered in and allowed to go forward in the report or not.  So they could cite any studies they could find in their report. But it was a scientific investigation and an expert panel. So anyway in the NRC report they noted that some infants may be exceeding the upper tolerable intake set by the Institute of Medicine.

So they (ADA , PC) said that for people concerned about the risk for developing enamel fluorosis, parents can mix infant formula with low fluoride water or no-fluoride water. Or they can just use the premixed formula and so forth. But…we also have content on this. The fact is people have been mixing infant formula - what’s interesting as well, but a little off subject – but around the same time Australia issued their recommendations on fluoride and they recommended that parents do mix infant formula with fluoridated water. I guess the thing to say about this from our side is that for decades people have been mixing infant formula with fluoridated water and children are at no greater risk then they ever have been but that all of a sudden there’s a new scientific report out of the University of Iowa which says that for the first time that the first year might be important for the development for fluorosis. See the permanent teeth don’t start developing until 18-22 months so we always thought that first 9 months of life when people have infant formula wasn’t a risk for enamel fluorosis. Since that report came out now from the University of Iowa, so we said well maybe parents are concerned should do something. But no the children are at no greater risk than they have ever been. I think water fluoridation has been around in Fairbanks for decades – right?

FAIRBANKS COUNCILOR: Yes

DR. WILLIAM BAILEY (CDC): So you can see what happens to the children or the people you know that have grown up with infant formula that was done with fluoridated water. I mean there is no greater risk than there ever has been and – children – there is no risk at all for the objectionable – both moderate and severe forms of fluorosis. We do know that – the CDC did a study 1999-2004 a national study – NHANES – and the amount of fluorosis was about 32% for adolescents. But that said – you know – many times the opponents will put things out showing teeth that are disfigured, saying that 32% of children have fluorosis like this. Well, you know, most everybody has a very mild form of fluorosis. Most people who have fluorosis, don’t even know that they have it and it takes a trained dentist to find it and you have to dry the teeth to find it and so forth. So I mean the common sense is go to an eighth grade and look at their eighth grade picture and have them all smile and look and see how many kids have brown or disfigured teeth. They have all been drinking fluoridated water so – you know, it isn’t that 32% of children across America have this disfigured – you know – severe form of fluorosis. 32% have some very mild or mild, and occasionally   severe fluorosis, but we don’t believe that is from drinking the water, but we do believe it is from total fluoride intake. That’s why we have recommendations on supervision of toothpaste – and trying to help kids not swallow toothpaste and not to have two year olds use it unless it is recommended by a dentist of a physician. You know – I think on the one hand you have to look at the science and the way that the science is done and on the other hand you have to use your common sense.

When people come and say this horrible disfigurement appearing on teeth comes from enamel fluorosis, look around and look at the kids and see. For the most part they have – I come from a generation and I can look back to my parents oral health and I am in my late fifties – I can look at the oral health of my parents and I can look at the oral health of my kids and see a vast difference and I am somewhere in the middle. A lot of that was due to fluoridation. Yes you can look at science and you can look at scientific studies and you look at the weight of the science but also use your common sense.

FAIRBANKS COUNCILOR: “This mayor Searle. Is there a pill to take fluoride out of the water?”

DR. WILLIAM BAILEY (CDC): There is a way to take out of the water but it is very, very expensive. I mean because nearly all the water contains some natural fluoride. You can do reverse osmosis and take nearly everything out of that water. The problem is that water purified like that it is very aggressive. Water is the universal solvent - you wouldn’t want that in your pipes because it is going to want to take everything it can find and would probably corrode the pipes. And something that doesn’t have minerals in – water like that is very aggressive. Yes there is a way to do it but it is very, very expensive. If you want to go absolutely no fluoride in your water you would have to go to reverse osmosis.

FAIRBANKS COUNCILOR: “I have just one more question – I am sorry –go ahead Tanya.”

FAIRBANKS COUNCILOR: “OK you said that – this is councilman Brown –you said can see a vast difference between your parents oral health, yours and then your kids?”

DR. WILLIAM BAILEY (CDC): Yes.

“What comes to my mind the difference in lifestyles changes, dietary habits, and I am taking that into account because – I mean – I am older generation thinking back to oral health of my grandparents and parents who were eating relatively healthy OK and their dental condition was good. There wasn’t a lot of cavities and that and then our generation had more cavities but there was some major dietary changes with the introduction of fast foods, more  sugar and other ingredients such as artificial flavors and that. So I am wondering how much these studies took this into account. Especially, western dietary habits which is bad for a number of reasons, but also with tooth decay and other problems. How much did the studies take into account lifestyle changes?”

Well there are studies which look at tooth decay and dietary habits and studies which look at tooth decay and other types of hygiene habit  and things like that – there are lots of those. It is hard to put it all together in one picture. And you are right. Living conditions have improved, health in general has improved and so forth. So you can’t just say that there is just one thing has accounted for this. But for the most part from my parents’ generation – and as you say your parents and grandparents – you may have lived in a fairly remote place where there was very little in the way of processed food- but in many parts of the country it was true that a lot of people were dentureless when they got to  their late 50’s or 60’s. It was almost the norm that you would wear dentures. Now it is becoming much less frequent occurrence and I think it is down around 29% now for the whole nation. So there has been an improvement but you are right, you have to factor in all the other health – you know –living conditions, health styles and so forth. That’s exactly right, you can’t just say that it is due to one thing.

FAIRBANKS COUNCILOR: “OK – taking into consideration my background – I grew up in Detroit but had access to different geographic areas – my dad was from the south, they ate primarily from the land – my mother was from the East coast – long Island and we ate primarily from gardens and that – we even had a garden in our back yard. So we ate fairly healthy and then you brought up -  wait a minute we ate fairly healthy until the lifestyle change came when my mother started working – she was home until my brother went to school – So then we cut back on the home cooked meals – so then we started eating out more and we noticed the change in our health within a few years, OK? Then the other thing with the dentures. Was there the knowledge of the implants and other technologies and other procedures which exist now, which didn’t exist then?   So were dentures prominent because they didn’t have those procedures in place back then and not because teeth were rotting out?”

DR. WILLIAM BAILEY (CDC): Well they didn’t have – you’re right they didn’t those procedures in place back then but the reality is that people are keeping their teeth longer. We know now that for example older adults are keeping their teeth, they are not losing their teeth like they used to. But that also creates the issue of tooth decay in older adults. We know for example that older adults have the same amount of new decay as children and we know that adults have more untreated  decay than children. So that is one of the great things about fluoridation is that it helps people of all ages. Your older adults are having as much decay as children now. So that’s one way that fluoridation really helps.

FAIRBANKS COUNCILOR: “What cumulative effect does fluoride have on adults other than fluorosis? Osteoporosis, thyroid conditions – things like that?”

DR. WILLIAM BAILEY (CDC): The CDC doesn’t investigate that we rely on the expert panels and other people who look at that. And a lot of people have looked at that. That’s why I really wanted you to have this report in brief because that was what the National Research Council was looking at – from the National Academies. They were looking at – and you are right the fluoride does accumulate throughout your lifetime, especially in your skeletal system – and so what this committee was looking at was people who drank excessive amounts of high natural fluoride – they were looking at people who drank 4 ppm or greater over a lifetime. So what they came out with was three recommendations that could have an affect on – for sure it would have an effect on fluorosis – severe fluorosis for people who drank 4 ppm over a lifetime 10% would be expected to have severe fluorosis – they said that it was likely to cause an increase in bone fractures – they weren’t unanimous on that – they found mottling rather than observations – but that it could result in an increase in bone fractures and it could also result in skeletal fluorosis. Now in the US over the last decade the most we have seen as far as skeletal fluorosis is about six cases that have been diagnosed, most of them from other things, for example from a person drinking a lot of concentrated iced tea. So they looked  at a lot of other things, but they only came up with these three things. They studied the science for three and half years. They made recommendations that other things needed study, but even drinking 4 times the amount of fluoride in your water over a lifetime. The only thing was a sure thing was enamel fluorosis. The things that could be was bone fractures and skeletal fluorosis. But they compared the bone fractures with people who drank water and 1 ppm not zero. Not very low. Some studies –some really good studies –well they followed people over time – prospective studies – which have shown that there may be a protective effect at 1 ppm for bone fractures. So if you have very low fluoride concentrations the bone fractures may be higher but as you come down to 1 ppm – about what we fluoridate the water – there may be a protective effect and then  as you go up to 4 ppm or greater your bone fractures go up. That’s because fluoride is attracted to the bone, especially for the long bone, it accumulates in the outside of the long bones which makes them strong on the outside but easier to break if you have very high concentrations of fluoride. They are thicker but they break easier.  

FAIRBANKS COUNCILOR: “The mayor asked you a question on is there a pill to remove fluoride from water. And my question is there any sort of filtering system which average households might be able to use to remove the fluoride or reduce the amount of fluoride?”

DR. WILLIAM BAILEY (CDC): There are point of use systems that you can put into your home. If you put in an activated charcoal filter or something like that on your faucet it won’t take out any fluoride. But there are point of use systems that actually work on a reverse osmosis or membrane type system that will take fluoride out – to some extent any way.

FAIRBANKS COUNCILOR: “And are those systems that are practical to use say in a single household in terms of cost – can you comment on that?”

DR. WILLIAM BAILEY (CDC): You know I am not an expert on that. I have heard that a number around $500 for those systems, but I am not an authority on that. That’s just something I have heard.

FAIRBANKS COUNCILOR: “I have two other questions. Those of us who are always  taught to brush your teeth after every meal and floss every night and use controlled Rx from time to time, are probably fine. I wonder if you would comment on people in Fairbanks who – through their upbringing or perhaps through socioeconomic reasons – don’t have the same knowledge and practices in terms of dental care – how the fluoride might impact these different groups?”

DR. WILLIAM BAILEY (CDC): Fluoride helps all groups but the higher the potential for caries the better the help. You know I guess that is the beauty about water fluoridation you don’t have to remember to do anything, you don’t have to be compliant in any way, in a way it is the perfect public health measure. All you have to do is drink water or use it for cooking an so forth, and you will get some benefit of fluoride. So certainly those people who will benefit from water fluoridation – they wouldn’t benefit much as if they brushed their teeth twice a day and also had community water fluoridation, but they would benefit from the fluoride in the water.

FAIRBANKS COUNCILOR: “From some of the information that’s been brought to our attention, I am under the impression that in Europe for example there is very little fluoridation and yet – if my impression is correct – when you look at dental decay and all that the statistics are the same as the United States. Can you comment on that?”

DR. WILLIAM BAILEY (CDC): Sure. Europe uses a lot of salt fluoridation, so they have just had their fiftieth anniversary of salt fluoridation in 2005.”

FAIRBANKS COUNCILOR: “Are you talking about table salt? You are talking about a container of table salt which you purchase at will. Is that correct?”

DR. WILLIAM BAILEY (CDC): Yes. A container of table salt like most salt has iodine in it. A lot of the salt in the Caribbean and South America. There are 27 countries in South America and the Caribbean which have salt fluoridation. And then Austria, Czech Republic, France, Germany, Hungary, Slovak Republic, Spain and Switzerland have fluoridated salt. So fluoridated salt  works to reduce tooth decay as well. Normally they fluoridate salt at about 250 ppm. The problem with fluoridated salt is that with water fluoridation you look at the natural amount of fluoride in the water and you adjust it up to a level which is optimal for health in the region. With salt fluoridation there is going to be some parts – different water sources –which have differing amounts of fluoride in them which people are drinking but the salt remains consistent throughout the region. Sometimes you will read from the opponents that Europe is totally against all (fluoridation) so forth but in fact the European Union passed a resolution in 2006 - I believe - that talked about the use of fluoride – in fact it was  16th May 2006 - the European parliament voted 526 in favor and 126 against this resolution that says ‘that the addition of fluoride to food practice or the addition of fluoride to drinking water or salt or milk is now authorized in the countries of the European Union.’ So that’s something which is very recent from 2006 and was voted on by the parliament there.

FAIRBANKS COUNCILOR: “I just have three more questions. I would like to ask you if you don’t mind Dr. Bailey if I could have time to prepare them and email them to you and have the answers for Monday’s meeting. Would you amicable for that?”

DR. WILLIAM BAILEY (CDC): Well, I will be glad to help. But I would rather that you work through your State dental director. Normally the CDC doesn’t hold ourselves out…

FAIRBANKS COUNCILOR: “That’s Brad. I’ll send it to Brad. The questions I have: Are you aware that in Canada the maximum contaminant level for the fluoride was 4 ppm but they reduced it? And reduced it all the way down to 0.6 ppm and since we have it naturally occurring at 0.5 ppm  and that is an incremental difference and I understand from brad that fluoridation only provides an incremental benefit to begin with. Do we have to supplement it with everything on the market, everything with fluoride in there and is it really when we have such naturally occurring fluoride?”

DR. WILLIAM BAILEY (CDC): Well, I believe that Canada’s maximum level is 1.5 ppm and is also the World Health Organization’s maximum level.

FAIRBANKS COUNCILOR: “I have some documentation  that indeed have lowered it for Canada. That might be a new revelation.”

DR. WILLIAM BAILEY (CDC): Maybe you could share that with me. I would be interested in the source to see whether it came from the Canadian government or rather from some sort of group that opposes fluoridation.

FAIRBANKS COUNCILOR: “OK. The other thing I wanted to ask and I think we all have hit on it. I want to do so again. Washington, DC, is fluoridated but they are having a dental decay crisis.”

DR. WILLIAM BAILEY (CDC): Yes.

FAIRBANKS COUNCILOR: “So are we back to the argument that the number one thing for good oral health is diet- and I think we can all agree that the direct application of fluoride is most beneficial?”

DR. WILLIAM BAILEY (CDC): Well, actually any body who has better economic status usually has better dental health in all areas. And so if we look at poor areas – especially pockets of poor areas – we know that for children  80% of the tooth decay for children is in 25% of the population but that subgroup is always the poorest segment of the population. So having community water fluoridation won’t eliminate tooth decay, it will help reduce tooth decay but it doesn’t overwhelm  all the other things that can  happen.

FAIRBANKS COUNCILOR: “Yes but this is an increase. They are having a crisis even with it in the water.”

DR. WILLIAM BAILEY (CDC): Sure. Because they don’t have access to dental care – because they – you know – they have a very low social economic status. You know any kind of disease – especially oral health – is multi factorial disease – you just can’t say because of what you eat, you can’t just say its because say  the cary you get, that’s its because your other health, but there’s a lot of things which enter into oral health. So community water fluoridation helps to reduce tooth decay and that’s in children in study after study but that does not mean that it is going to overwhelm other factors. For example, I have worked with the Indian Health Service for 14 years. We did community water fluoridation and sealant programs and still we were overwhelmed in certain ways and a lot of it comes from poverty.

FAIRBANKS COUNCILOR: “I have checked here in the clinic here and the other facility we have. They have a sliding scale – they have dental available – they have fluoride tablets available to folks at the lower end of the socioeconomic scale.”

DR. WILLIAM BAILEY (CDC): Well they shouldn’t because if you have fluoridated water they shouldn’t be giving out fluoridated tablets because that’s what causes dental fluorosis.

FAIRBANKS COUNCILOR: “That leads into the next question. You said that in Northern climates you recommend higher levels. Well in the winter we have lots of tea here made with hot water. Heating water causes the greater concentration of fluoride. Fluoride comes through to us in fruits and products, backed goods from other parts of the US, which use fluoride. So we are getting such a multitude area of fluoride that like you said it is hard  to pin down and having been told that it provides an incremental benefit taken systemically do you have any thoughts on how if are at 0.5 ppm natural occurring fluoride, what would it take to make up the incremental difference of the bottom of the scale that is recommended – even at the 2.2 ppm. Would that be using the mouth wash?”

DR. WILLIAM BAILEY (CDC): I am not sure that I totally understand your question.

FAIRBANKS COUNCILOR: “If you are going to replace the value of fluoride that is taken systemically which was told to me to be of incremental value – if I understand incremental value it means small…”

DR. WILLIAM BAILEY (CDC): Progressively greater. You are going to get more value at fluoridating at 1 ppm than your are at 0.5 ppm. In  other words, the higher the fluoride goes up you get an incrementally greater benefit the higher the fluoride goes up.  

FAIRBANKS COUNCILOR: “Do we know what that incremental benefit is across the board when you are looking at fluoridated toothpaste, mouth wash and diet? What role does that value make systemically? Is that 10% of it, is it 5% of the whole value that you need from fluoride?”

DR. WILLIAM BAILEY (CDC): I don’t know. I haven’t seen any studies on that. But you know that you are getting from fluoride (fluoridated water) is 1 ppm; toothpaste has 1000 ppm, the amount that rinses have is over 1500 ppm, so you are looking 1 thousandth of what’s in the water right now. I am not diminishing that you are getting a lot of your intake from drinking water and other beverages but you have to also keep in mind that some of these other things that you are talking about – for example tooth paste, which have concentrations 1000 times the concentration that’s in water.

FAIRBANKS COUNCILOR: “And they are directly applied? So you want me to send these questions onto Brad - the remaining questions that I have? – there is one thing I want to be clear about – Dr. Bailey - I am  talking about the Fairbanks community not sweepingly across the world – I am saying that this community has it naturally. I don’t want you to think I am just spreading it.”

FAIRBANKS COUNCILOR: “The impact on bones – I am not talking about the naturally occurring fluoride – makes the bones hard on the outside but weaker on the inside. Are you talking about the added fluoride?”

DR. WILLIAM BAILEY (CDC): Any fluoride actually. The York study looked at this in 2000 and said that they could find no difference between natural fluoride and fluoride that is added to the water. There’s been studies- the latest by Finney, in 2006 - they’re water chemists- and they looked at the dissociation of the various fluoride additives and they said that in the end it is all just the fluoride ion that is working in  the water but so it doesn’t matter where it comes from. The fluoride ion is the fluoride ion and is the same whether it is naturally occurring or put in using an additive.

FAIRBANKS COUNCILOR: “So Dr. Bailey all water has natural fluoride in it or is that correct?”

DR. WILLIAM BAILEY (CDC): Yes it is in everything.

FAIRBANKS COUNCILOR: “Is our naturally occurring fluoride in water more than any where else in the country? Different levels?

DR. WILLIAM BAILEY (CDC): There are different levels. In 2006 the National Research Council report says that there is about 1.6 million people in the US that have over 2 ppm naturally occurring in their water. So it is not – you know – when you look at 1.6 million people out of 300 million that’s not a great amount percentage wise but 1.6 million is still a lot of people. So we would like to see those people with 2 ppm or greater try to find alternative water sources for their children before their teeth are developing.

FAIRBANKS COUNCILOR:“ I too would like to forward a few questions. Here there is not time – so Brad is that the gentleman to email them to?”

DR. WILLIAM BAILEY (CDC): Yes

Will Brad be able to respond within a day or two – if the questions are not too difficult?

Brad : “If you can get me questions, I will try to respond to them by tomorrow. Etc

FAIRBANKS COUNCILOR: “Dr. Bailey you mentioned that there were two types of studies – scientific studies - one in where you follow people through time and the other is you compare one city against another city or one area against another area. One having had fluoride the other not. The first one you said you follow people through time and I didn’t hear a follow up statement by you as to what study might have done that. I assume that has probably been done that people have been followed through time or questionnaires have been delivered to people on a broad enough scale to make it somewhat reliable. Do you know of any studies like that?”

DR. WILLIAM BAILEY (CDC): Yes for example a study done by Kathy Phipps in the Northwestern part of the United States. She followed over 9000 post-menopausal women because at the time there was some concern that fluoride was related to fractures, especially hip fractures. And so she followed these 9000 women and recorded there fractures and what she found was that there was that there was not an increased risk for hip fractures.

FAIRBANKS COUNCILOR: “In that study was there a finding on the benefit of fluoride to teeth?”

DR. WILLIAM BAILEY (CDC): No she just looked at bones.

FAIRBANKS COUNCILOR: “So, I am looking for that one. Were there any where people were followed through time where the benefit to teeth was examined?”

DR. WILLIAM BAILEY (CDC): Normally – there probably are studies like that but I don’t know of any of the top of my head – normally what they do is they look at – they almost always used children because – at the beginning they thought fluoride was only good for children. Also it is an easy group that is in a school. Normally they look at 12 year old children – then they look at 12-year old children – 5 years later but they would be different groups.

FAIRBANKS COUNCILOR: “The second issue one was one city or area versus another. You mentioned that those were difficult because you know whose drinking who isn’t, whose taking artificial and who isn’t – regressional analysis could… (side 1 of tape ended)… any of that you might know of?” 

DR. WILLIAM BAILEY (CDC): Sure. We can go all the way back to when they started water fluoridation. What they did there they used pairs of cities one of which was fluoridated and the other that wasn’t…

FAIRBANKS COUNCILOR: “if you would just tell us the one… (Bailey continues to talk about the early trials)… I am looking for one that is recent, because in the old days we didn’t have fluoridated toothpaste. Could you give me the best study that you can come up with that’s recent that shows pretty clearly that an area without fluoridation where they used fluoridated toothpaste versus an area that doesn’t. Do you know of a recent study like that?”

DR. WILLIAM BAILEY (CDC): There was a school children in the late 80’s - Brunelle and Carlos’s paper from 1989 – where they reported – it was a national study – that was when toothpaste was in full use – just about – and they reported – this was a national study - and they reported about a 25%  reduction in the difference between the  fluoridated and non-fluoridated areas when you adjusted for other …

FAIRBANKS COUNCILOR: “

FAIRBANKS COUNCILOR: I can find that if I look up national schoolchildren in 1989 I can find that?”

DR. WILLIAM BAILEY (CDC): I can send you a copy of the Brunelle and Carlos report.

FAIRBANKS COUNCILOR: “Thanks I appreciate that. OK thank you.”

FAIRBANKS COUNCILOR: “I have my last question. You had made the comment that the fluoride which was natural is the same as the added fluoride. Where does added fluoride come from? Where is that product derived from that we put into our water supply?”

DR. WILLIAM BAILEY (CDC): It mostly comes from the fertilizer industry. Phosphorous fertilizer industry. It’s a by-product. They do this with a lot of industrial things they take – gypsum is also another thing that comes from  that phosphorous fertilizer industry but – that’s where the majority comes from – that’s the fluorosilicic acid. You’ll see things about they scrub it out of the smokestacks- well they don’t scrub it out of smokestacks – they use a reclaiming process and they get the fluorosilicic acid that way.  (discusses other source for the computer industry). But almost of it comes from the Phosphorous fertilizer industry.

FAIRBANKS COUNCILOR: “if as a community we took the fluoride out of our water how long would it be – a generation, 20 years – before we would see an impact from it. Statistically?”

DR. WILLIAM BAILEY (CDC): I can’t give you an answer on that. Some of the studies that did that – I don’t have any recent ones. These were all years ago – decades ago. Antigo, Wisconsin, in 1949 fluoridated and they fluoridated till 1960 and they discontinued. Five and half years later – and now this was before (fluoridated) toothpaste – five and half years later they saw a 70% increase in caries. The community guide (2002) talked about discontinuation of fluoride as well. This study came out in 2002 and this was a systematic review and they looked at the studies and  they said stopping water fluoridation resulted in a median 17.9% relative increase in  caries – tooth decay. But they don’t say how many years.

FAIRBANKS COUNCILOR: “I would like to know - you said that the non-natural fluoride comes from fertilizer – which companies and what’s in it and where can I get that information?”

DR. WILLIAM BAILEY (CDC): If you go to our website – I can send the link to that as well – we have a whole section on additives – questions and answers about additives and so forth. The other thing that it explains there is the fluoride additive – it isn’t just something that somebody is collecting and dumping in your water. There are regulations which relate to the additive too – they have to be of a certain purity. The American Water Works Association has standards that are national standards for the additives – for any additives which go into our water – and NSF international has standards and those are all talked about there as well - on our website - as well. I can send you this link if you like on the additives.

FAIRBANKS COUNCILOR: “So what else is in water besides fluoride?”

I DR. WILLIAM BAILEY (CDC): am not an industry person but of course chlorine is in the water. They add things to reduce iron in water, because iron can stain fixtures – I wish our fluoridation engineer was here because he knows all of that. If you have specific questions about engineering questions I can forward…

FAIRBANKS COUNCILOR: “That’s OK, I just know that if we were to remove fluoride they would add something else to maintain the pH balance. So take out one additive and get another it seems like.”

FAIRBANKS COUNCILOR:“ I think certain additives are for the purity of the water but this (fluoride) is actually an additive for medication for a physical aspect rather than for safety of the water.”

 DR. WILLIAM BAILEY (CDC): It’s not considered a medication it’s er…

FAIRBANKS COUNCILOR: “It’s curious when we speak about it and we talked about doses or suggested amounts that people should drink – pregnant, young etc – I am a large woman so I drink one glass so I am under-dosing and I have a skinny friend who exercises all the time and they are drinking 20 glasses a day so. To be in the system you get doses for people of different sizes, weights and activities – so it is a curious thing that we are trying to decide what is healthy and we have got that stated.    Then habit. Then personal choice comes into play. So…”

 DR. WILLIAM BAILEY (CDC): Yes it does. But for over 60 years there have been people of all kinds of medical conditions and of all kinds of different sizes and different intakes and so forth and for over 60 years we have not seen an adverse effect. Other than fluorosis that’s related to intake of all levels – so….

 MAYOR: “Well thank you Dr. Bailey very much.”