Making the argument for fluoridation
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By George Malkemus  June 6, 2014 12:00 am

Fluoridation is the most effective means of reducing decay and dental cost in communities. More than 200 million Americans, over 70 percent of the U.S. population, are benefiting from water fluoridation with more than a 30 percent reduction in tooth decay.  We have had more than 65 years of experience with fluoridation in the United States, 60 years in San Francisco and 40 years in Marin County and the East Bay.  More than 24 million Californians enjoy the benefits of water fluoridation.  The water in Healdsburg has been fluoridated since 1952, and Healdsburg was the first community in California to do so.  Sadly, however, most communities in Sonoma County are not fluoridated.

Anti-fluoridation began in the 1950s because of fear that fluoridation was a Communist plot and worry about the government putting anything in our water.  However, every U.S. health organization, (including the AMA, ADA, CDA, CDC and the Redwood Dental Society) as well as every Surgeon General for more than the past 50 years strongly supports fluoridation as the best and most cost effective means of reducing dental disease.  Amazingly, fluoridation of drinking water is considered one of the 10 greatest public health achievements in the 20th century, yet it is still not available in most of Sonoma County in the 21st century.  


What is fluoride?

Fluoride is the 13th most common element on earth and occurs naturally in almost all surface and ground waters.  The natural fluoride level supplied by the Sonoma County Water Agency is 0.13 parts per million (ppm).  The recommended level of fluoride in drinking water to prevent tooth decay is 0.7 ppm.  (The fluoride level in the ocean is 1.4 ppm, which is two times higher than the level that should be supplied in our drinking water.) So, fluoridation involves adding the right amount of fluoride to the drinking water to bring the level to the ideal amount of 0.7 ppm.


How does fluoride in 

water prevent decay?

Fluoride strengthens the enamel of teeth and helps resists decay.  Enamel is the white, outermost layer of the tooth that covers the crown (the part of your tooth that you see, above the gum line). Enamel is the hardest substance in your body, and the second hardest substance in nature. Only diamonds are harder. Actually, I use small diamond burs to be able to drill through enamel.  Enamel provides strength for biting and chewing, and it protects the inner layers from plaque and bacteria that lead to decay.

Bacteria use food debris, particularly sugar, to eat through the hard enamel by secreting acid.   Enamel is particularly susceptible to acid.  By incorporating fluoride into the crystalline structure of enamel, it becomes extremely resistant to acid breakdown and thus decay.

Actually, fluoride in the drinking water helps protect teeth in two ways – in the internal structure of the enamel and on the surface on the enamel.  First, when teeth are forming before birth until the age of 15, the fluoride is found throughout the thickness of the enamel, making it particularly strong and resistant to acid breakdown from decay.   So it is particularly important that children have fluoride.  When fluoride is not in the drinking water, like in most of Sonoma County, then supplements should be taken by children, prescribed by their physician or dentist.  Fluoride in the drinking water is a much easier, cheaper and effective means of delivery.  Only a small percentage of children have access to fluoride supplements.

Secondly, when drinking fluoridated water, the surface enamel has a continual protective washing throughout the life of a tooth.  Fluoride is also found in saliva, which helps constantly wash the teeth and protect the teeth from decay.  Surface fluoride actually works to stop enamel mineral loss from decay and can even re-mineralize the surface enamel.  The surface tooth protection from fluoride is effective for children and adults. This is especially important for our aging population, which often has reduced saliva flow and difficultly maintaining their teeth with brushing and flossing.  


History of fluoridation

In the early 1900s, some communities in the United States were found to have ugly, gnarly looking teeth with brown stains and white spots.  Two such communities, Bauxite, Ark., and Colorado Springs, Colo., were studied and found to have almost no decay even with the poor oral hygiene of the times.  The similarity between these two communities was the presence of high levels of fluoride in their natural drinking water.  This discoloration of teeth from fluoride is called fluorosis.

By the end of the 1930s, the ability to detect fluoride at low concentrations and to determine an effective level of fluoride to prevent decay was achieved.  It was recommended that 1.0 ppm of fluoride be in the drinking water to prevent decay and prevent fluorosis.   The level has been recently revised to 0.7 ppm.

In 1945, the public water system in Grand Rapids, Mich., was fluoridated to a 1.0  ppm level and a 15-year study was conducted of 30,000 school children.  By year 11 of the study, the decay rate among the children dropped 60 percent with little evidence of fluorosis.

Since that time, communities have been fluoridated throughout the country.  Scientific studies have been conducted continually for the last 65 years with no problems with fluoride, except tooth coloration when high levels are used. Public water fluoridation has been proven safe and effective by repeated studies throughout the years.   Many studies have shown the amazing reduction in decay and tooth loss, the large reduction in  time  lost from school and work, and the extreme cost savings from reduced dental treatment.


California mandate for 

water fluoridation

California’s fluoridated drinking water act, Assembly Bill 733, became law in 1995.   This bill authorized water systems with 10,000 or more service connections to fluoridate once money from an outside source is provided.  Yet, Sonoma County is still not fluoridated.  Why?


State of fluoridation 

in Sonoma County

One ongoing, passionate, well-meaning but misinformed group of fluoridation opponents continue to interfere with the progress of public health at the cost of individuals susceptible to dental decay, particularly children and the elderly.

Recently, Fluoride-Free Healdsburg gathered enough signatures to place an initiative on the ballot to stop fluoridation.   It is estimated that the cavity rate in Healdsburg will increase 30 percent if the measure passes.

On Feb. 14, the Sebastopol City Council voted unanimously to oppose water fluoridation.  On Nov. 18, 2013, the Cotati City Council voted unanimously to oppose water fluoridation.  I only recently learned this had happened, and being a Cotati resident, I am sorry that this passed without my knowledge.  Fluoridation should not be a political topic but a long-term scientific fact.  The passage had little input from the local dental and medical community.

The main reason for passage as stated by Cotati Mayor Mark Landman was to allow individual choice in deciding what medications their families receive.  Fluoride is not a medication, but a natural occurring mineral found naturally in most water sources. Fluoridation is designed to create the ideal level of fluoride in drinking water.

Fluoridation efficacy was determined long before smoking was determined to be bad for health and before seat belts and baby seats were determined necessary for health.   Yet, individuals are not allowed to smoke in public places and do not have the choice of not wearing seat belts.  If public water was fluoridated to help children and adults reduce decay and help those who are unable to pay for dental treatment, individuals opposed to fluoridation have the choice to have bottled water or an osmosis system remove fluoride. 

The Sonoma County Water Agency supplies water to more than 600,000 people in Sonoma and Marin counties, including Cotati, Petaluma, Rohnert Park, Santa Rosa, Sonoma, Windsor, Marin and North Marin Water Districts, Valley of the Moon Water District and several other smaller retailers.  Substantial savings will be attained if fluoridation is provided through the SCWA versus multiple smaller sources.

Dentistry has a long history of stressing preventive health, including dental hygiene, regular dental check ups and cleanings, brushing and flossing and fluoride use.   Dental disease is the most prevalent of human aliments.  

That is why dentistry branched off from medicine more than 150 years ago.  The dental profession is ethical. We continually try to put ourselves out of work by stressing oral health.  Oral hygiene and fluoridation are obvious to us for healthy mouths and bodies.

Support water fluoridation.  Support a public health need that is long overdue.  In the meantime, parents speak to your pediatrician or dentist about fluoride drops, fluoride tablets or vitamins containing fluoride for your children. 

To learn more about fluoridation’s safety and benefits, go to   Campaign for Dental Health at

Enjoy life and keep smiling.


George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@  Visit Dr. Malkemus’ Web site at

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