Comment by efitz
19 days ago
It is trivial today to get whatever level of fluoride is recommended for dental health, via toothpaste. So there is no compelling need to fluoridate as there exist viable alternatives to achieve the same that fluoridation is for any other purpose than dental health.
In the USA, dental care is not covered by public insurance, and is an optional add-on to insurance through one’s employer.
So without addressing at all whether fluoridation is effective or safe, there doesn’t seem to be any compelling need to fluoridate public water, and there’s no economic down side for the public if governments choose not to do so.
Given this, why not just leave people alone to make their own choices? If the citizens in a city or state want to fluoridate the public water supply, then do so; if they choose not to, then leave them alone. It’s a free country and voters are grownups; let them choose for themselves.
If you live in a place that chooses the choice you dislike but for some reason fluoridated public water supply is a critical issue for you, either campaign to change it or vote with your feet.
This issue just doesn’t seem important enough to me to spend any effort arguing either way.
> This issue just doesn’t seem important enough to me to spend any effort arguing either way.
Your comment is well-stated, and in the spirit of a free and liberal society. The problem—not with your argument, but with the world—is that today there seems to be literally no issue unimportant enough not to argue about, or use as the battlefield for an unending ideological proxy war. My guess is that few of the people arguing this issue on HN have strong feelings about flouride qua flouride, but have strong feelings about the kinds of people they believe oppose or support the use of flouride in water, and this notion is what they're really railing against.
This rings true for my gut reaction. The family and acquaintances in my life who have been up in arms against fluoride for years now are actual neo nzs (like “deport all non whites”, “you-know-who controls america”, “superiority of the white race” level).
So my instinct is to really be afraid of this anti-fluoride wave, even tho practically I don’t care one way or another.
I think one thing you're not considering (especially when you say we should vote with our feet) is poverty. It’s true that fluoride toothpaste is widely available, but for people in poverty, of which there are millions in our country, basic hygiene items like toothpaste and a toothbrush aren’t guaranteed. Neither is it guaranteed that everyone has a perfect daily brushing habit like the dentist tells us; there are people who don't brush every day, or even every week.
You talked about dental care not being covered by public insurance — is it not worth considering that some basic level of dental care is already being applied to the country via fluoridation? It's a minimal, cost-effective way to prevent tooth decay at scale. Fluoridated water is one of the few dental protections available to everyone regardless of their income.
If you're not brushing your teeth, periodontitis will get you; the resulting bone decay will cause your teeth will fall out. But sure, great, the water was fluoridated, so I guess it's nice that those now-missing teeth are free of caries?
there are people who own a toothbrush but do not purchase toothpaste. money is not something everyone has and when you start having to choose between certain things, tough choices get made.
I really don't feel like you're interpreting my comment in good faith. Do you really think I was arguing that poor people literally never brush their teeth, and every single poor person in the country will eventually suffer from periodontitis? If you read my comment again, I'm sure you could find a way to engage in better faith.
I don't believe there's a single person in the USA that's so poor they can't pay $3 for toothpaste every 3 months. I also believe that having such a low personal hygiene where you don't brush your teeth altogether, even if you drink water with fluoride, will have terrible results anyway for your teeth anyway.
I'm completely sure that any people that don't brush their teeth is just because they are too lazy to even bother.
This trope of justifying everything with "but there are millions of poor people in the USA" is really tiresome.
It's not that they can't afford a $3 toothpaste, it is the environment they are in that makes it hard to prioritize things like this. It is the education and the overall life quality (or the lack there of) that causes this problem.
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Your argument essentially amounts to "why are poor people poor when they can just get a job." I can't find anything to say about it that isn't snarky.
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The number of Wal-Mart employees I know who can't get their managers to schedule them for the thirty hours a week required to be eligible for dental care far exceeds the number of Wal-Mart employees I know who can.
Trivial is what we have now. Taking fluoride from the water means people will have to spend extra time and money on fluoride and dental treatments. When I viewed it, your comment appeared directly after this one (https://news.ycombinator.com/item?id=43524171), which talks about a town in Canada that voted to abandon fluoride , saw worse health outcomes, and then voted to reinstate it. This tells us that fluoride is not trivially available to people, and taking it away from them enriches corporations while making people less healthy.
So you’re saying that forcing a treatment on people that don’t want it, is a fair price to pay to reduce inconvenience for others?
I’m not sure what your anecdote proves because I’m wholly in support of a polity being able to make that decision.
I was responding to this point:
I also agree that people should be able to make decisions like this, but they should be aware that one of the results of these kinds of efforts could be that everyone gets less healthy, rather than everyone stays at the same level of health with less cost.
Presumably when they voted to get rid of fluoride in the water in Calgary, they didn't do so expecting the outcome would be that people in their town would be less healthy overall. Nonetheless, that was the outcome of their vote.
The anecdote shows that it's not trivial, because when the fluoride in the water went away, people were not able to trivially replace it, leading to worse health outcomes. Ultimately people found too high of a cost, seeing as that they reversed the decision.
Sadly it took a decade for them to realize their mistake. I worry people today are making the same mistake, and we will reverse it in a decade after health outcomes are shown to have worsened.
> via toothpaste.
I wonder how many people really brush their teeth on a regular basis.
> either campaign to change it or vote with your feet.
I imagine that campaigning to change it requires notifying people there is a problem, and getting it into the news and spreading that news.
> I wonder how many people really brush their teeth on a regular basis.
Whatever the number is it's not appropriate for the state to medically intervene on their behalf.
Why not?
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Sadly people that don’t brush are probably not drinking plain water either.
I was thinking the same thought- maybe we should fluoridate Brawndo :-)
Thats not really true. I had problems brushing during my childhood, because most toothpastes triggered my gag reflex, but I mostly drank tap water.
Your indifference is based on some core assumptions that are false. In reality, 1) Fluoride in water works in addition to fluoride in toothpaste to protect our teeth - rather than two highly concentrated events of reminieralization, fluoriated water reminieralizes the teeth throughout the day. 2) There is a strong economic downside to ceasing fluoridation: Fluoridation saves millions of dollars that otherwise would be spent on dental bills by the public - https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.0... - shows cost savings ratio of twenty dollars for every. dollar invested in reduced treament costs. This remains apt: https://pmc.ncbi.nlm.nih.gov/articles/PMC7164347/ 3) The best way to preserve choice is to maintain fluoridation. People cannot choose to fluoridated their own water system - they can choose to live in unfluoridated areas, use filters that remove fluoride, or otherwise avoid the tap water. 4) Removing fluoridation means acces to fluoride becomes much more difficult and expensive. The reason fluoridation is so cost effective is that it is delivered through the public water system - a community resource. Bottled fluoridated water is more expensive than gasoline. It is also less regulated and less available in the U.S.A.
In general it's some weird relic of medieval view on dentists not being medical professionals but someone akin to barbers. It shouldn't exits but it persists.