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THE LITTLE KNOWN HISTORY OF FLUORIDE

A behind-the-scenes look
at a 20th-century achievement in science and health

"Phillip..."

"Yes, Francis."

Dr. Philip Jay,
Professor at the University of Michigan

Dr. Francis Arnold, Assistant Dental Surgeon, and later, Director of Dental Research, at the National Institutes of Health

"Are we going to be here all night with these petri dishes?"

"Yup."*

Photo of Dr. Philip Jay (left), Professor at the University of Michigan, and Dr. Francis Arnold (right), Assistant Dental Surgeon, and later, Director of Dental Research, at the National Institutes of Health

*O.K., so that's just what we think we would be saying here. We have no idea how long Drs. Jay and Arnold spent on their microscopes that day, but you have to admit, that is a lot of F'n petri dishes they had to examine.

What do we know about what they were doing?

We know they were working as part of a larger team of Public Health Service researchers, NIH scientists, and university professors studying the very first community water fluoridation effort in the United States.

We also know what was in those petri dishes. Bacteria. The nasty bacteria that infect our teeth with decay.

And we know what they found during their hours hunched over their microscopes. We know the knowledge gained from their work plus decades of research in oral health since ... Fluoride fights bacteria, and the tooth decay caused by those bacteria.

We know where those bacteria came from, too. Kids. Lots of kids. Kids in Grand Rapids, Michigan, and kids in Muskegon, Michigan.

Kids playing during recess at Hall Elementary School in Grand Rapids. 1940s.

After decades of research on fluoride which occurs in water naturally, Public Health Service researchers at the newly formed NIH had amassed much evidence that they could prevent two dental conditions when water had a fluoride concentration of about 1 part per million (ppm). Both tooth decay and fluorosis were low at that amount of fluoride. In collaboration with Public Health Service researchers, Grand Rapids started a demonstration project in 1945 and adjusted the level of fluoride in the town's drinking water to 1 ppm. Public Health Service researchers did extensive before and after dental exams, saliva samples, and bacterial counts for kids in Grand Rapids. They also did all those exams and sampling in nearby Muskegon. Muskegon served as a comparison city for 7 years, with no fluoridation until 1951. By 1951, the results for kids' teeth in Grand Rapids were so good, Muskegon started fluoridating their water, too.

Photo courtesy of HistoryGrandRapids.org and the Grand Rapids Community Archives and Research Center.

"Karen, don't you think this is kind of gross that we've got to spit in these vials?"

"Heck no, Susie. Those 14 cavities my older brother got were way grosser. I'll take a vial of spit over a dozen fillings any day."

Grand Rapids school kids giving saliva samples for bacterial counts to be done by Drs. Jay and Arnold.

Again, we don't know what the kids here were really saying, but 14 cavities was typical for kids before fluoridation. And we do know what at least one kid thought. Chase Klinesteker today is a dentist. But in 1945, he was a kindergartener in Grand Rapids. He remembers giving saliva samples and getting dental exams as part of the research on fluoride and tooth decay. He says sample containers included wax to chew and a glass bottle to spit in. Imagine that! Sanctioned spitting in school!

Dr. Klinesteker's father was also a dentist, and through his family connections, he also knew other dentists serving Grand Rapids before and after fluoridation. Before fluoridation, tooth decay was so rampant in the area that Grand Rapids dentists had wild stories. One dentist, Dr. Bill VerMeulen would be booked solid on Saturdays to work on teenagers' dental problems ... what was he doing? Removing all of their teeth and giving them dentures! For teenagers! Another estimated that three-quarters of his practice before fluoridation was extractions and dentures.

Madison Elementary School 1st grade class in 1959, Room 5, Mrs. Kaye's class. Grand Rapids, Michigan.

These first graders did not participate in the research on cavities, fluorosis, and oral bacteria done with older children in Grand Rapids, but they were still amongst the first kids in America whose smiles were made stronger with fluoride. By this point in the research in Grand Rapids, public health scientists were still following kids from older cohorts— perhaps some of these kids' older brothers and sisters. Also, in case you're wondering, the kid in the front row on the far right is indeed wearing a shirt that says "Robert" over and over again. Bet you wished you had a cool shirt like that, with your name all over it!

Photo courtesy of HistoryGrandRapids.org and the Grand Rapids Community Archives and Research

What else do we know about this work on fluoride in Michigan back in the 1940s and 1950s?

We know that this historic study of fluoridation resulted in a multitude of publications in premier journals ... such as...

  • ... the Journal of Public Health Dentistry
  • ... Public Health Reports
  • ... the Journal of the American Dental Association
  • ... and the American Journal of Public Health.

But ...

For our purposes here ... What is really important to know ...

What's critical to see in our look at this 20th-century public health achievement is...

The U.S. Centers for Disease Control and Prevention (CDC) identified this research in Michigan as a cornerstone of a broad and rich history of fluoridation and fluoride science.

A key piece in a decades-long quest in dental health. A quest that resulted in our modern-day use of fluoride at low levels — for its benefits — as well as our modern-day control of the dangers of too much fluoride.

The details of that history of fluoride — and CDC's review of fluoridation as one of the greatest accomplishments in public health — are the focus of this e-book. Read on to delve into our re-telling of CDC's 4th public health achievement ...

PUBLIC HEALTH ACHIEVEMENT
OF THE 20TH CENTURY #4

Fluoridation of
Drinking Water to
Prevent Dental Caries

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