Surgeon Generals and their scientific assessments of fluoride in drinking water
Richard Carmona, Surgeon General ...
a.k.a. the Nation's Doctor ...
visiting kids at a school in New York City.
Some of the insignias worn by Surgeon Generals and other officers of the U.S. Public Health Service.
Richard Carmona, American's 17th Surgeon General, had a definite professional opinion about the question: is fluoride good for your teeth?
As we've said previously, what he is most well-known for saying about fluoride is ...
"Fluoridation is the single most effective public health measure to prevent tooth decay and improve oral health over a lifetime, for both children and adults."
That sounds like an unabashed yes.
A big yup, yeppers, yessiree ... fluoride is good for your teeth. And that yes went for everyone ... adults and kids. As much as Dr. Carmona clearly cared about kids, he wasn't just talking about kids ... he was talking fluoride being good for your teeth, too. But ...
That yes did have a qualification to it.
His scientific opinion was that fluoride is good for your teeth if you get the right amount of fluoride ... the amount in community water fluoridation(or fluoride supplements your dentist or doctor recommends if your community doesn't have fluoridated drinking water)+ the amount you get from brushing your teeth two or three times a day with fluoride toothpaste+ any other fluoride treatment your dentist recommends.
But he did not think you should go eating whole tubes of toothpaste.
And if you live in certain areas in the U.S. and drink well water, you might have natural levels of fluoride in your water that Dr. Carmona would say are too high. He'd say you should get your well water tested to find out.
Or if you live in certain parts of China, India, or Africa, Dr. Carmona would be worried about you drinking water that has too much fluoride in it, too. For sure, Dr. Carmona recognized that a person getting more than his recommended amount would be too much fluoride.
But if you're an American, and you don't drink well water, Dr. Carmona was definitely way more concerned that you may not be getting enough fluoride. And ... fluoride in water and toothpaste, at the right amount ... definitely good for your teeth in Dr. Carmona's professional opinion as America's doctor.
OK, that's great, but ...
Who is this Surgeon General Carmona dude?
Why do you keep saying he was the nation's doctor?
And what makes you so sure his opinion is a scientific one?
Who is Surgeon General Carmona? Well, he has a pretty interesting biography. We've mentioned elsewhere that his heritage is Puerto Rican, he grew up in Harlem, and he had a rough childhood of poverty and homelessness.
And in 1966, he was a high school dropout.
So, wow. How did he go from high school dropout to leader of America's public health?
Well ... he enlisted in the army in 1967, served in Vietnam as a medic, worked his way through college as a paramedic and nurse, and then graduated at the top of his medical school class at the University of California, San Francisco – one of the nation's most rigorous medical schools – which is where he also did his surgical residency.
He followed all that up with a distinguished career in law enforcement, including serving as medical director of Pima County's police and fire departments.
Whew, we could use a nap after simply writing up the highlights of Dr. Carmona's career prior to becoming Surgeon General ... and we didn't even mention that he went back to get a Master's degree in Public Health in 1998 at the age of 49. Like having gone into army training and then going to school for a decade to learn to be almost every kind of healer possible (medic, paramedic, nurse, doctor) wasn't enough? Nope, this dude was like, "I need to learn even more about preventing disease and I'm going back for a Master's in exactly that subject!"
What else haven't we mentioned about him yet? Oh, just that time, as sheriff's deputy, that he rescued someone from the side of a cliff in Arizona by rappelling from a helicopter.
So Dr. Carmona brings the science cred ... plus some action hero badass-ness!
In 2002, Dr. Carmona was nominated U.S. Surgeon General. Carmona became the head honcho of our nation's Public Health Service – one of our nation's two main public health agencies.
Carmona then took his official stand on fluoride, as Surgeon General, on July 28, 2004.
Official stand was? Good for your teeth.
In a signed statement on HHS letterhead, titled simply "Surgeon General Statement on Community Water Fluoridation," one of the things he said was the above quote.
Of all the statements we could have quoted from Surgeon Generals over the years ... of all the statements we could have used as an opening quote in our feature on Surgeon Generals and whether fluoride is good for your teeth ... we chose this one ... for some very particular reasons related to our mission in science learning.
We chose this one because it is a strong, clear statement.
We chose this one because it encapsulates the scientific opinion of the nation's highest office in public health.
We chose this one because it reflects an important scientific truth about fluoride ... and it does so using a memorable sound bite.
We chose this one because it best represents 65 years of Surgeon General assessments of fluoride.
For 65 years, the considered opinions of the "Nation's Doctors" about fluoride have boiled down to "single most effective public health measure to prevent tooth decay." For 65 years, when America's official head doctors are asked, "Is fluoride good for teeth?" they assess all the research again and their answers have all been that fluoride is a big boon to teeth, if it's at the right amount.
These Surgeon Generals are the same national leaders in health who turned the tide against our national addiction to cigarettes in 1964 ... the same national health leaders who have been warning you about cigarettes causing cancer for decades ... the same national leaders who weren't afraid to talk frankly about AIDS, condoms, and human sexuality.
Surgeon General Luther Terry speaking at the press conference on the 1964 report on Smoking and Health, a landmark report that was one of the biggest news stories that year and turned the tide against smoking in America.Surgeon General C. Everett Koop in his Washington D.C. office in 1988. Koop mailed a booklet "Understanding AIDS" to all 107 million households in America in 1988. To date, it is still the largest mailing for public health ever done.Surgeon General Joycelyn Elders, first African-American to serve in the post, was a strong advocate for immunization, drug reform, and comprehensive health education, including sex education. She was forced to resign after a controversial remark about sex education, but went right back to work as a professor of pediatrics at the University of Arkansas for Medical Sciences.
Famous examples of U.S. Surgeon Generals speaking their professional opinions about public health topics and science
Surgeon Generals Terry, Koop, and Elders all stated their professional opinion of fluoridation, too.
Dr. Luther TerryNinth Surgeon General of the United States"FLUORIDATION IS ONE OF THE FOUR GREAT, MASS PREVENTIVE HEALTH MEASURES OF ALL TIME."
In his scientific assessment of public health accomplishments, Surgeon General Terry cited four public health measures as having accomplished the most for prevention of disease, as of the 1960s: pasteurization, water purification, immunization, and controlled fluoridation of water. Is fluoride good for teeth? The same guy who first got our nation to really wake up and understand that smoking causes cancer said yes.
Dr. C. Everett KoopThirteenth Surgeon General of the United States
Surgeon General Koop was particularly active in fluoride and fluoridation science. He convened multiple study panels on fluoride. He advised the U.S. EPA to adopt a maximum level of twice the optimum of fluoride in water (approximately 2 ppm), in order to prevent dental fluorosis. Why? Because fluorosis is what happens if kids get too much fluoride. Koop also released a comprehensive 727-page report on nutrition and health, which included an extensive review of the effects of sugar, fluoride, and other nutrients on cavities. What did the review say? Fluoride, at the right amount, is good for teeth.
He also summarized his assessment of the science in no uncertain terms when he said, "It is clear from the evidence that at the level of fluoride that is recommended for community water systems, dental decay is significantly reduced and no deleterious side effects are experienced .... with water fluoridation, the beneficial results have been markedly significant, consistent, and reproducible." But he may be most famous for saying that fluoridation is:
"THE SINGLE MOST IMPORTANT COMMITTEMENT THAT A COMMUNITY CAN MAKE TO ORAL HEALTH OF ITS CHILDREN AND TO FUTURE GENERATIONS."
Dr. M. Joycelyn EldersFifteenth Surgeon General of the United States"OUR WORK ISN'T FINISHED UNTIL EVERY COMMUNITY IS FLUORIDATED."
Surgeon General Elders was a frequent keynote speaker at oral health events, including the 60th anniversary of community water fluoridation and the National Oral Health Conference, where she presided over a plenary about wide-ranging improvements and sustainability in oral health programs. She advised that fluoridation needed to be comprehensive and encompassing all communities. And her professional opinion was that fluoride is good for your teeth.
And what is our latest Surgeon General's assessment of the science?
Dr. Vivek Murthy, appointed as Surgeon General by President Obama, also took a thorough look at the science. What did he have to say about whether fluoride is good for your teeth?
Dr. Vivek MurthyNineteenth Surgeon General of the United States
"As Surgeon General, I encourage all Americans to make choices that enable them to prevent illness and promote well-being.
"Community water fluoridation is one of the MOST PRACTICAL, COST-EFFECTIVE, EQUITABLE, AND SAFE MEASURES COMMUNITIES CAN TAKE TO PREVENT TOOTH DECAY AND IMPROVE ORAL HEALTH."
"Fluoride's effectiveness in preventing tooth decay extends throughout life, resulting in fewer and less severe cavities."
"Water fluoridation's biggest advantage is that it is the best method for delivering fluoride to all members of the community regardless of age, education, income level, or access to routine dental care."
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So far, we have only scratched the surface of the intriguing history of Surgeon Generals, their role in fluoride and fluoridation as a public health measure and a scientific question, and their role in science broadly.
There is so much science and fluoride history wrapped up in the office of the Surgeon General. And it is a complex story of some of the most important scientific triumphs of all time, completely mixed up with some of the most troubling science history imaginable.
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