San Francisco residents have been drinking fluoridated water for nearly 50 years with no known and/or apparent adverse health impacts. Nonetheless, a public debate over the benefits and impacts of fluoridation has been ongoing since the inception of water fluoridation in the mid-1940's. Key organizations that endorse fluoridation include the California Medical Association, the California Department of Public Health, the American Medical Association, the U.S. Public Health Service, the American Public Health Association, the American Council on Science and Health, and the World Health Organization. Some of the organizations that oppose fluoridation include the Citizens for Safe Drinking Water, the American Holistic Health Association and the American Preventive Medicine Association.
Organizations in support emphasize the benefits of fluoridation for community prevention of dental caries (or tooth decay) and maintain that fluoride poses no health risks. Proponents emphasize the dental health benefits community fluoridation provides to lower socioeconomic segments of the population. In April 1999, the Center for Disease Control and Prevention proclaimed fluoridation to be one of the top ten greatest public health achievements of the century. Similarly, in its report - Oral Health in America (September 2000) - the US Surgeon General states that "community water fluoridation remains one of the great achievements of public health in the twentieth century - an inexpensive means of improving oral health that benefits all residents of a community, young and old, rich and poor alike."
Parties that oppose fluoridation argue that fluoride, as opposed to a disinfectant such as chlorine, is not required to make the water safe to drink. Opponents refer to fluoridation as forced medication and insist fluoridation could lead to a wide range of serious ailments, including dental fluorosis (visible mottling and/or discoloring of tooth), hip fracture, and neurologic impairment. Furthermore, opponents argue that adequate amounts of fluoride for dental benefit exist in toothpaste and food products.
One of the most reliable and extensive study on water fluoridation was commissioned by the United Kingdom government and undertaken by the University of York. This review of 214 previous studies on water fluoridation concluded that there was a slight increased proportion of children with reduced dental caries in fluoridated communities, coupled with a dose-dependent increase in dental fluorosis. The study, which was published in the October 7, 2000 issue of the British Medical Journal, also concluded that there was no clear evidence of potential adverse health effects other than dental fluorosis.
Input from public health officials on the health benefits and impacts of fluoridation was solicited as part of the SFPUC Fluoridation Feasibility Study. The California Department of Public Health and the Public Health Agencies from the four counties included in the SFPUC service area (i.e., counties of San Francisco, San Mateo, Santa Clara and Alameda) all expressed strong support for the system-wide fluoridation of the SFPUC system.