represent the present position of the American Medical Association's approval of the association committee on health? Dr. GALE. I do not think I quite understood the question. Mr. HESELTON. I will try to rephrase it. You have made, by reference, a statement concerning the American Medical Association. Dr. GALE. Yes. Mr. HESELTON. As being a member of the Inter-Association Committee on Health. Dr. GALE. Yes. Mr. HESELTON. My recollection is that there has been some testimony that the American Medical Association has taken a position that was one of qualified approval and this statement is dated May 6, 1954. I would be interested to know whether this supersedes the previous statement that has been submitted to the committee. Dr. GALE. May I read to you, sir, a letter here signed by George F. Lull, who is secretary of the association, to Dr. H. L. BloomMr. HESELTON. Secretary of which association? Dr. GALE (reading): I have your letter of April 6, written by your assistantand so forth. This statement is as follows: I can say that the American Medical Association endorses the fluoridation of public water supply. George Smith and many others have twisted the words around because of the fact that in one action of the house of delegates, the word "principle" was used. No matter what words were used, the endorsement is that public water supply should be fluoridated in order to prevent dental caries in children. Does that answer your question? Mr. HESELTON. The secretary of the association? Was that of the American Medical Association? Dr. GALE. I think it was. Mr. GARVEY. Secretary and general manager of the American Medical Association. Mr. HESELTON. What date was that? Dr. GALE. That was April 14, 1954. Mr. GARVEY. May I say also, Mr. Heselton, that Dr. Lull has filed a statement with the chairman of this committee on behalf of the American Medical Association to the same effect, and asked that it be incorporated in the record. The CHAIRMAN. It is already a part of the record. Mr. WILLIAMS. Mr. Chairman. The CHAIRMAN. Mr. Williams. Mr. WILLIAMS. Doctor, I believe you represent the American Dental Association? Dr. GALE. That is correct. Mr. WILLIAMS. And the American Dental Association has taken a position in favor of-or certainly not objecting to-fluoridation? Dr. GALE. In favor of. Mr. WILLIAMS. In taking that position, Doctor, does the American Dental Association have anything in mind other than a sincere desire to promote dental health? Dr. GALE. No, sir; I firmly believe that the American Dental Association in recognition of its responsibility to the general public in the matter of health-they have always been as much interested in preventing dental diseases as they have been in curing dental diseases. Mr. WILLIAMS. Doctor, the effects of fluoridation are known, I presume? Dr. GALE. I can say from my own experience, and I may be encroaching perhaps on someone who can better express this later, but from my own experience in the new experiment in Newberg which has been referred to before, I know that if it is to be termed an experiment, has been conducted by the full health team, and it has not been conducted by the dental department, but by the full health team, where they were constantly X-raying, blood tests taken, and medical tests taken, as the work went on. So that we are quite sure of the safety of the application of the use of the fluorides in water. Mr. WILLIAMS. Has any tangible evidence ever been presented to you on which to base a finding to the effect that fluoridation is harmful? Dr. GALE. No. Harmful? No. Mr. WILLIAMS. On the other hand, I presume that affirmative evidence has been presented as to its benefits? Dr. GALE. I would say that when the State health department personally supervised-with a full medical team, because they are interested not in the matter of dental caries alone, but in the entire health picture of the State-that they would be the last people in the world to allow a thing of that kind to continue if there was even the smallest evidence there was any physical danger attached. Mr. WILLIAMS. Doctor, not being a scientist or a doctor, I am wondering why there are such diverse opinions among the men in the medical association concerning the effect of fluoridation. Dr. GALE. I might say, so are we, and I do not mean to be dodging the question, sir. Mr. WILLIAMS. I understand. That is a very good answer, I think. I asked you the question as to what motive the American Dental Association might have in supporting fluoridation, other than to promote the dental health of the people of America, and your answer was "None." On the other hand, do you know of any ulterior motive of any kind, which might be behind the opposition to the fluoridation of water, other than a sincere desire on their part to protect the dental and physical health of the people? Dr. GALE. I cannot say that I do know of any. Mr. WILLIAMS. Then it is your opinion, that it is just a simple, but open, difference of opinion among the men in medicine? Dr. GALE. And, let us hope, an honest difference of opinion. The CHAIRMAN. Any further questions? Mr. Hale? Mr. HALE. Doctor, there was some testimony here this morning, if I understood it correctly-and I am not sure that I did, but if I did understand it, it was that the fluoridation benefits to children's teeth is for a period up to 7, or say 8, years of age, and after that, that it does more harm than good. Would you comment on that? Dr. GALE. I think I would prefer, perhaps, to have one of the gentlemen who follow me make a comment on that. I might say, though, that if you will remember, that statement was made by a gentleman who admitted that he was not of the dental profession. And it is a well recognized fact in dentistry that the ages of perhaps 10 to 14 and 15 are the ages when there is the highest incidence of dental caries under any conditions, because that is the time the child is developing most rapidly, and the teeth are called upon to supply so many needs of the body, so it is not surprising to us that there might be an increase in the instance of dental caries in that age. The differentiation being whether or not, under the fluoride program, it was still, to some degree, a control, whereas, without control, it would have existed to a much greater extent. tell Mr. HALE. Just so that we may have it in the record, can you the committee without too much technical language, what dental caries is? What causes it, and what it does to our general health? Dr. GALE. Well, I could give you-I will attempt to give you in layman language, the most commonly accepted theory of dental decay, that being Mr. HALE. Caries means decay ? Dr. GALE. Dental caries is dental decay, yes; they are synonymous terms. The most accepted theory is, of course, that the enamel is broken down by the acids in the mouth, formed perhaps in the initial stages of digestion with sugars and carbohydrates and by the bacteria invasion of the dentine of the teeth; and in the days when I went to school, unless they have changed it, they used to say that bacteria thrives on the albuminous constituents of the dentine, and hence you have the breaking down of the teeth. Now, may I say this off the record, please ? (Discussion off the record.) Mr. HALE. Anyway, the tooth decay sets in, or may set in, at least almost as soon as the infant acquires teeth; is that correct? Dr. GALE. That is true. In fact, many children between two and two and a half have mild incidence of decay. Mr. HALE. And then when the permanent teeth come, they have to start all over again? Mr. GALE. Many times. Mr. HALE. I believe that is all, Mr. Chairman. Mr. WILLIAMS. Mr. Chairman. The CHAIRMAN. Mr. Williams. Mr. WILLIAMS. Doctor, you heard the testimony a few moments ago of Dr. Ginn. I believe you were in the room, were you not? Dr. GALE. Yes. Mr. WILLIAMS. Dr. Ginn, if I recall correctly, presented as an exhibit to his testimony, two sets of teeth: one set allegedly taken from a continuous user of fluorinated water, and the other set from a person who had not used drinking water with fluorine in it. I believe it was his intention in presenting the two sets of teeth to show that in one set of teeth, the teeth were in bad shape, and I believe that the other was in good shape. One set was sound and the other set was unsound, and he attributed the condition of the bad set of teeth to fluorination. I believe he challenged any member of the dental profession to contradict his statement to the effect, I believe, that the teeth which had been subjected to fluorination were solvent in some kind of acid and that the others were not. Would you care to comment on that? Dr. GALE. I would much prefer, if it meets with your permission, to defer that question to one of the members of the profession who will follow me, Dr. Doty, or Dr. Dean, either one of whom, I am sure, can answer the question to your satisfaction. Mr. WILLIAMS. I would like to hear some qualified witness elaborate on that subject. Dr. GALE. Yes. Mr. WILLIAMS. And to explain to the committee the significance of such testimony. Dr. GALE. I think it is insignificant, but I would prefer to have the gentlemen who follow me cover it. Mr. WILLIAMS. Unfortunately, we are not expert in this particular field, so we have to rely upon those whom we know to be expert. Dr. GALE. Yes. The CHAIRMAN. Any further questions? If not, we thank you. STATEMENT OF DR. H. TRENDLEY DEAN, SECRETARY, COUNCIL ON DENTAL RESEARCH OF THE AMERICAN DENTAL ASSOCIATION Mr. GARVEY. Mr. Chairman, the next witness will be Dr. Trendley Dean, secretary of the Council on Dental Research and Therapeutics of the American Dental Association. The CHAIRMAN. Dr. Dean, you may proceed. Dr. DEAN. Mr. Chairman and members of the committee, it is a pleasure, Mr. Chairman, to appear before this committee and discuss the relation of fluorine to dental health. I am H. Trendley_Dean, secretary of the Council on Dental Research of the American Dental Association, Chicago, Ill. I graduated in dentistry from the St. Louis University in 1916. For more than 20 years my efforts have been devoted to the study of fluorine and dental health. A list of 46 of my papers dealing with this subject as recorded in the periodical literature is attached to this statement. A listing of 8 chapters contributed to 6 different books is contained in my curriculum vitae which is likewise attached. The disclosure of the fluorine-dental caries relationship resulted from field epidemiological studies. For the benefit of the committee, may I very briefly define the modern concept of epidemiology. Through long common usage the term "epidemiology" came to mean the study of epidemics, or of diseases characterized by a sharply increased case incidence within a relatively short period of time. Today this concept no longer obtains. The past generation has been the horizon of epidemiology markedly expanded, particularly in the field of environmental factors affecting man. Epidemiology has, in fact, become medical ecology, and this method of study is being applied to the study of any mass disease or condition, the cause of which may be known, suspected, assumed or unknown.12 For those unfamiliar with epidemiological procedures, one point might well be stressed: A population of individuals constitutes the 1 Gordon, J. E. IV. The Twentieth Century-Yesterday, Today, and Tomorrow (1920-), in The History of American Epidemiology, Top, F. H., ed., C. V. Mosby Co., St. Louis, 1952. 2 Clark, E. G. An Epidemiologic Approach to Preventive Medicine, in, Textbood of Preventive Medicine, Leavell, H. R., and Clark, E. G., McGraw-Hill Book Co., Inc., New York, Toronto, London, 1953. unit of investigation. This is in distinct contrast to the clinical method in which the individual, rather than a population of individuals, is the basis of study. In an epidemiological inquiry, all observations are related to the group; in a clinical study, the observations remain related to the particular individuals under study. Epidemiological observations are particularly concerned with operations of nature and man's reactions to the nature around him. Naturally man's environment is an ensemble of extreme complexity; hence, it is essential that we utilize all the scientific disciplines pertinent to an explanation of the phenomenon under observation. When marked differences are observed in health and disease, one naturally asks what different factors, causal or otherwise, may be operating in these several populations. Thoroughgoing studies of certain of these phenomena in nature have provided some of the outstanding control measures in preventive medicine, that is, cowpox virus as a preventive for smallpox, citrus fruits for scurvy, iodine for endemic goiter, quinine for malaria, and fluorides for dental caries control. Mottled enamel, or the dental manifestation of an excessive intake of fluorides during the calcification period of the teeth, has been known for at least a half century. The first report in the United States literature was that of Eager in 1901, describing an endemic area in Italy. The classical studies of McKay and Black in this country appeared in 1916. Other studies on mottled enamel included the extensive work by Argentinian, North African, and Japanese workers in the 1920's, while in the early 1930's reports of studies in England, Italy, and China appeared. 4 In 1931, 3 independent investigators, 2 in the United States and 1 in north Africa, reported that excessive amounts of fluoride in the drinking water was the causative factor. Subsequent research demonstrated the quantitative relationship between the fluoride concentration of the drinking water, and the prevalence and severity of endemic dental fluorosis, as mottled enamel was subsequently termed. It was also demonstrated quantitatively that under average water consumption and climatological conditions in the United States a concentration of 1.0 part per million in the drinking water was not associated with the development of mottled enamel.5 6 The relation of fluorides to dental caries has been intensively studied for more than 20 years. The earlier mottled enamel studies were concerned with the dental effects resulting from the use of domestic waters containing too much fluorides. In these early studies one fact kept continuously recurring, the repeated observation that the amount of dental caries (decay) was lower in endemic mottled enamel areas than in areas not affected. The universality of this observation suggested that nature was showing the way to a new control measure. Not only was this phenomenon observed in the United States but in the Argentine, in England, and in Japan as well. Eager, J. M.: Denti di Chiaie (Chiaie Teeth). Public Health Report 16: 2576-2577, November 1, 1901. McKay, F. S. (in collaboration with Black, G. V.): An Investigation of Mottled Teeth: an endemic developmental imperfection of the enamel of the teeth, heretofore unknown in the literature of dentistry. Dental Cosmos, 58: 477-484 (a) May; 627-644 (b) June; 781-792 (c) July; 894-904 (d) August 1916. 5 Fluorine and Dental Health: F. R. Moulton, editor, publication No. 19, American Association for the Advancement of Science, Science Press, Lancaster, Pa., 1942. Dental Caries and Fluorine: F. R. Moulton, editor, American Association for the Advancement of Science, Science Press, Lancaster, Pa., 1946. |