(62) Faulstich, C. B.: Am. Institute Baking Bull. No. 66 (July 6) 1950. (63) Greenleaf, C. A.: National Canners A. Res. Rep. No. 6-51 (June) 1951. (64) Slater, R. R.: Proc. Am. Soc. Brewing Chemists, p. 60, 1951. (65) Bratton, G. S.: J. Am. Water Works A. 45: 364–368 (April) 1953. (66) Weir, W. V.: J. Am. Water Works A. 45: 369-375 (April) 1953. (67) Maier, F. J.: J. Am. Water Works A. 42: 1120-1132 (December) 1950. Mr. HALE. The committee will now stand in recess until 2 p. m. (Thereupon, at 12:28 p. m., the committee took a recess until 2 p. m., of the same day.) AFTERNOON SESSION The hearing was resumed at 2 p. m. Mr. HALE. The committee will come to order. Congressman Derounian has asked leave to submit the following telegram from Dr. Joseph G. Zimring, chairman of the legislation committee of the Nassau County Medical Society, and letters from Dr. S. S. Medvin, secretary of the Suffolk County Dental Society, Dr. Charles A. Wilkie, secretary of the Dental Society of the State of New York, and Dr. Solomon N. Rosenstein, president, the New York State Society of Dentistry for Children, for the record. If there is no objection, it is so ordered. (The documents referred to are as follows :) Hon. STEVEN B. DEROUNIAN, MINEOLA, N. Y., May 20, 1954. House Office Building, Washington, D. C.: The Nassau County Medical Society wishes to go on record as supporting the dental profession's opposition to the proposed antifluoridation bill H. R. 2341 which seeks to prohibit fluoridation of certain water supplies. Representative STEVEN B. DEROUNIAN, JOSEPH G. ZIMRING, M. D., Chairman, Legislation Committee. SUFFOLK COUNTY DENTAL SOCIETY, House of Representatives, Washington, D. C. DEAR SIR: On May 19, 1954, our society in a general meeting unanimously voted to request your cooperation as a representative of the State of New York in preventing the enactment of the Wier bill, H. R. 2341; a bill to protect the public health from the dangers of fluoridation of water. Fluoridation of community-water supplies, is an established fact for over 20 million people. Its success as a retardant of dental caries (cavities) has been proven in many studies. In our own State of New York, the NewburghKingston experiment conducted by the State health department has conclusively proved the benefits of water fluoridation. There has been no evidence of any harmful effects from proper fluoridation from this and other scientifically controlled investigations. Unfortunately opposition to fluoridation seems to be an emotional or prejudicial factor and is not based on any scientifically proven theory. Even the Christian Science organizations no longer oppose fluoridation. Please prevent the passage of H. R. 2341 and thus enable our future population to be one of greater dental health. Sincerely yours, S. A. MEDVIN, D. D. S., Secretary, Suffolk County Dental Society. Hon. S. DEROUNIAN, May 18, 1954. THE DENTAL SOCIETY OF THE STATE OF NEW YORK, The House of Representatives, Washington, D. C. DEAR SIR: At the annual meeting of the Dental Society of the State of New York, the following action was taken by the governing body: "The Dental Society of the State of New York on many occasions has stated its approval of the fluoridation of community water supplies. "Epidemiological studies have demonstrated that no harmful effects have resulted from this procedure when it is applied under properly controlled conditions. Further controlled studies have indicated beyond doubt that the procedure does in fact materially reduce dental decay in the teeth of children. "Fluoridation of community-water supplies is enthusiastically endorsed as a public-health measure by such organizations as the American Dental Association, the American Medical Association, the American Public Health Association, the United States Public Health Service, the National Research Council and other national and local organizations of scientific repute. "Therefore, the Dental Society of the State of New York takes this opportunity to reiterate its approval of the fluoridation of community water supplies where practicable as a means of reducing the incidence of dental disease." For the above-mentioned reason, may I earnestly request that you support the action of the dental profession in opposing the Wier (antifluoridation) bill, H. R. 2341. Very truly yours, CHARLES A. WILKIE, D. D. S., Secretary. May 18, 1954. THE NEW YORK STATE SOCIETY OF DENTISTRY FOR CHILDREN, Congressman STEVEN B. DEROUNIAN, Member, Interstate and Foreign Commerce Committee, DEAR MR. DEROUNIAN: During the annual meeting of our New York State Society of Dentistry for Children, we were informed of the Weir bill, the enactment of which prohibits fluoridation of public water supply by communities. In the light of scientific findings published to date, I feel that enactment of such legislation would be unwise and not in the interest of maintaining good dental health for the children in all communities. The scientific evidence so far presented indicates that an appreciable degree of reduction of new dental caries results from the addition of 1 to 2 parts fluoride per million parts of water. Also at such dilution, findings indicate that there is absence of unfavorable accompanying signs or conditions. It would be in the best interests of good dental health for children, and thereby contribute to their general good health to prevent passage of such prohibiting legislation. Sincerely yours, SOLOMON N. ROSENSTEIN, DDS, President. Mr. HALE. We will resume the hearing on H. R. 2341, and the witnesses who will testify will be Dr. John Knutson, chief dental officer, Public Health Service, Dr. N. C. Leone, chief, medical investigations, National Institute of Dental Research, and Dr. Isadore Zipkin of the National Institute of Dental Research. The committee is pleased to have you gentlemen with us. STATEMENTS OF DR. JOHN W. KNUTSON, CHIEF DENTAL OFFICER, PUBLIC HEALTH SERVICE; DR. NICHOLAS C. LEONE, CHIEF, MEDICAL INVESTIGATIONS, NATIONAL INSTITUTE OF DENTAL RESEARCH; AND DR. ISADORE ZIPKIN, SENIOR SCIENTIST, NATIONAL INSTITUTE OF DENTAL RESEARCH Dr. KNUTSON. Mr. Chairman and members of the committee, I am glad to meet with the members of this committee to present the view of the Department of Health, Education, and Welfare on H. R. 2341, a bill to prohibit fluoridation of public water supplies. Our position on this bill has been presented in Secretary Hobby's letter of January 20, 1954, to the chairman of this committee. In her letter the Secretary noted that the bill would categorically prohibit Federal, State, or local governmental agencies from treating public water supplies with any fluoride compound and from making water so treated available for use by or on behalf of any such agency. She stated that it is the view of the Department of Health, Education, and Welfare that the decision on whether to fluoridate public water supplies should continue to rest with the local communities. We believe that they are entirely competent to make such decisions and that Federal intervention, either to require or to prohibit fluoridation, would not be justifiable. The Secretary also referred, in her report on the bill, to the extensive research which has been done by the Public Health Service and many other investigators on fluoridation. I would like to review the highlights of this research with particular emphasis on the effectiveness and safety of this procedure. Later, I should like to discuss the relationship of water fluoridation to the total dental problem in the United States, as well as the role of the Public Health Service with respect to this preventive measure. Our position favoring the adoption of fluoridation is based on several decades of study of the uses, action, and effects of fluoride compounds on both animals and humans. Because of the widespread distribution of fluorides in nature, especially in water, scientists had a natural laboratory of unprecedented scope in which to study this element. The opportunity for detailed study of the biological effects of fluoride consumption has led to the development of an unusually large body of knowledge on this subject. Today the list of scientific writings on fluoridation, including books, papers, and reports, runs to more than 7,000 publications. Substantial evidence that dental caries is influenced by small amounts of fluoride was accumulated during the 30-year period 1908-38. The research efforts of this era led to the hypothesis that the use of drinking water with one part of fluoride per million parts of water will reduce the amount of tooth decay in humans by twothirds. From 1938 through 1945, intensive studies were conducted to follow up this promising lead. These investigations, in the field and in the laboratory, on animals and on man, further demonstrated the dental benefits that had been reported, and at the same time gave no indication_that_the_consumption of small amounts of fluoride produced any harmful physical effects. Controlled water fluoridation study projects were then begun in 1945 in Grand Rapids, Mich.; Newburgh, N. Y.; Brantford, Ontario, and later in several other cities. These projects were designed to determine whether a purposefully fluoridated drinking water would produce the same beneficial effect as a naturally fluoridated one. A corollary purpose was to gather experience on the mechanical problems of adding and controlling the fluoride concentration in a water system. The results from these fluoridation study projects have amply demonstrated that the supplementation of a fluoride-deficient water supply is a practical, safe, effective, and an economical procedure. In view of these facts, in April 1951, the Surgeon General indicated that the Public Health Service endorsed the fluoridation of public water supplies. Let me consider now the specific dental benefits associated with the ingestion of a proper concentration of fluoride. From chart 1, shown to my right, here, you can see the actual change effected by fluoridation. CHART 1 Decayed, Missing & Filled Teeth Per Child (FLUORIDE & NON-FLUORIDE COMMUNITIES) The top line represents the amount of tooth decay experienced by children living in Grand Rapids, Mich., before that city added fluoride to its water supply, that is, before 1945. It shows a progressive increase in dental caries at the rate of about a tooth each year. This rate of increase continues incidentally, until adulthood is reached. The bottom line indicates the level of tooth decay in children from Aurora, Ill., whose drinking water contained 1.2 parts per million of naturally occurring fluoride. As you can see, decay occurs in these children at a considerably lower level. The contrast shown in this 48391-54-24 chart has been confirmed by observations on thousands of children in communities throughout the United States. The impact of fluoridation on Grand Rapids children is shown in chart 2. 16 CHART 2 Decayed, Missing & Filled Teeth* Per Child NINE YEARS AFTER FLUORIDATION (GRAND RAPIDS, MICHIGAN) 12 8 5 6 7 AGE *PERMANENT TEETH The center line represents the amount of tooth decay observed in Grand Rapids children in 1953, 9 years after fluoridation started. It has been superimposed upon the first chart. You can see how very closely the level of tooth decay in Grand Rapids now approximates that in Aurora, especially in the younger age groups. Children 11 years of age or younger showed the greatest benefit. However, it is interesting to note that children who were 3 to 7 years of age at the start of fluoridation and who are now 12 to 16, also acquired a considerable amount of protection. Another of our studies produced evidence that the dental protection of fluoridation continues throughout life. In chart 3 you can see the difference in the level of tooth decay in adults residing in Colorado Springs, Colo., who were served by a water supply containing 2.5 parts per million of fluoride, compared with the tooth decay observed in adult residents of Boulder, Colo., which has a fluoride-free water supply. It is apparent that those persons living in Colorado Springs continue to have about one-third the tooth decay found in adult residents of Boulder. |