Dr. KNUTSON. No significant differences can be seen in deaths from these causes either before or after 1945, when fluoridation was started in Grand Rapids. As you know, many American communities have already instituted controlled fluoridation. Chart 11 shows the number of communities which have decided to supplement their water supply, and the populations residing in these communities. The numbers in the red circles are the number of communities. You will note that in 1950 there were 850 communities. The scale on the right is the population in millions. In other words, at the end of 1953, 850 communities were fluoridating their water supplies, serving approximately 16 million people. There has been a slow but consistent increase in the use of this procedure since 1945. In the United States today there are about 17 million people in over 900 communities consuming water which has been supplemented with fluoride. These communities are using in a precise manner something which nature has distributed irregularly. Now, I would like to discuss briefly the role of the Public Health Service with respect to the Nation's dental health problems in general, and to fluoridation in particular. Dental disease is of considerable public health significance. Probably no other disease category affects so large a proportion of the population. Dental defects accounted, for example, for 21 percent of the rejections among the first 2 million men called for service in World War II. The most important single type of dental disorder is dental caries, or tooth decay. Neglect and the vast backlog of accumulated needs have led to loss of teeth, to impaired dental function, and to general ill health. Although less than one-third of the American people receive adequate dental care, the economic burden of dental disease is a sizable one. In 1953, the American people spent about $1.6 billion for dental care, about one-sixth of the total expenditure for personal health services in the Nation. This sum, an all-time high in dental expenditures, is but a fraction of the estimated amount needed to provide adequate care for the American people. Even if there were an unlimited amount of money available for dental care, there are simply not enough dentists to furnish the required volume of services. Thus, there is little possibility that the Nation's dental health problem can be solved in the near future solely by increasing the correction of existing defects. This points up the needs very sharply. There are several, including the need to conduct research into the basic problems of dental diseases and disorders, to stretch the limited supply of dental manpower, and to use all available resources for a maximum contribution to dental health. Most prominent, however, is the need to develop, perfect, and apply more effective methods of preventing dental disease. As you know, the Public Health Service is charged by law to conduct health research, to develop and test measures for the preven tion and control of disease, to help States and communities apply those measures, and to disseminate public health information. In accordance with this mission, we have been active in each of the areas of need I have just mentioned. We have conducted studies, for ex ample, on the use of dental assistants and multiple chairs in the dentist's office. This has enabled dentists to increase their productivity and to treat more people. We are doing research on diseases of the gums and the bony supporting structures. Through State and local health agencies, we work with schools and clinics to encourage periodic dental examinations, to apply proper methods of mouth hygiene, and to promote desirable dietary habits. In addition, as in all public health programs, we provide technical and advisory services for official health agencies. In all of this work, we attempt to translate new knowledge into practical public health procedures. Our job, in other words, is to help apply research and laboratory findings for the benefit of all the people. One such finding, as I have pointed out, is fluoridation. This measure has a great potential for improving health, lowering dental bills, and for reducing the Nation's dental needs to manageable proportions. Consequently, public health workers have given their wholehearted endorsement to this procedure. In the Public Health Service, as in health agencies throughout the Nation, fluoridation is one part of a diversified and balanced approach to meeting our total dental health needs. Fluoridation followed the typical pattern in the development of a public health technique. It met all the tests. It was studied over a long period of time, both by research workers in the Public Health Service and by other investigators. It was subjected to intensive field testing for safety and practicability. Its effects were demonstrated, checked, and rechecked. Practical methods for its application were worked out and perfected in considerable detail. And it finally became part of the public health armamentarium, along with other preventive techniques. The responsibilities of the Public Health Service were clear: to make the facts about fluoridation known to State and local health agencies, and to provide them with technical assistance in the application of this important public health advance. In view of the convincing amount of scientific evidence, we could do no less and still meet our obligations as a national health agency. As with all public-health procedures, the decision on fluoridation rests and, in our opinion, should continue to rest, with the local community. In public-health works, it could not be otherwise, nor would we wish it to be otherwise. All local health activities, from the operation of clinics to the enforcement of sanitary regulations, are the responsibilities of the community. We believe that there is no justification for any Federal intervention into local health matters. We feel certain that in fluoridation, as in other health matters, the combination of professional public health leadership and enlightened citizen interest will insure the decision that will enable communities to go forward in health. To summarize, Mr. Chairman, we cannot accept the premise that fluoridation of public water supplies constitutes a hazard to public health. On the contrary, we believe that its safety has been clearly established and that its potential for improving dental health warrants the serious consideration of all communities concerned with progressive health measures. We believe, however, that the determi 48391-54-25 nation of proper action in this matter can and should be left for each community to decide for itself, and that no Federal controls are necessary or desirable. We therefore recommend against enactment of H. R. 2341. (Charts and tables referred to are as follows:) FIGURE 1.-Fluorine reported in dry substance of food Honey Milk chocolate_. Chocolate (plain). Tea (various brands). Cabbage Lettuce Spinach Tomatoes Turnips Carrots Potato (white). Potato (sweet_. Apples Pineapple (canned). Orange Fluorine parts per million Pork chop-- Frankfurters FIGURE 2.-Fluorine reported in food as consumed Round steak___. Herring (smoked) Canned sardines_. Canned salmon__. Fresh fish_____ Canned mackerel.. Fluorine parts per million 1.00 1.70 1.30 1.50 3.50 4.50 7.30-12.50 8.50-9.00 1.60-7.00 26.89 FIGURE 3.-Estimated fluorine ingested in food and in drinking water containing 1 part per million fluorine |