Update on Resources to Sustain Fluoridation May 23, 2012 Marcy Frosh

1. Update on Resources to Sustain Fluoridation May 23, 2012 Marcy Frosh Children’s Dental Health Project mfrosh@cdhp.org

2. Disclaimer The information in this presentation does not represent official positions of the U.S. Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention/HHS, or state and local governments.

3. Question: How hard is it to find reliable information about community water fluoridation on the Internet?

4. It was always there, but harder to find … For years, information has been available on the CDC website as well as websites of AAFP, AAP, AAPD, AAPHD, ADA, ASTDD, APHA, State and Local health departments, and more. The problem has been that many other sites might look highly technical, but contain information on science that is unconfirmed or not widely accepted in the scientific community. Information may also be blended with commercial interests.

5. Visibility on the Internet is still an issue, but added new resources ARE now available! Information / Messaging: ADA Fluoridation Resources: www.ada.org and Campaign for Dental Health: www.Ilikemyteeth.org Legal background: www.fluidlaw.org (see also ADA for “Suggested Provisions” – www.ada.org) (Very soon) Science: www.flouridescience.org (Soon) Technical training: CDC Water Fluoridation Principles & Practice

6. ADA Fluoridation Resourceswww.ada.org/fluoride Available now: • View Fluoridation Facts • View Statements from Ten Leading Health Authorities Regarding Community Water Fluoridation (PDF) • View Fluoridation Ordinance—Suggested Provisions (PDF) • Media Press Kit Coming soon: • ADA Fluoridation Toolkit (July 2012) • Videos, photos, posters, editorials, case studies, and more

7. www.Ilikemyteeth.org “The Campaign for Dental Health,” originating with Pew Center for the States, is a network of groups providing information such as: • How Fluoride Works • What Do the Leading Health and Medical Authorities Say About Community Water Fluoridation? • MYTHS & FACTS: Responses to Common Anti-Fluoride Claims • Savings from Water Fluoridation: What the Evidence Shows

8. www.fluidlaw.org New Online Legal Resource on Community Water Fluoridation. The Fluoride Legislative User Information Database or "FLUID" is a comprehensive database containing historical information on legal cases decided by U.S. courts and current information on federal and state policies regarding community water fluoridation.

9. What’s New in FLUID? Recent State Statutes: • ARKANSAS. 2011 law established a statewide fluoridation program for water systems that supply water to 5,000 persons or more. (http://fluidlaw.org/policy/arkansas-statute-0). The statute requires the State Board of Health rulemaking on permissible concentrations of fluoride. Water systems are not required to comply with the requirements of the system until there are funds available to pay capital start-up costs for fluoridation equipment from a source other than tax revenue. • ILLINOIS. 2011 law requires fluoride concentration levels that adhere to “current federal recommendations.” Previously, a fluoride concentration level (0.9-1.2 ng/L) was codified in statute. See FLUID State and Local Action tab and search for Statutes in Illinois (http://fluidlaw.org/policy/illinois-statute-2).

10. What’s New in FLUID (cont’d)? Federal Action: Update on HHS Proposed Recommendation for Community Water Fluoridation. On January 7, 2011, DHHS announced that it was proposing a change in the recommended level for community water fluoridation in the United States to prevent dental caries. The new recommendation-- available in the FLUID database under the topic “Federal Action” (http://oehha.ca.gov/prop65/public_meetings/CIC101211/comments/FDACDER_fl.pdf) was published as a Federal Register Notice on January 13, proposing a single level for the nation of 0.7 milligrams of fluoride per liter of water. Public comment was sought through April 15, 2011. HHS is currently reviewing and addressing comments received from the public and stakeholders. Final guidanceis expected in Summer 2012 and will immediately be posted on FLUID.

11. What’s New on FLUID (cont’d)? Activity in CALIFORNIA: • On April 10, 2012 U.S. District Court in San Diego granted public utility’s motion to dismiss in the case of Foli v. Metropolitan Water District (United States District Court, Southern District of California, Case No. 11CV1765 JLS). Plaintiffs alleged claims of unlawful business practice, unfair business competition, and fraudulent business practice under the California Business & Professions Code. See FLUID at: http://fluidlaw.org/caselaw/foli-v-metropolitan-water-district-southern-california • New policy (November 2011) for Santa Clara Valley (CA) Water District to support fluoridation at each of the district’s three water treatment plants and three water supply wells available on FLUID at: http://fluidlaw.org/policy/california-local-authority-san-jose • FDA Comments at October 2011 California fluoridation hearing (stating that FDA-regulated food and drug products containing fluoride that have cancer warnings are misbranded and are in violation of federal law) are available on FLUID at: http://fluidlaw.org/federal-action

12. What’s New in FLUID (cont’d)? New Feature added to FLUID: Sample case pleadings for selected casesto familiarize users with the type of pleadings filed by parties both challenging and defending fluoridation requirements. The first case to be included is Coshow v. City of Escondido (California) (2004) at: http://fluidlaw.org/caselaw/coshow-v-city-escondido

13. Are people using FLUID?

14. . . . and coming soon! FLUORIDE science • Review of frequently cited fluoride studies • Information on the science of Fluoride

15. . . . and another development!

16. User friendly on-line technical training

17. State-of-the-Art Approach

18. High Potential for Increased Participation

19. Big Challenges Require New Ideas/Strategies Where: Localities in states as different as Florida and Alaska ended fluoridation in 2011 Who, what, and why it happens: Example: Medical society (student group) raised questions in Michigan recently .

20. Example: Resource that can “fuel” an Idea • New York and Maryland have found that water operators can be strong fluoridation advocates (labeled “Circuit Riders”) • Sending Water Operators to the CDC on-site training is expensive • Forthcoming CDC on-line course can help get more Water Operators to join on the “circuit”

21. Thank you! Children’s Dental Health Project Marcy Frosh mfrosh@cdhp.org