The mystery in Colorado Springs that led to fluoridation | Health

Soon after the turn of the 20th century, a dapper young dentist from the Boston area collected his degree from the University of Pennsylvania and turned his sights west.

Dr. Frederick McKay opened a practice in Colorado Springs and began treating patients in 1901. The following spring, he addressed the 18 members of the newly formed El Paso County Odontological Society at their first meeting, presenting “A Plea for the Less Frequent Use of Arsenic for Devitalization of the Dental Pulp,” according to the Colorado Springs Dental Society’s “History of Dentistry in the Pikes Peak Region.”

McKay’s name, and the city that inspired and launched his pioneering work, would later enter history for research into a different mineral’s role in dental health.

The doctor’s evolution into fluoride firebrand began locally with observations of young teeth that appeared visibly compromised — mottled and pitted — but that nonetheless, remarkably, were cavity-resistant.

“He was doing primary research, sampling water, trying to figure out what was in it, trying to figure out if there were other causes,” said Matt Mayberry, director of the Colorado Springs Pioneers Museum. “He ultimately traced it back to the levels of fluoride in the water.

“That research began here, but it’s a story that spreads far beyond Colorado Springs,” Mayberry said.

McKay’s work helped fuel an eventual sea change in how America addresses dental health on a personal and societal level, as well as a generations-long debate that has simmered, stilled, and now been dialed up to a boil, with President-elect Donald Trump’s appointment of anti-fluoride activist Robert F. Kennedy Jr. to lead the Department of Health and Human Services.

To be fair, too much fluoride can definitely leave a mark.

Such evidence was what led early researchers down the path of eventual discovery more than a century ago.

McKay was not the first doctor to notice the tell-tale dark stains and marble-like ridges on the teeth of young patients whose permanent teeth had yet to erupt.

In fact, the condition was so prevalent it had a name: “Colorado brown stain.”

Speculations about the cause ranged from poor nutrition and too much pork in the diet, to radium exposure and tainted cow’s milk, according to the dental society’s historical timeline.

McKay at first thought he was on the verge of identifying a “new type of dental disease or anomaly,” said Dr. Bruce Dye, a professor and chair of the Department of Community Dentistry and Population Health at the University of Colorado School of Dental Medicine on the Anschutz Medical Campus.

“It was not what he had seen in his training out on the East Coast, so he was very interested in what was causing these brown colorations,” said Dye, co-author of the seminal U.S. study, “Oral Health in America.”

Despite the look of patients’ teeth, McKay also noted the enamel appeared to be remarkably resistant to cavities, and theorized that whatever was staining patients’ teeth was also making those teeth stronger.

But what, exactly, was that thing?

Bad teeth? No military service

McKay joined fellow Odontological Society members, and researchers around the country, on a decades-long quest to track down, isolate and understand a source that hinted at a natural defense against the growing epidemic of dental decay.

Increasingly sugar-filled diets in the 20th century meant that, before the advent of modern dentistry and the wide use of preventatives such as fluoride (and flossing!), Americans had pretty gnarly chompers, if they had God-given teeth at all.

The first National Health Survey in the early 1960s found that more than 50% of American adults 65 and older were toothless, said Dye, adding that roughly 20% of men were rejected for service in World War II because of the condition of their teeth.

“This was a problem going into the late 1940s and early 1950s, because we were getting ready to fight the Soviet Union” and enter the Cold War era, he said. “The United States was looking at why so many young men were not eligible for service in the military.”

The roots of the problem could be traced back to a national devolution in eating habits and general health around the turn of the century, through World War I and the Great Depression, as well as nascent science that was struggling to gain converts even within its own ranks. For generations, extraction was the go-to treatment for cavities, and the denture industry was booming. 

Slowly, as the century matured, so did the thinking.

“Tooth decay was really bad in the 1920s in a number of the population, and there was a lot of interest in what we can do in order to help people reduce tooth decay and help them keep their teeth,” said Dye.

An understanding of the effects of poor nutrition on bodies, and teeth, began to take hold. Public health efforts seeking ways to improve outcomes, on a grand scale, were gaining attention and steam.

But for those whose scientific processes were feeding the change, sharing of research was “nothing like it is today,” Dye said. The learning curve required patience, and a willingness to travel long distances to personally source information.

As McKay pursued his own exhaustive project, which would grow to include countless samples of groundwater — creek, stream, river, pond and well — at dozens of locations throughout the Pikes Peak area, he was “quickly learning that the mottling was present on teeth in other parts of the country,” said Dye.

And, it was “becoming clear that this mottling most likely was associated with fluoride.”

Fluoride the elusive key

Fluoride is a mineral naturally found in rocks and soil. While more prevalent in certain parts of the country, including in Colorado, and therefore more prevalent in the groundwater that filters through the earth in such areas, in other places in the mid-20th century, the works of man were working to skew nature’s bounty — and pave the way for an epiphany.

As the Great Depression raged, McKay and Dr. Grover Kempf, of the U.S. Public Health Service, converged in Bauxite, Ark., an Aluminum Company of America (Alcoa) town where there had been reports of children with the brown-stained teeth, according to “The Story of Fluoridation” by the National Institute of Dental and Craniofacial Research.

Expanding their research beyond Bauxite, McKay and Kempf discovered the stains weren’t present among children in a nearby community. Those findings eventually led to further analysis of the Bauxite water and the discovery that — due to runoff from the chemical plant — it contained much higher levels of fluoride than surrounding water sources.

Fluoride was the elusive key for which researchers had long quested.

McKay’s notebook from 1931, among an archive collection at the Pioneers Museum, contains detailed research into the mineral content of a vast number of springs, creeks, rivers and basins throughout the Front Range, all written in tidy, looping script.

At first, “Nobody knew how they were being exposed to fluoride,” Dye said.

Finding a common denominator locally was elusive, but once the investigation was expanded the answer quickly rose to the surface.

It was the water.

“In the late 1800s and early 1900s in Colorado, residents got their water from a limited number of places, most of them naturally occurring,” Dye said.

Turns out, most of those sources in the Colorado Springs area — Fountain Creek, wellsprings in Manitou Springs, runoff from mountain snowpack — was, just like the rocks and soil, rich in the mineral deposits.

Later studies confirmed that trace amounts of fluoride in drinking water boosted cavity protection, and did not lead to stains or pitting of teeth.

With that knowledge in hand, Grand Rapids, Mich., was the first city to add fluoride to its municipal drinking water, in 1945.

Subsequent cities followed suit, with fluoridation becoming something of an institution, being delivered via not only water but an array of dental products (and even milk, in some European countries) as well as in community projects promoting fluoridation en masse among school children in places where drinking water was without.

Springs in the Goldilocks range

In recent years, a growing number of communities have begun fighting for the right to opt out.

A federal ruling in September, the outcome of a seven-year legal battle brought by grassroots health organizations in California, determined that fluoride could pose risks to developing brains, and lawmakers ordered the Environmental Protection Agency to better regulate, and mitigate, its addition to drinking water. The lawsuit has the potential to drastically change the flow of America’s fluoride program.

According to the Fluoride Action Network, an anti-fluoride nonprofit that advocates for policy change and awareness about the potential toxic effects of fluoride, more than 170 U.S. communities have rejected the addition of fluoride in their water since 2010.

Where nature doesn’t do the job itself, the decision to infuse public drinking water with trace amounts of fluoride is by and large made at the local level, by a vote of the people.

Fluoride is naturally occurring in most of Colorado’s drinking water sources, including in Colorado Springs and Denver, at rates which “generally” fall within the current Goldilocks range — below 0.7 milligrams per liter, an optimum level for preventing tooth decay while avoiding potential any downsides of exposure, said Vanessa Bernal with the Colorado Department of Public Health and Environment.

Because of the natural abundance of fluoride in the Pikes Peak watershed, the mineral content is managed by dilution, blending local water with “transmountain” supplies imported from other watersheds, said Jennifer Jordan, with Colorado Springs Utilities. 

According to the Centers for Disease Control and Prevention, fewer than 1% of the U.S. population currently consumes water from private wells or drinking systems with fluoride higher than 2 milligrams per liter, an amount which could lead to the brown stains and mottling observed by Frederick McKay.

The amount of fluoride in Colorado drinking water varies, depending on residents’ location. Colorado Springs Utilities offers an “interactive fluoride map” at csu.org/water-service/fluoride, showing water fluoride content by address. 

While it is possible to remove naturally occurring fluoride from water on a municipal scale, it “is not a simple or inexpensive endeavor,” said Jordan.

If successful, it also comes at a cost.

“Almost all scalable treatment methods that remove fluoride also remove minerals like calcium, magnesium and potassium,” Jordan said. “These minerals not only improve the health benefits and taste of water, they are also critical for corrosion control, and helping prevent the breakdown of lead pipes or solder in older homes.”

Few home filtration systems or devices are capable of removing fluoride from water, she said.

Dye said he hopes health-conscious residents keep in mind that the CDC remains unwavering in its support of water fluoridation programs, which repeated studies have shown are safe and highly effective.

Benefits, say dentists and health leaders, far outweigh any potential negatives.

For Dye and other doctors, researchers and historians who credit fluoride for changing the trajectory of the nation’s prognosis — especially given an increasing understanding of how dental health factors into overall resiliency — a resurgence of doubt is a source of existential concern.

“The thing that worries me is we use chemicals for a lot of things in order to make our lives better,” Dye said. Vitamins are added to milk and juice, and iodine to salt. “We use chlorine to help purify the water that we drink, and too much chlorine can certainly be bad for you.”

Too much of any “good” can be bad.

Except teeth.

You can never have too many good teeth.