waterBEST: the first study of its kind

We would like to let the families and community know that while this study is the first of its kind, this refers to how the study has been designed.  It is not an “experiment” with people or fluoride.  The benefits of fluoride in reducing cavities were first seen in 1901 in Colorado Springs, Colorado.  A dentist, Dr. Frederick McKay, set up his office in that city and noticed a brownish stain on children’s teeth that couldn’t be easily removed from the tooth, if at all. He was equally surprised to see far fewer cavities in the teeth of children from Colorado Springs compared to other mid-west towns. 

Dr. McKay contacted his dental school instructors to ask about this as they’d never learned about it in dental school.  They did not have any answers.  The U.S. Public Health Service was called in to help with this discovery.  Imagine not having almost any cavities in 1901!  That was big news.  The stain on the teeth was initially called Colorado brown stain.  That name later became changed to mottled enamel and ultimately dental fluorosis. 

Over a period of 30 years of study and careful research, the U.S. Public Health Service discovered that people in some other communities had this same stain and very few cavities, while in other communities’ people had very few cavities and nice looking teeth.  The thing that these families did in common was to drink from the same water sources in these communities.  In testing the water in Colorado Springs as well as these communities without brown stains on the teeth, it was found that fluoride in the water was high in Colorado Springs (2-12 milligrams of fluoride/liter of water) while in the other communities it was lower (1 milligram/liter).  Mother Nature had shown how low levels of fluoride would make the teeth harder and much more resistant to cavities without any visible stains.  The story about the timeline of this major discovery can be read here https://www.cdc.gov/fluoridation/basics/timeline.html.

The type of research that was done by the U.S. Public Health Service is called an Observational Study.  They were observing differences that occurred naturally, in the community – in this case, the underlying cause of the difference was the differing levels of fluoride created by Mother Nature. In later years, other observational studies discovered that lung cancer is caused by tobacco smoking, and that liver disease (cirrhosis) is caused by excessive alcohol consumption. 

The waterBEST study design is using a different type of study called a Randomized Controlled Clinical Trial.  This study differs from Observational Studies in that the study is determining who drinks fluoridated water and who does not, rather than relying on the level of fluoride that happens to be in the tap water that children drink.  Using a process of random allocation (like tossing a coin), children in the study are given either water from New Bern that naturally contains fluoride at the levels that prevents decay without causing dental fluorosis, versus water from North Lenoir County, that has a much lower level of fluoride. As an extra step of scientific rigor, nobody in the study team at Kinston knows what type of water is given to any particular house, and nor does Dr. Slade, the study’s lead investigator. Instead, a computer keeps record of the type of water to be delivered to each household.  This is called “blinding” or “masking” of the study team and study participants. This kind of blinded, randomized controlled clinical trial provides the strongest evidence about the effects of fluoride on health, just as randomized controlled clinical trials provide the necessary proof that vaccines and medicines are safe and beneficial.

Because a randomized controlled clinical trial of fluoride in drinking water has never been done, the results of the waterBESTstudy in Kinston/Lenoir County are being watched closely by people around the world.  If this study proves that cavities can be reduced by providing fluoridated water to communities without is by providing 5 gallon bottles of water, think of the remote areas of the world where this could be applied to reduce this most common long-term disease of children and adults around the world.  For instance, in remote areas of Alaska where Native Americans and Alaska Natives do not have access to running water and many have to melt ice for drinking water, they are not able to have access to fluoridated water. The Lenoir County community is on the cutting edge of revealing a very likely answer to what researchers said could never be done.  And this research will potentially become a major scientific breakthrough on how to benefit adults and children who aren’t getting enough fluoride in their drinking water to receive the benefits of this naturally occurring mineral, fluoride.