It sounds like another can’t-win situation for the health-conscious consumer.
Bottled water, missing bad stuff, is also missing something most scientists say is good. Millions who have turned away from the tap are giving up a primary source of fluoride, the public health system’s main weapon against tooth decay.
Americans drink almost 3 billion gallons of bottled water a year, a gush from a trickle a dozen years ago. Some home filters also remove fluoride.
Is that bad for dental health? Scientists are not sure. People get fluoride in other ways.
But they do say people relying on bottled water should look at their other defenses against cavities and consider fluoride supplements or perhaps a return to the faucet if safeguards are lacking.
Fluoridated community water, now available to a majority of Americans, has been achieved over fierce objections that it intrudes on individual choice if not liberty itself.
“The great communist plot thing is over with, I think,” said Al Warburton of the American Water Works Association, recalling debates that lasted decades after pioneering Grand Rapids, Mich., fluoridated in 1945.
When it’s good, tap water is a bargain - a penny for 5 gallons, on average.
Still, Americans flock to the bottle. Among other things, they like the absence of chlorine that can give tap water a temporary aftertaste or odor.
Their verdict: Tastes great.
“I’m concerned about people who are relying on bottled water,” says Dr. Michael Easley, speaking for the American Dental Association. “They’re not getting enough fluoride and may not realize they’re depriving their children, who will pay the price their entire lives.”
That link has not been thoroughly studied, some dispute it, and the government has not taken a position on it.
“I can’t help but think that unless an individual uses enough of other (sources) of fluoride, it’s going to be a problem,” says Dr. Alice Horowitz of the government’s National Institute of Dental Research. “But nobody knows that.”
At issue is whether people who drink bottled water get enough of the enamel-toughening element from toothpaste, rinses, sodas, canned goods and other products where fluoride is present naturally or as a water additive.
The dental association says relying solely on those sources “is not an effective or prudent public health practice.” At the federal Centers for Disease Control and Prevention, Dr. William Kohn isn’t sure.
Fluoride is especially important for children and its use benefits teeth throughout life, he said.
“Still the most cost-effective way to get fluoride is through community fluoridation, but there are other ways of getting it,” Kohn said. “We don’t know about the bottled water connection.”
The International Bottled Water Association recommends customers talk to their dentist or doctor about supplements if they are concerned about fluoride deficiency.
The dental association says tablets - or, for babies, drops - are the best alternative to fluoridated water, but pricey.
Only about 20 of the more than 500 brands of bottled water sold in the United States have added fluoride.
Dr. Steve Levy at the University of Iowa, who has tested bottled water for fluoride, says most brands are way under the optimal level of 1 part per million. Most are under 0.3 ppm, the level at which supplements have been recommended.
Levy says parents who use only bottled water and have children at risk of tooth decay should consider supplements or tap water. Others may be getting enough fluoride already, he said, and adults who eat and brush properly might get by with flouridated mouth washes.
Risk can be hard to assess, but factors include improper brushing or diet and a history of cavities in the child or siblings.
A minority scientific view persists that even the recommended concentrations are bad for health. The U.S. surgeon general says proper levels are safe.
With the science on bottled water uncertain, dentists reach their own conclusions.
At his Chantilly, Va., practice, Dr. Mark Grimes tells patients bottled water is probably OK for grown-ups. “But if they’re into giving their kids bottled water, I’d discourage them.”
MEMO: This sidebar appeared with the story: DRINKING IT UP Annual consumption of bottled water per person: 11 gallons, more than double the rate 10 years ago. Highest: 21.8 gallons in Pacific states, five times rate in central states. National consumption of bottled water: 2.9 billion gallons, up from 1.2 million gallons 10 years ago. Daily home use of public water per person, for all purposes: 86.5 gallons. Average cost of 5-gallon bottle of water, delivered: $5.29 (1993) Average cost of 5 gallons of public water: 1 cent.