June 11 ,2002

Nobuhiro Hanada, D.D.S.,Ph.D.
Director and Professor
Department of Oral Health
National Institute of Public Health 1-23-1
Toyama,Shinjuku-ku, Tokyo 162-8640, Japan

Dear Dr. Hanada:

This letter is written in regards to your recent inquiry about water fluoridation policy in the United States. It is graftifying to hear that several Japanese local goverments,with support from the Japanese Ministry of Health, Labor and Welfare, plan to provide the health benefit of fluoridated water to thier citizens.

Since my lecture of Junuary 15, 2002, at the Tokyo Medical and Dental University there has been no change in the U.S. Public Health Service policy in regards to water fluoridation. let me share with you, however, some additional information that has been published since the Centers for Disiese Control and Prevention (CDC) released our Recommendations for Using Fluoride to Prevent and Control Caries in the United States in the Morbidity and Moetality Weekly Report (MMWR) in August 2001.

Two analyses conducted by reseachers here at CDC showed that in the U.S.,community water fluoridation, through its caries preventing action, provides an annual per person dental cost savings of approximately $16 to $19 depending on the size of the community. (An Economic Evaluation of Community Water Fluoridation- Griffin SO, Jones K, Tomar SL.Spring 2001, Journal of Public health Dentistry pp. 78-86). This cost-savings can be demonstrated even in communities that have already low prevalence of dental caries. In addition, a second study demonstrated that we may actually underestimating fluoridation benefits because of the "halo"or "diffusion effect" whereby people outside of fluoridated communities also benefit from fluoridated water by consuming food and beverage products prepared in fluoridated communities. (Quantifying the Diffused Benefit From Water Fluoridation in the United States -Griffin SO, Gooch BF, Lockwood SA, Tomar SL. Community Dent Oral Epidemiol. 2001; 29: 120-129)

In Noxember 2001,CDC published key findings of a systemtic review of the scientific evidence of effectiveness for community water fluoridation and other selected interventions to promote oral health. The review was conducted by the independent, non-Federal Task Force on Community Preventive Services and confirmd that fluoridation is effective in reducing tooth decay. Based on this review, the Task Force issued a strong recommendation that community water fluoridation be included as part of a comprehensive strategy to prevent or control tooth decay in commuties. In July 2002, a full presentation of the Task Force Nobuhiro Hanada, D.D.S.,Ph.D.

Recommendations and supprting evidence for interventions to promote oral health will be provided in a supplement of the American Journal of Preventive Medicine. More information about the Community Preventive services (including links toa variety of resources and related published articles) is available at www.thecommunityguide.org.

We continue to make progress towards achieving our national health goal for the year 2010 to have 75% of all US citizens served by publc watersystems to have the benefit of fluroridated water. A Febluary 2002 report of our CDC water fluoridation reporting system(WFRS) showed an increasing trend tpwards achieving this goal. In the United States during 2000, 162 million persons (65.8% of the population) served by pulic water supplies received optimally fluoridated water copared with 144 million persons (62.1%) in 1992. We view this as a sign of continued strong US support of this preventive measure.

Dr. Hanada, let me conclude by repeating a portion of the statemant made by the U.S. Surgeon General in December 2001. "The U.S. Centers for Disease Control and Prevention has recognized the fluoridation of drining water as one of ten great public health achievements of the twenty century. Water fluoridation has helped improve the quality of life in the United States through reduced pain and sufferung related to tooth dacay, reduced time lost from school and work, and less money spent to resrore, remove ,or replace decayed teeth. Fluoridation is the single most effective public health measure to prevent tooth decay and improve oral health over alifetime,for both children and adults."

We believe that community water fluoridation is a safe, effective and inexpensive way to prevent dental caries. Perhaps its greatest utility is that it benefits persons of all ages and of all social and economic standing, including those difficult to reach through public health programs or who have limited access to private dental care.

I have enclosed copies of the documents that I have referenced in this letter and I wish you great success and applaud your efforts and those community leaders in Japan who are working to improve the oral health of your citizens.

                                      Sincerely yours,               
                                      Willams R. Mass, D.D.S.,M.P.H.
                                      Division of Oral Health
                                      National Center for Chronic Disease ,Prevention and Health Promotion.