Air Force adoption of water fluoridation in 1954 led to dental improvements

Published Oct. 29, 2021
By Dr. Joseph Frechette, Ph.D.
Air Force Medical Service History Office

FALLS CHURCH, Va. --

Image of a piece of paper. — Dental survey from crew member of B-29, Deacon’s Disciples II. (Photo by National Museum of the U.S. Air Force)

On September 22, the National Museum of the U.S. Air Force posted images to its social media page as part of a story about one of the crewmembers of Lt. Col. Charles “Deacon” Miller’s B-29, Deacon’s Disciples II, whose last flight in World War II set a record for the fastest non-stop trip from Hawaii to Washington, DC. As fate or social media algorithm would have it, a photo of a crewmember’s dental survey displayed first, in at least one instance, revealing the undeniable impact Air Force dentists and the push for fluoridation would have on preventive dental health care.

The number of missing teeth in the photo is a window into the early 20th century, before fluoridation, when dental decay and tooth loss were inevitable facts of life. In 1950, 90% of Air Force recruits needed fillings for an average of eight cavities each, and 19% needed dentures.

On September 28, 1954 Ramey Air Force Base in Puerto Rico became the first U.S. military installation to fluoridate its water supply under the direction of the base dental surgeon, Col. Carlos F. Schuessler. Then-U.S. Air Force Surgeon General, Maj. Gen. Harry G. Armstrong, had approved the project on June 23, 1954, after receiving a letter from the National Research Council. The letter noted, “There is sufficient scientific evidence of the merits of fluoridation of public water supplies to justify its use on military posts wherever feasible, and especially where there is a child population in residence." Within two years, the Air Force had approved fluoridation projects for 15 bases. By 1965, 80 bases had either installed fluoridation systems or had access to sufficiently fluoridated water, and by 1976 the number had grown to 146.

In many ways, fluoridation of public water supplies was still a novelty in the early 1950s. The results of dental surgeon and epidemiologist H. Trendley Dean’s comparative study of 21 cities with varying fluoride levels in their water supplies had only been published in 1942. Although early studies were suggestive, it was only after the 1949 preliminary results of field trials in Grand Rapids, MI showed dramatically positive results that the U.S. Public Health Service and American Dental Association endorsed fluoridation of public water supplies in 1950.

Even then, as with so many public health measures, the politics of the issue were fraught, and anti-fluoridationists quickly organized in opposition.

Adoption of fluoridation by U.S. municipalities peaked in 1953, with slower rates thereafter. Over the years, objections have ranged from health and religious concerns to environmental arguments, concerns over cost-effectiveness, creeping government encroachment on individual liberties, and even, as so famously lampooned in the 1964 dark comedy, “Dr. Strangelove,” fear of communist subversion.

Nevertheless, it is unsurprising that the Air Force was at the forefront of such efforts and stuck with them. The nascent Air Force Medical Service prioritized preventive dentistry for its members. Likewise, the public health advantages proved to be dramatic. Sharp decreases in the severity of cavities were observable in the cities that adopted fluoridation by the 1960s, which slowly encouraged further adoption.

At least 60% of Americans now receive fluoridated public water and tooth loss is no longer inevitable. By 2000, despite the vast majority of military recruits still needing fillings, the average number required by each had dropped by roughly two thirds.

Alas, none of this would have been of any benefit to the particular flyer whose dental survey is in question here. It actually belongs to “Col. Elmer E. Elmer,” the teddy bear mascot of Deacon’s Disciples II, who has his own Air Force story, decorations, dogtag, and even dental records. The bear has resided in the National Museum of the U.S. Air Force since Miller donated it in 1986.