FLUORINE IN UNITED STATES WATER SUPPLIES! 
PILOT PROJECT FOR THE ATLAS OF DISEASES 
By ANASTASIA VAN BURKALOW 
[With 1 plate (map) ] 
Within the last 15 years attention has been increasingly directed 
to the distribution of fluorine in the water supplies? of the United 
States; for it has been demonstrated that a small amount of fluorine, 
about 1 part per million, is necessary for optimal dental health. 
Where the fluorine content of the drinking water is much less than 
this, the dental-caries experience rates are high; where it is greater, 
the disfigurement known as dental fluorosis or mottled enamel is 
endemic.’ . 
Because of this direct relationship between dental health and an 
element of the physical environment, the water supply, a study of the 
problem was chosen as the pilot project for the American Geographi- 
cal Society’s proposed Atlas of Diseases,t the primary purpose of 
which is to show the correlation of disease with the natural and 
social environment. The growing public interest in the effects of an 
excess or deficiency of fluorine on the teeth, and the many studies 
of the problem made in recent years contributed to the choice of 
this project as the first to be undertaken.© Dr. H. Trendley Dean, 
senior dental surgeon, United States Public Health Service, who 
has done outstanding work in this field, has kindly served as con- 
sultant for the investigation, the purpose of which is to determine 
the distribution of fluorine in the water supplies of the United States 
as far as it is now known and to show where possible the correlation 
1 Reprinted by permission from The Geographical Review, vol. 36, No. 2, April 1946. 
2The fluorine in water supplies is, of course, in combined form, most of it probably as 
calcium or sodium fluoride. In the analyses, however, amounts are expressed in terms of 
uncombined fluorine. 
>For a review of the studies that have led to these conclusions see F. S. McKay, H. 
Trendley Dean, et al., Fluorine in dental public health: a symposium, New York 
Institute of Clinical Oral Pathology, New York, 1945. 
4 Geogr. Rev., vol. 34, pp. 642-652, 1944. 
. This decision was made by the Steering Committee for the Proposed Atlas of Diseases, 
at its meeting at the house of the Society on Sept. 22, 1944. During the rest of 1944 pre- 
liminary correspondence with the State sanitary engineers was carried on by the Director 
of the Society, Dr. John K. Wright. In January 1945, work on the project was assigned to 
a research assistant, Mrs. Luella N. Dambaugh. Upon her resignation in August of that 
year, she was succeeded by the writer. 
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