To Fluoridate or Not to Fluoridate, Should It Really Be a Question?

Jul 26, 2021
To Fluoridate or Not to Fluoridate, Should It Really Be a Question?
Growing up in Queens NY, it was a given that the water we ingested was fluoridated. It was never something I nor my parents gave much thought to.

Growing up in Queens NY, it was a given that the water we ingested was fluoridated. It was never something I nor my parents gave much thought to. Not until dental school were its benefits fully explained and I truly understood its outstanding qualities and how it positively contributed to our oral well being. Armed with the knowledge of the great impact fluoridation of community water has had in the field of dentistry, I became a big advocate of fluoridation. It puzzled me how whole communities would opt out of its benefits. Since it is relatively impossible to please all of the people all of the time, I listened to the critics of fluoridation with a grain of salt.

Not until I started practicing dentistry, in a non fluoridated water community, did I get to see first hand how the dental health of the community is compromised. I’ve had the pleasure to practice dentistry in 3 varying places with different availability of fluoride (FL). One faction is Greenwich CT, where part of the town is supplied by town water which is fluoridated while the other part is supplied by well water- not fluoridated. Thankfully the town provides a FL rinse program so all children benefit from the advantages of fluoride. The second community is in NYC where all have the benefit of fluoridation. The third location is in Pomona NY. The leaders of this particularly community had opted out of fluoridating the local water in 1978 and continue to oppose it today. I, as a practicing dentist, have the frustrating job of restoring caries prone teeth again and again in young children in this community. This is not the same experience I have in the other communities embracing the benefits of FL.

As I speak to parents and caregivers, I realize there is a general lack of information regarding the basic facts about FL. Many erroneously consider FL a vitamin, forgetting that it’s an element on the periodic chart. I though a background of general information about this mineral extremely valuable.

What is fluoride?

Fluoride is a natural element which is abundantly found in the earth’s crust as a ion. It only exists in combination with other elements and is a component of rocks and soil. It is actually present in all water sources. It’s concentration varies depending on the source of the body of water. Underground water has a much higher concentration than surface water.

Who discovered the benefits of fluoride?

It was discovered way back in the early 1900’s by a young brilliantly curious dentist, Dr Fredrick McKay, who discovered that many local residents had brown stained teeth that were surprisingly resistant to decay in his practice in Boulder Springs Colorado . After many years of research and careful study, the first community water fluoridation program began in Grand Rapids Michigan in Jan 1945. It was quickly followed by three other studies in Newburgh NY, Branford Ontario and Evanston Illinois. After the overwhelming success of these initial studies, other communities quickly embraced water fluoridation as a safe and effective public health intervention to prevent dental decay. Since 1950, the American dental association (ADA) has continuously, without reservation, endorsed the optimal fluoridation of community water. This support is based heavily on continuing evaluation of scientific research, ongoing studies and credible scientific evidence.

How does fluoride prevent decay?

Fluoride protects teeth in two distinctive ways- systemically and topically. Systemic benefits are during the process of tooth formation in young children when the ingested fluoride becomes incorporated into the structure of the developing tooth buds. There is longer lasting protection if the fluoride is ingested regularly while teeth are being developed ( prior to actually erupting). Because fluoride is deposited throughout the entire tooth surface, it is much less prone to decay. Topically applied fluoride benefits erupted teeth by providing local protection on the tooth surface. Examples of topically administered fluoride include toothpastes,mouth rinses and professional applied gels, varnishes and foams. The maximin benefits of fluoride is when its incorporated at all stages of development (pre eruptive to post eruptive). Fluoridated water provides that protection in all stages of development. Research has shown that FL has reduced caries level in primary teeth by 60% and 35% in permanent teeth. Caries is considered one of the most commonly preventible diseases in children.

What is water fluoridation?

It is important to remember that all drinking water has naturally occurring FL. Fluoridation is merely an increase in the FL ion in the water to an optimal level that provides maximum benefits. Through extensive research it was determined the optimal concentration of FL in community water is between the range of .7-1.2 parts/million. This range is dependent on regional area’s annual average maximum daily air temperature. Local health departments as well as the local water suppliers can provide the FL levels in local community water.

How much does water fluoridation cost?

It is the most cost effective way to provide maximum protection against a very common disease that effects both children and adults regardless of the social status or socioeconomic conditions. It’s estimated that in large communities, it costs $.50 a year/person to $3 a person/year in smaller communities. Fluoridation of community water is one of the ten great public health achievements of the twentieth century. Approximately 170 million people, roughly 2/3 the population of the US, is served by fluoridated public water. Dental decay is by far the most costly and common oral health issue in all age groups.

Dietary FL supplements are an effective alternative for children living in non fluoridated communities. This is only available by prescription thru a pediatrician or dentist and is adjusted according to age.

Incidentally many countries around the world use salt FL . This type of fluoridation doesn’t require a centralized pipe water system which may not be available in developing third world nations. This form provides adequate FL benefits over extended usage.

What is Fluorosis ?

Fluorosis is a condition when the permanent teeth are discolored due to a high level of ingested FL during tooth formation. It can vary greatly in severity from a very mild discoloration effecting only a few teeth or only parts of teeth to being very pigmented, affecting the enamel formation. Generally mild fluorosis is caused by ingesting toothpaste as a toddler. Severe forms of fluorosis would be attributed to very high levels of Fl found in local water. Non fluoridated toothpastes are strongly recommended for children under age 3. For children older then 3, it’s recommended to use only a pea size amount of toothpaste. It’s important to note that both adult and children toothpastes have the same concentration of Fl so a frugal use of toothpaste in younger children is strongly recommended. Older children and adults are not in danger of getting fluorosis as their permanent teeth have already formed.

The downside of bottled water

Consumption of bottle water in the US has grown drastically over the years and so has the caries level in adults. The main reason for this is that bottle water has less than the optimal level of FL needed for adequate protection. The higher the consumption of bottled water, the less topical benefits of Fl, the more trips to the dentists for adults as well as children.

New kid on the block There is an excited buzz in dentistry, especially among pediatric dentists, about a new kind of fluoride treatment that has been shown to stop tooth decay in its tracks. It’s an anti microbial liquid called Silver Diamine Fluoride( SDF). It’s been used in Japan for decades and has recently been cleared in the US by the FDA to be used for adults as a tooth desensitizer. The extraordinary component of this product is that it’s been shown to prevent caries by halting its progression. The potential benefits is tremendous in caries control and management across the board from young toddlers, special needs patients, adults and the elderly-who tend to suffer from root caries. It’s not yet a ‘miracle fix all’ however. For sustainable benefits more than one application is necessary. Insurance companies have not started covering this procedure although I am very confident they will fight to jump on board once given evidence of the cost saving benefits. Then there is the small matter of a characteristic dark staining on the tooth surface once treated by SDF. People having silver allergy will also not be able to benefit from SDF. Many studies and clinical trials are currently underway. This is a product to keep a keen eye on for it has a huge potential of changing how dentistry is approached in the near future.

Why the controversy?

Critics of fluoridation have questioned its safety and effectiveness. It’s been linked to a host of illness and cancers though none have been substantiated by generally accepted scientific research. It is always important to check the research and validity of articles posted on the Internet. The ADA is a great source of Information regarding research and longitudinal studies regarding the safety and effectiveness of the use of Fl.

I have tried to condense the major bullet points on the benefits of Fl and give a bit of background on its origin and inception into our lives . There is more information available to anyone interested in ‘digging deeper’ thru the ADA website.