A big discussion throughout the nation and specifically in our backyard is fluoride. Should it be in the water? Should it not? With three-fourths of the country drinking water with fluoride added in, Wichita has voted to reject adding fluoride to the local water in 1964, 1978, and in 2012 with a 59% “no” vote in the most recent of those dates. (Lefler, D., Calovich, A., 2012) The question is why? In the end, based on statistics, is this vote hurting your children, your parents, your neighbors, your friends, and your pocketbook?

Fluoride comes from a natural element, fluorine, and is found naturally in many foods and water. Sometimes when water does not have enough natural fluoride in it, it can also be added. This is done to help protect the teeth of those who drink it. Every day, minerals are added to and lost from a tooth’s enamel layer through two processes, demineralization and remineralization. Minerals are lost (demineralization) from a tooth’s enamel layer when acids — formed from plaque bacteria and sugars in the mouth — attack the enamel. Minerals such as fluoride, calcium, and phosphate are redeposited (remineralization) to the enamel layer from the foods and waters consumed. Too much demineralization without enough remineralization to repair the enamel layer leads to tooth decay. (Friedman, M., 2017)

Tooth decay (cavities) is one of the most common chronic conditions in children in the United States. Untreated tooth decay can cause pain and infections that may lead to problems with eating, speaking, playing, and learning. About 1 in 5 children aged 5 to 11 years have at least one untreated decayed tooth. (CDC, 2014). 92% of adults aged 20 to 64 have had dental caries in their permanent teeth. (NIH, 2018). An estimated 51 million school hours per year are lost in the US due to dental-related illness. Employed adults in the United States lose more than 164 million hours of work a year as a result of oral health problems or dental visits. (Dept of Health, 2006)

Fluoride helps prevent tooth decay by making the tooth more resistant to acid attacks from plaque bacteria and sugars in the mouth. It also reverses early decay. In children under 6 years of age, fluoride becomes incorporated into the development of permanent teeth, making it difficult for acids to demineralize the teeth. Fluoride also helps speed remineralization as well as disrupts acid production in already erupted teeth of both children and adults. (Friedman, M., 2017).

The CDC reports that “panels of experts from different health and scientific fields have provided strong evidence that water fluoridation is safe and effective.” Community water fluoridation has led to such dramatic declines in both the prevalence and severity of tooth decay that the Centers for Disease Control and Prevention named it one of 10 great public health achievements of the 20th century (Fluoride in Kansas, n.d.).

Not only does fluoride provide benefit to teeth but it also provides benefit to the whole community including those who may not have the care or access to things like fluoridated toothpaste or professional services. Keeping the community healthy with water fluoridation is not only easy and effective but is also cost effective.

• Out-of-pocket spending for dental services—costs not paid by insurance—accounts for about 40% of all dental expenditures
• Every $1 invested in fluoridated water saves $38 in dental costs.
• Fluoridated water is 70 times cheaper than fluoride supplements, 1/2 the cost of fluoride rinse, and cheaper than varnishes and gels.
• When everyone has access to fluoridated water, fewer Medicaid dollars are spent on dental care. Those without dental care access benefit from better oral health, and we all benefit from less Medicaid spending.
• National savings from water fluoridation: $3.84 billion each year as estimated by scientists who testified before Congress in 1995. (Fluoride in Kansas, n.d.)
• Average cost of water fluoridation is $0.13-$5.48/person/year. (Cooper, M., 2013.) This range differs depending on the size of town you live in.

Can fluoride be poisonous? In excess, yes, it can. It is noted that children six years of age and under should not use fluoride rinses due to the risk of swallowing the higher concentration of fluoride.  Toxicity of fluoride (acute or chronic) can result in gastrointestinal symptoms and if a large amount is consumed it can lead to convulsions, cardiac failure, and other health concerns. The amount of fluoride needed to be ingested to trigger a “toxic” dose is greater than 5 mg/kg and to ingest a “lethal” dose is greater than 15 mg/kg. There are also concerns with chronic exposure to fluoride which results from water with 10-25 ppm (parts per million). Things such as dental fluorosis or skeletal fluorosis can occur from chronic exposure. Optimal fluoride level in water to prevent dental decay is .07ppm mg/L. (Cooper, M., 2013).

I understand the concern behind fluoride. However, the key word to remember is “excess” and anything in excess is not good for the body. Too much sun can lead to a sun burn or skin cancer, too much sugar can lead to weight gain and high blood sugar levels which can cause diabetes. But then you also think of all the benefits that water fluoridation can bring-fewer cavities, less need for fillings and removing teeth, less pain and suffering-as much as a 60% reduction in decay. (CDC, 2006). As a dental professional, I see the long-term effects of dental decay with many adults having problems spanning from childhood. Of course, having proper at-home oral care that includes brushing at least twice daily for two minutes each and flossing daily can help prevent decay but so can water fluoridation. That’s something that benefits you without having to even think about it. Not only based on the research and studies conducted, but also on my personal and professional experience, I would consider fluoride a penny-saver, every day.

If you wonder where your community stands or if your water is fluoridated, look at www.fluoridekansas.org.

Author:  Shelby Hermreck

 

Children’s Oral Health. (November 10, 2014). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/oralhealth/children_adults/child.htm.

Cooper, Mary Danusis. (2013). Dental Hygiene Board Review. Georgia.

Dental Caries (Tooth Decay) in Adults (Age 20 to 64). (July 2018). National Institute of Dental and Craniofacial Research. Retrieved from https://www.nidcr.nih.gov/research/data-statistics/dental-caries/adults.

Friedman, M. (January 24, 2017). Dental Health and Fluoride Treatment. WebMD Medical Reference. Retrieved from https://www.webmd.com/oral-health/guide/fluoride-treatment#1.

Know the Facts about Fluoride. (n.d.). Fluoride in Kansas. Retrieved from http://www.fluoridekansas.org/facts.html.

Lefler, D, and Calovich, A. (Novemver 7, 2012). Wichita voters reject fluoridated water. The Wichita Eagle. Retrieved from https://www.kansas.com/news/article1102401.html.

The Impact of Oral Disease. (December 2006). Department of Health New York State. Retrieved from https://www.health.ny.gov/prevention/dental/impact_oral_health.htm.

Water Fluoridation: Nature’s Way to Prevent Tooth Decay. (2006). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/fluoridation/pdf/natures_way.pdf.