A topic that is often forgotten nowadays (probably because it is taken for granted by a lot of people?) is the use of fluoride in water to promote dental health. Just like anything else in life (here you can substitute for fluoride things like: climate change, trans-fats, vitamins, vaccines, have-we-really-been-on-the-moon, probiotics, red meats, is-the-earth-really-round, eggs, evolution, etc., etc.), there is room for some debate. One can find opposite views on basically any topic that can be thought about.
In the case of water fluoridation, however, science and studies are overwhelmingly in favor of a positive effect for it.
Here is some basic information and facts directly from the American Dental Association:
- Fluoridation of community water supplies is the single most effective public health measure to prevent dental decay.
- Throughout more than 60 years of research and practical experience, the overwhelming weight of credible scientific evidence has consistently indicated that fluoridation of community water supplies is safe.
- The Centers for Disease Control and Prevention has proclaimed community water fluoridation (along with vaccinations and infectious disease control) as one of ten great public health achievements of the 20th century.
- More than 100 national and international health, service and professional organizations recognize the public health benefits of community water fluoridation for preventing dental decay.
- Studies prove water fluoridation continues to be effective in reducing dental decay by 20-40%, even in an era with widespread availability of fluoride from other sources, such as fluoride toothpaste.
- Community water fluoridation benefits everyone, especially those without access to regular dental care. It is the most efficient way to prevent one of the most common childhood diseases – dental decay (5 times as common as asthma and 7 times as common as hay fever in 5-to-17-year-olds). Without fluoridation, there would be many more than the estimated 51 million school hours lost per year in this country because of dental-related illness.
- Community water fluoridation is the adjustment of fluoride that occurs naturally in water to optimal levels to protect oral health.
- For most cities, every $1 invested in water fluoridation saves $38 in dental treatment costs.
- Water that has been fortified with fluoride is similar to fortifying salt with iodine, milk with vitamin D and orange juice with vitamin C.
- Simply by drinking water, people can benefit from fluoridation’s cavity protection whether they are at home, work or school.
- The average cost for a community to fluoridate its water is estimated to range from approximately $0.50 a year per person in large communities to approximately $3.00 a year per person in small communities.
- More than two-thirds of the population in the United States are served by public water systems that are optimally fluoridated.
- Fluoridation has been thoroughly tested in the United States’ court system, and found to be a proper means of furthering public health and welfare. No court of last resort has ever determined fluoridation to be unlawful.
- Be aware of misinformation on the Internet and other junk science related to water fluoridation.
- One of the most widely respected sources for information regarding fluoridation and fluorides is the American Dental Association. The ADA maintains Fluoride and Fluoridation Web pages at http://www.ada.org/goto/fluoride.
Of all the above, I believe the benefits for children is the most important. This is done without any special effort from the child or the parents, a clear benefit especially for children who do not see the dentist regularly or at all. Yes, it does happen a lot unfortunately. The second most important may be the warning about the internet and junk science: There is certainly a lot of that out there, and a clear tendency to try to reject proven beneficial treatments (vaccines come to mind) based on anecdotal unproven side effects or long-term issues. It is easy to spread doubt and fear...But do we really want to go back to the "good old days" of polio and smallpox epidemics, with "iron lungs" and lifetime facial scars? The golden times when a dental abscess could kill you from not having antibiotics? Something to think about...
Application of fluoride directly on the tooth (as in toothpaste and with applicators in the dental office) is also useful, of course, but it treats only the outer layer of the tooth; the fluoride in water is better since it is actually used and incorporated in the tooth structure as it forms, making it stronger and more resistant to cavities as a whole.
Can a good thing become bad? Sure, like anything else also. Too much fluoride can lead to "fluorosis", something that can damage (mostly forming) teeth. This is why you have to control the amount of toothpaste on your child's toothbrush ("pea size") and encourage them to brush and spit and rinse after (not to swallow it even though they make great tasting mixtures for kids!!) Fluoride supplements can be great, but only after checking other potential sources of fluoride intake, such as the levels of fluoride in your local water. For that, the CDC (Centers for Disease Control and Prevention) has a pretty impressive site:
You can check there your town by starting with state, then county. Interestingly, for example, Clifton Park is NOT fluoridated, while Halfmoon IS. Burnt Hills, Cohoes are NOT. Saratoga Springs IS, but after all it has become famous for the medicinal and healing properties of its water!!! You have to be careful with the exact source of your water however, since water for neighbors can come from a different supply. Once you know exactly your local fluoride concentration, then it is time to discuss fluoride supplements - or not - with your dentist. The optimal levels recommended are 0.7 to 1.2 ppm.
For even more information on water fluoridation, the CDC (again!) has an extremely detailed site with LOTS of information on every aspect of it:
Enjoy! I hope this helps, and I will be back later with more dental topics!
Christiane Ashba, DMD