Fluoridation debate

Fluoridation seems to be a popular topic in the media recently. The Times article on community water fluoridation and a battle in Bellingham, Wash., generated quite a renewed interest in fluoridation. A Harvard student’s study on the relationship between a rare bone cancer and fluoridation, coupled with the press conference on a recent report by the U.S. Environmental Protection Agency on naturally occurring fluoride standards, was in the spotlight too. Friends, patients, and acquaintances will be asking you about fluoridation, if they haven’t already!

I remember learning that water fluoridation is one of the 10 greatest public health achievements as stated by the U.S. Public Health Service. I also know that water fluoridation continues to be supported by the Centers for Disease Control and Prevention (CDC), the American Dental Hygienists’ Association, and the American Dental Association (ADA). However, unless actively working on a fluoridation campaign or working as a public health hygienist, most hygienists do not deal with fluoridation daily, as we do, for example, with the periodontal probe or loss of attachment measurements in clinical practice.

This information from the CDC’s Achievements in Public Health, 1900-1999: Fluoridation of Drinking Water to Prevent Dental Caries may be of interest:

• “A review of studies indicates that fluoridation reduces enamel caries in adults by 20 to 40 percent and 8 to 37 percent in adolescents.

• “Water fluoridation is especially beneficial for communities of low socioeconomic status. These communities have a disproportionate burden of dental caries and have less access than higher income communities to dental-care services and other sources of fluoride.

• “Laboratory and epidemiologic research suggests that fluoride prevents dental caries predominantly after eruption of the tooth into the mouth, and its actions are primarily topical for both adults and children. These mechanisms include ① inhibition of demineralization, ② enhancement of remineralization, and ③ inhibition of bacterial activity in dental plaque.

• “Approximately 70 percent of all U.S. cities with populations greater than 100,000 use fluoridated water.

• “Compared to other methods of community-based dental caries prevention, water fluoridation is the most cost-effective for most areas of the United States in terms of cost per saved tooth surface.

• “The safety and effectiveness of water fluoridation have been reevaluated frequently, and no credible evidence supports an association between fluoridation and any negative conditions.

• “Despite the substantial decline in the prevalence and severity of dental caries in the United States during the 20th century, this largely preventable disease is still common.”

There are two great resources for you to get tons of information on fluoridation. The full CDC report can be found at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4841a1.htm.

Another wonderful resource is the ADA’s Fluoridation Facts document and other fluoride-related materials at http://www.ada.org/prof/resources/topics/fluoride.asp#report.