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 "Community water fluoridation is the single most effective public health measure to prevent tooth decay. Additionally, the Centers for Disease Control and Prevention proclaimed community water fluoridation as one of the 10 great public health achievements of the 20th century." (Fluoridation Facts, American Dental Association, 2005). In my 25 years as a dentist, I have seen tremendous decrease in dental decay, and the improvement continues today. This year marks the 63rd anniversary of community water fluoridation. The American Dental Association has continuously endorsed the optimal levels of water fluoridation as safe and effective in reducing dental decay in all communities. In 1995, the US Public Health Service (USPHS) recognized water fluoridation as being the most cost effective and safe method of reducing dental decay. Community water fluoridation is accessible to all members of a community regardless of socioeconomic status, is effective throughout the life span in reducing decay and does not require a change in behavior to be beneficial. Studies have shown that water fluoridation can reduce the amount of cavities in primary (baby) teeth by 60 percent and in adult teeth by nearly 35 percent. The reduction in decay helps people keep their teeth throughout their lifetimes and in reduces the emotional and economic stress of treating dental disease. In spite of the proven effectiveness of water fluoridation, only about 67 percent of the U.S. population receives fluoridated water today. In 1998, the USPHS established the goal of providing 75 percent of the population with fluoridated water by 2010. Dental decay is caused by dental plaque (bacterial deposits), which are constantly present on the surfaces of teeth. When carbohydrates and other sugars are eaten, the bacteria produce acids that attack the outer surface of the teeth - the enamel. Over time, the acids produce a cavity or hole, in the tooth structure. Several factors contribute to the formation of tooth decay, including poor oral hygiene, a diet high in sugars, decreased flow of saliva (a side effect of many medications), gum recession that exposes susceptible tooth roots, high levels of bacteria, deep pits and grooves in the tooth anatomy, and a low level of fluoride exposure. What is fluoride? The fluoride ion is a compound that comes from the element fluorine and is abundant in the Earth's crust. It occurs in all water as a result of water run off into lakes and streams. The fluoride ions help to make the enamel surface of teeth more resistant to decay, as well as helping enamel repair or remineralize itself during the early stages of the decay process. Fluoride protects the teeth through the systemic route as well as through topical application. When fluoride is ingested before the eruption of the teeth occur, it is incorporated into the tooth structure, thus providing protection throughout the entire tooth structure. After the teeth erupt, benefit can also be achieved by topical fluoride application through tooth pastes and mouth rinses that contain fluoride, as well as professionally applied fluoride foams, varnishes and gels. The presence of fluoride in the water supply provides the benefits of both systemic and topical fluoride application. Fluoride additives used in our public drinking water are sodium fluoride, sodium fluorosilicate, and fluorosilicic acid. In the U.S., the Environmental Protection Agency regulates any drinking water additive. The recommended amount of fluoride concentration is the water supply is 0.7 to 1.2 ppm. The EPA reviews research and regulations every six years to ensure the safety of our water sources. The EPA does not, however, regulate bottled water, which has become very popular during the past decade. In fact, most bottled water does not contain fluoride, and when used as the primary water source the incidence of dental decay increases. Bottled water is considered a "food" and is regulated by the Food and Drug Administration ( the FDA).It is important to also note that many home water filtration systems filter out the fluoride from the municipal water systems. The amount of fluoride recommended is based upon age and body weight. Many pediatricians and dentists will advise families about the recommended amount of fluoride for their child. In areas where fluoridated water is not available, other fluoride supplements, such as fluoride tablets, may be recommended. You can find out the fluoride levels levels in your own water supply by contacting your municipal water company. Generally, for young children (under age 6) who live in fluoridated areas, using no more than a pea-sized amount of fluoridated toothpaste is recommended. In rare instances, higher than optimal amounts of fluoride can cause a condition called Dental Fluorosis. This condition can change the appearance of the enamel of the teeth but is considered a cosmetic problem and not a structural one. The majority of cases are mild and appear as small white spots on the surface of the tooth. With the benefits of water fluoridation clearly established in decreasing dental decay, why does dental decay continue to be a problem for so many people? Other factors contribute to the incidence of decay. A common side effect of many medications is dry mouth. Dry mouth is caused by a decrease of saliva. Dry mouth allows the bacterial plaque to remain on the tooth surfaces longer, often resulting in tooth decay. Radiation treatment to the head and neck may also decrease the amount of saliva formed. It is often recommended that individuals who receive head and neck radiation should have additional sources of fluoride. Dental students now receive training in caries (decay) risk assessment as a crucial component in their dental education. Risk factors for developing caries include high levels ot bacteria in the mouth. The harmful bacteria may be measured and if found to be a high risk factor, specific antibiotic medications and mouth rinses may be recommended. For individuals at moderate to high risk for developing decay, dietary habits are examined, proper oral hygiene practices are taught and often topical application of fluoride onto the tooth surfaces is recommended. The frequency of the topical fluoride application, bacterial testing and the use of antibiotic treatments should be determined by your dentist. Caries risk assessment is an important component to proper dental care and should be evaluated periodically as patients' age and health circumstances change. Research has shown that the topical application of fluoride varnish every six months is effective in preventing decay in both primary and permanent teeth and is an easy and affordable addition, when needed, to the fluoridated water in our municipal water supply. In my practice, I have seen a dramatic decrease in the incidence of decay in my pediatric patients who have grown up in our fluoridated community. In my aging patient population, the use of additional treatments such as fluoride products has been a tremendous benefit in controlling dental decay.
Molly P. Newlon, DDS, MA, graduated from UOP Dental School in 1982 and completed a GPR residency at the Veteran's Administration Hospital in San Antonio, Texas. She was director of the Faculty Dental Practice for nine years, and 11 years ago became director of health and safety for the UCSF School of Dentistry. Molly provides training in infection control and health and safety to faculty, students and staff, and is an active member on numerous campuswide committees on health and safety and terrorism preparedness. Send your questions to Molly@smartnow.com. |
