Fluoride in the water supply is a valuable cavity prevention approach that has a large body of evidence supporting its use. Cavities begin in childhood and eventually affects 90% of adults especially in low-income individuals. Results of the National Health and Nutrition Examination Survey III during 1999-2004 indicated 24% of 2 – 4 year old and 51% of 6 – 8 year old had cavities in their primary teeth. Among 12 – 19 year old 59% had cavities in permanent teeth and children living below 200% of the federal poverty level (FPL) had more cavities relative to children at or above 200% of the FPL.
Dental decay is a transmissible infectious disease in which cavity causing bacteria are passed from mother (usually) to child. These bacteria produce acids which dissolve the calcium-phosphate mineral of a tooth’s enamel called demineralization. Fluoride that comes into contact with a tooth (through community water fluoridation (CWF) or toothpaste) helps build up the calcium-phosphate mineralization in the tooth’s enamel and is itself incorporated into the calcium-phosphate mineral. This fluoride containing enamel is harder than the original enamel it replaces thereby reducing cavity risk.
Topical fluoride, through CWF or toothpaste, is more effective than supplements that are swallowed and has beneficial effects throughout life. CWF is considered among the 10 greatest US public health achievements of the 20th century. However, too much fluoride can cause fluorosis which refers to localized changes to tooth enamel and is caused by elevated fluoride ingestion only during tooth development. Once permanent teeth mineralization is complete, by 8 years old, there is no longer risk of additional dental fluorosis with further fluoride exposure. It is recommend that fluoride intake in children not exceed 0.05 to 0.07 mg/kg of body weight daily. Of note reverse osmosis and distillation remove virtually all fluoride from water. UV light exposure, water softeners, under the sink, faucet-mounted and pitcher type activated charcoal filtration units do not affect fluoride concentration.
Despite fluoride’s benefits and safety, myths and anti-fluoridation assertions persist. Several include that fluoride is “a toxin” added to the public water system and is more toxic than lead. Actually, fluoride is naturally present at varying concentrations in all bodies of water including ocean water at 1.2 part per million (ppm). An estimated 57.4 million people worldwide drink naturally fluoridated water in which fluoride is already present at approximately 1 ppm. Unlike fluoride and other micro nutrients there is no safe threshold for lead exposure.
Another claim is CWF represents “mass medication”. Medications are used to treat disease. CWF is not intended to treat disease but to prevent it on a population level. In addition, some claim “CWF eliminates individual choice about fluoride and People who want fluoride can take fluoride supplements” As you now know, cavities are present more often in people of low economic means and CWF helps to equalize risk of cavities across socioeconomic groups in a way that fluoride taken on an individual basis does not.
Individual choice is still possible in that one can opt out of drinking tap water. Finally some state”Fluoride results in adverse health effects such as increased risk for diminished IQ, cancer”, etc. There is no established evidence for an association between CWF and any disease or intellectual impairment nor any disease state including cancer.
We hope this information is helpful and as always feel free to call with any questions you have about your child’s health!
MacKoul Pediatrics is an amazing local pediatrics office in Cape Coral, FL where caring, compassionate doctors and nurses work with you to keep your children as healthy as possible. MacKoul cares for children from birth to college age, from Cape Coral, Fort Myers, Naples, and beyond.
May 13, 2014