Recently, fluoride and its benefits have become controversial. As a practicing pediatrician, I think it is imperative for Utah’s parents to understand fluoride so they can make data-informed healthcare decisions for their children.
Let’s step back in time to the 1900s and Dr. Fredrick McKay’s 30-year investigation into the “Colorado Brown Stain.” Dr. Mckay noticed a peculiar phenomenon of chocolate brown teeth in many patients at his Colorado Springs dental practice.
Coincidentally, these teeth also lacked dental caries, a chronic bacterial infection of the teeth causing tooth decay and dental cavities. He discovered similar findings in other communities across the country. Ultimately, the answer was found through analysis of water samples from an affected community in Arkansas, which showed high levels of fluoride, a naturally occurring compound in water and soil at varying levels. Dr. McKay’s decades-long collaborative quest culminated with the discovery of fluorosis; the brown discoloration of tooth enamel caused by exposure to extremely high levels of fluoride, more than 10x higher than typically recommended for benefit. Continued research by NIH’s Dental Hygiene Unit helped determine the amount of fluoride that can be safely consumed while still avoiding fluorosis.
Water fluoridation, the controlled process of adding safe amounts of fluoride to a water system, is one of the most successful public health interventions of the 20th century. Regular exposure of our teeth to topical or systemic fluoride protects them from dental caries by helping us fight against the bacteria in our mouth. It does so by stopping the activity of the harmful enzymes produced by the bacteria. Fluoride also strengthens developing enamel, repairs mildly decayed enamel and arms our teeth to fight against bacteria, thereby reducing tooth decay.
A 10-year-long research study after the start of water fluoridation in Grand Rapids, Michigan, showed a significant decrease in dental caries of both permanent and baby teeth without the negative effect of fluorosis. On the other hand, Calgary, like Utah, stopped fluoridating their water back in 2011 and, in their research study that followed, they found a significant increase in dental caries of local babies’ teeth.
The results of the Calgary research should make us Utahns nervous with our new ban on water fluoridation, which went into effect on May 7, and potentially a federal ban on ingestible fluoride supplementations. Although exposure to topical fluoride can be achieved with fluoride varnish or fluoride toothpaste, fluoridating our water is an easy way to provide children from all backgrounds and socioeconomic status the same standard of care to protect them against dental caries regardless of access to dental care.
Tooth decay is bad because, when left untreated, it can cause permanent tooth loss, severe gum disease and smoldering infection.
Treatment for dental caries can be complex, expensive and may require dental procedures which can cause unnecessary exposure to anesthesia. Furthermore, not everyone can afford expensive therapies or even routine dental care. Now, without water fluoridation, we have lost our one weapon to shield our kids from tooth decay. We have also increased the barriers for all kids, especially those from lower socioeconomic status and rural communities to receive this standard of care.
Another concern recently raised is the effects of fluoride on neurodevelopment. The National Toxicology Program in the U.S. analyzed existing research and found no evidence of adverse effects of fluoride on cognition in adults when used in safe quantities but recommended more research to understand the effects on children. It is my opinion, based on existing evidence, that the known risk of dental caries and its long-term negative implications on overall health greatly outweighs the risks of insufficient evidence to prove that fluoride does not affect cognition in kids.
It is vital that parents know about other options to access fluoride so they can better advocate for their kids. Our current options to ensure kids get fluoride in safe quantities are toothpaste with fluoride, fluoride varnish and dietary fluoride supplements. Parents can start to use a smear of fluoridated toothpaste as soon as baby teeth start to come in. Fluoride varnish can also be helpful and is typically applied by healthcare providers. Dietary fluoride supplements can also ensure that kids get safe and protective quantities of fluoride. However, they are not available over the counter and need to be prescribed by doctors.
I urge parents to talk with their child’s primary care provider or dentist to discuss the best option for their child to receive fluoride safely so they can optimize their child’s oral health. I also urge pediatricians and dentists to have a conversation about fluoride with parents. We now have a collective responsibility to ensure our children receive the best care possible and prevent an epidemic of dental caries in Utah.
(Sarmishta Kannan) Dr. Sarmishta Kannan, MD, is a pediatrician in Salt Lake City.
Dr. Sarmishta Kannan, MD, is a pediatrician in Salt Lake City with an interest in pediatric emergency medicine, public health, advocacy and medical education.
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