Water Fluoridation Safety and Efficacy for Children and Young Adolescents By: Sunday Rivers Walden University PUBH-8165-2 Environmental Health

Water Fluoridation In 2000, the center for disease control and prevention (CDC) estimated that 162.1 million Americans were receiving fluoridated water, which is 57.6% of the total population and includes 65.8% of those on public water systems (Macek, Matte, Sinks, and Malvitz, 2006, p.130). Reference: Macek, M., Matte, T. Sinks, T. and Malvitz, D. (2006). Blood lead concentrations in children and method of fluoridation in the United States, 1988-1994. Environmental Health Perspectives, 114, (1), p.130-134.

Water Fluoridation Fluoridation of drinking water began 60 years ago in the United States, and it continues in 60% of public water supplies in the country (Kauffman, 2005, p.38). Harmful effects my include bone and tooth fractures and increased cancer rates. Reference: Kauffman, J. (2005). Water Fluoridation: a Review of Recent Research and Actions. Journal of American Physicians & Surgeons, 10 (2), 38-44.

Water Fluoridation 70% of cities in the United States with populations > 100,000 have community fluoridated water programs. 42 of the 50 largest cities in the United States had fluoridated water supplies by 1992 Reference: Milgrom, P. and Reisine, S. (2000). Oral Health in the United States: The Post-Fluoride Generation. Annual Review Public Health, 21, 403-436.  

Other Sources of Fluoride Toothpaste Most widely used topical source of fluoride Fluoridated food meat, fish, poultry Beverages (tea) Breast milk Professional Use Mouth rinse Reference: Milgrom, P. and Reisine, S. (2000). Oral Health in the United States: The Post-Fluoride Generation. Annual Review Public Health, 21, 403-436.   Mouth rinse: the most widely used fluoride mouth rinsing agent is NaF. Food makes up 6% to 7% of total dietary fluoride. The fluoride concentration of beverages matches the fluoride concentration of water, because the content of beverages is mostly water. In most established communities, fluoride toothpaste makes up 95% of the commercial dentifrices market. The amount of toothpaste ingested is inversely proportional to age. Fluoride ingestion from toothpaste is a particular problem for young children in fluoridated communities, since they already receive sufficient fluoride. Young children should use only dab or pea-sized quantity of toothpaste on a child. Raw tea leaves may contain as much as 400ppm of fluoride.

Community Water Fluoridation Remains one of the most successful public health programs in American history. Fluoridated water is accessible to all people regardless of socioeconomic status, educational attainment or other social measures Members of the community do not need to change behavior to obtain the benefits of fluoride The frequency of exposure is higher and is present over time, making it effective through the life span in preventing caries Community water fluoridation is more cost effective than other forms of fluoride application Despite the problem of fluorosis that accompanies fluoridation and despite the fact that other sources of fluoride are now supplementing water fluoridation.

No Water Fluoridation Although safety and efficacy of water fluoridation is well established in the scientific community, some oppose its practice. Opponents of fluoridation have argued that fluoridation is associated with increased risk of cancer, congenital anomalies Alzheimer’s disease, AIDs, bone fractures, and Gilberts disease

Fluorosis Dental fluorosis is a hypomineralization of enamel of teeth caused by the chronic ingestion of excessive amounts of fluoride during the period when teeth are forming within the jaw. Fluorosis does not affect the health of teeth or of an individual, but, it in its more severe forms, may cause cosmetic concerns. Critics of water fluoridation and some public health officials have been concerned that fluoride exposure may be too high.

No Water Fluoridation Other arguments against community fluoridation center around cost, freedom of choice, violation of individual rights and religious beliefs Antifluoridation activists have also argues that fluoridation is conspiracy involving the US government, the health care establishment, and industry. Reference: Milgrom, P. and Reisine, S. (2000). Oral Health in the United States: The Post-Fluoride Generation. Annual Review Public Health, 21, 403-436.  

Why Water Fluoridation? Starting of continuing water fluoridation in a community can decrease tooth decay by as much as 50%, while discontinuing the practice can increase dental caries by as much as 60% (Water Fluoridation crucial for community health., 2002). Reference: Water Fluoridation crucial for community health. (2002). Nation's Health , 6.

Why Water Fluoridation Fluoride has change the face of dental diseases in this country Dental caries or tooth decay, is a symptom of bacterial infection in the mouth that causes a physiological disturbance resulting in demineralization of the teeth.

Why Fluoridated Water? Dental caries and periodontal disease are the most common oral health problems of children and adults in the United States. 20% of children, however, have 80% of all dental problems. Reference: Milgrom, P. and Reisine, S. (2000). Oral Health in the United States: The Post-Fluoride Generation. Annual Review Public Health, 21, 403-436.  

Intervention If prevention is to be maximized, initial examinations and the education of parents in the application of preventive procedures should begin during the first year of life. Reference: Milgrom, P. and Reisine, S. (2000). Oral Health in the United States: The Post-Fluoride Generation. Annual Review Public Health, 21, 403-436.

Barriers Many of the challenges facing the post-fluoride generation have to do with poverty other socioeconomic disparities Lifestyle Limitations in access to care Dental fear Children and adults from low income and immigrant families in the united states are often in poor oral health. Fluoridation programs are widespread throughout the country yet nearly half the population do not know the benefits of such a program. Medicaid intended to help the most needy of individuals is limited in terms of its access to dental care. Payments to dentist from Medicaid are so low that many dentist do not accept this insurance.

Strategies for Public Health Dental health needs should transcend the local and state level. It must gain national attention More community outreach programs Early intervention Increase periodontal care Increase attention to smoking cessation and oral cancer. Reference: Milgrom, P. and Reisine, S. (2000). Oral Health in the United States: The Post-Fluoride Generation. Annual Review Public Health, 21, 403-436. Dental programs should be linked to prenatal and baby care. Most people lose their teeth because they have never seen a periodontists. Mass media campaigns against smoking that have improved behavior could reduce smoking prevalence and oral cancer.

References Horowitz, H. (1999). Proper use of fluoride products in fluoridated communities. Lancet, 353 (9613), 1462. Kauffman, J. (2005). Water Fluoridation: a Review of Recent Research and Actions. Journal of American Physicians & Surgeons, 10 (2), 38-44. Macek, M., Matte, T. Sinks, T. and Malvitz, D. (2006). Blood lead concentrations in children and method of fluoridation in the United States, 1988-1994. Environmental Health Perspectives, 114, (1), p.130-134. Milgrom, P. and Reisine, S. (2000). Oral Health in the United States: The Post-Fluoride Generation. Annual Review Public Health, 21, 403-436. Water Fluoridation crucial for community health. (2002). Nation's Health , 6.