Dr. Royal P. DeLegge Environmental Health Director Salt Lake County Health Department.

Slides:



Advertisements
Similar presentations
Muddy waters: the use and abuse of findings from the 'York Review' on fluoridation Paul Wilson.
Advertisements

Water Fluoridation and Children's Teeth Audience This presentation has as primary target audience: Parents in Congolese communities in the United States.
Chromium and Fluoride Analysis in Water Travis Rutherford Mitchell Small.
COMMUNITY WATER FLUORIDATION IN NEW YORK STATE MAY 7, 2013 Jay Kumar, DDS, MPH.
Katya Mauritson, DMD Oral Health Unit Director Colorado Department of Public Health and Environment.
Food Safety Legislation. Introduction Victorian England ( ) The history of much modern food safety legislation can be traced back to Victorian.
Prepared by Margo Eyeson-Annan New South Wales Health Survey Program, Centre for Epidemiology and Research New South Wales Department of Health March 2006.
Fluoridation seems like a “no-brainer” Helps Americans keep their teeth (reduces cavities by up to 40%) Saves millions in treatment costs and eliminates.
Improved risk communication through assessment of Kentucky citizens’ perception of environmental pollutants, health and nutrition behavior. Elizabeth Willett.
An Assessment of First Dental Visits Between Birth and the 1 st Year, Utah Shaheen Hossain, PhD Karen L. Zinner, MPH Peggy A. Bowman RDH, BA.
 Since the 1960s, the United States Government has defined poverty in absolute terms. This makes poverty more easily measurable.  The "absolute poverty.
There’s Something in the Water: Ten Facts About Fluoridation Presentation by Michael Connett Fluoride Action Network January 13, 2010.
Assessing Disease Frequency
New Employee Orientation
Evaluation of the Qualified Loss Management Program for Massachusetts Workers’ Compensation History and description of the Program Data and techniques.
A Weighty Proposition What is Known Regarding Childhood Obesity Learning Session #1.
The UK Freedom of Information Act – A Practical Guide for Academic Researchers Cambridge Wednesday, 16 February 2011.
DR. SHAHZADI TAYYABA HASHMI Systemic Fluorides. Fluoride supplementation SystemicTopical Dietary fluorides Salt fluoride Fluoride in sugar Water fluoridation.
SDWA1 The Safe Drinking Water Act (SDWA) The Safe Drinking Water Act (SDWA)
History of Water Fluoridation. Two stories unfolded over more than half a century:  The story of the harmful effects of fluoride in large doses  The.
Katya Mauritson, DMD Oral Health Unit Director Colorado Department of Public Health and Environment.
1..  Fluoride is the ionic form of the element fluorine.  Fluoride is a mineral found throughout the earth's crust and widely distributed in nature.
Our Government in Action
Rosa Martinez. Benefits of natural water fluoridation were noticed in 1930 by Dr. Frederick Mckay. In 1945, Grand Rapids, Michigan became the first city.
TASER ® Risk Avoidance Program (RAP) MICHIGAN MUNICIPAL RISK MANAGEMENT AUTHORITY.
Soil Contamination Countermeasures Hyogo Prefectural Government Agricultural & Environmental Affairs Department Environmental Management Bureau Water &
IFA Global Conference Prague May 2012 Kick Off Mandatory Reporting Pros and Cons A USA Perspective Susan B. Somers, JD Secretary General INPEA.
The INTRODUCTION. Purpose: to convince the reader that your study will yield knowledge or knowhow that is new and useful.
Managing Challenges to Water Fluoridation
SYSTEMIC FLUORIDES Dr. Shahzadi Tayyaba Hashmi
“...the potentially harmful impact on human health and the environment.....” The Montreal Protocol and Human Health STRATOSPHERIC OZONE DEPLETION INCREASED.
Oral Health in Maine: Facts & Figures, August 2005 Judith A. Feinstein, MSPH Director, Maine Oral Health Program ME Center for Disease Control & Prevention.
West Contra Costa USD Presentation to the Facilities Subcommittee December 11, 2012.
Water Fluoridation November 21, 2007 Abdullah S. Al-Swuailem BDS, MS, MPH, Dr PH.
Amherst County Comprehensive Plan (Update)
What are some ways to reduce the risks to public health in drinking water from Salinas Valley? Andrew Mims Nitrates In Groundwater Presentation ENSTU 300.
LEARNING OBJECTIVES Understand the biologic mechanism of fluoridation Understand the biologic mechanism of fluoridation Understand the benefits, possible.
Bureau of Environmental Health Assessment Massachusetts Department of Public Health February 13, 2002 Public Meeting: MDPH Activities in South Weymouth.
Democracy, Discrimination & Public Trust by. Canadian Dental Association Code of Ethics:
Reclaimed Wastewater Quality Criteria, Standards, and Guidelines
1 Children and chemical safety: framework for action to protect children from harmful exposures Presented on behalf of the IFCS Children & Chemical Safety.
Equitable access to water, Paris Access to Drinking Water in MDA Ion Shalaru, Head of Environmental Health Department, National Scientific.
A TOUR OF NORTH CAROLINA COUNTY GOVERNMENT WHAT IS A COUNTY?
Report to the Legislature Required by Senate Bill 2202 (due January 1, 2002) Board Briefing June 13, 2001 Agenda Item 5 Attachment 1.
Chapter 21 Water Pollution. Types of Water Pollution  Water pollution  Any physical or chemical change in water that adversely affects the health of.
By Michelle Hoang Period 2 APES April 30, 2012 The Toxic Substances Control Act of 1976.
The Importance of Caring for Baby Teeth
Critical Improvements to National Mercury Disposal Practices Presented by: Mercury Waste Solutions, Inc. ©COPYRIGHT 2003 – Mercury Waste Solutions, Inc.
Water Quality By Taylor Vigil, Zachary Borrego, & Kenneth Trujillo.
SCHOOL LEVY INFORMATION Quincy School District February 2015.
Activities Review for the Water Unit Test.
1. Consumers, Health, Agriculture and Food Executive Agency Risk assessment with regard to food and feed safety Risk analysis Why risk assessment in the.
School Oral Health Program (SOHP) 2 Dr Hidayathulla Shaikh.
Community Water Fluoridation Community Water Fluoridation Maintaining a Legacy of Healthy Teeth in Muskoka Dr. Charles Gardner, Medical Officer of Health.
Community Water Fluoridation Maintaining a Legacy of Healthy Teeth in Tottenham Dr. Charles Gardner, Medical Officer of Health New Tecumseth Council Committee.
Fluoride is a substance found in water as well as numerous types of foods. Even so, the majority of American children don’t consume enough fluoride for.
Occupational Health Indicators in Wyoming, 2001 – 2005 Mulloy KB 1, Stinson KS 1,Boudreau Y 2, Newman LS 1, Helmkamp J 2 1 – Mountain and Plains Education.
Catering Food Service Development
SWDA.  The average total home water use for each person in the U.S. is about 50 gallons a day.  The average cost for water supplied to a home in the.
Community Water Fluoridation Community Water Fluoridation Maintaining a Legacy of Healthy Teeth in Muskoka Lakes Dr. Charles Gardner, Medical Officer of.
The history of water fluoridation
Dental Fluorosis BY SULU SAMOYLOV.
OFFICE OF THE CITY CLERK AUGUST 24, 2017 REQUEST FOR DIRECTION REGARDING POTENTIAL AMENDMENTS TO THE CITY CHARTER THAT MAY BE NECESSARY TO COMPLY WITH.
Water and food fluoridation
Fluoride Supplements.
Lesson 26: How Does American Federalism Work?.
Water Fluoridation Safety and Efficacy for Children and Young Adolescents By: Sunday Rivers Walden University PUBH Environmental Health.
Minamata Convention on Mercury
The History Of Water Fluoridation
MEASURING DENTAL FLUOROSIS
Presentation transcript:

Dr. Royal P. DeLegge Environmental Health Director Salt Lake County Health Department

The story of fluoridation begins with a mystery staining of the teeth first described by dentist Dr. Frederick McKay in Colorado in 1901 and, independently in Naples, Italy in 1902 by Dr. J.M. Eager, an American dentist stationed there.

Dr. McKay became aware of several cases that suggested that the water supply might be responsible for the staining. He also noted that decay rates were much lower in areas with endemic dental staining than they were in other adjacent areas.

In Essex, United Kingdom, a dentist named Norman Ainsworth had found local dental staining similar to McKay's description of “Rocky Mountain Mottled Teeth”. In a 1925 study Dr. Ainsworth examined more than 4,000 children and produced a statistical comparison of decay rates between populations with the staining and those without. This study showed that individuals living in areas where mottled teeth were most common tended to have a much lower incidence of dental decay.

The US Public Health Service investigated this relationship and appointed a dentist, Dr. H.T. Dean, to carry out the research. In a series of epidemiological investigations, Dr. Dean established that mottling of the teeth was extremely rare at fluoride levels of 1ppm or below, while there was a significant preventive effect for dental caries found at 1ppm.

Public health authorities in the United States decided to try and reproduce this effect in low-fluoride areas by adding fluoride to community water systems. No obvious negative health effects had been noted in those populations served by naturally fluoridated water.

Pilot Programs A number of pilot programs were set up to see whether the idea could work in practice. On 25th January 1945, Grand Rapids, Michigan, became the first town in the world to be artificially fluoridated. The previous year, a baseline study comparing Grand Rapids with the neighboring town of Muskegon had found similar decay levels in deciduous and permanent teeth in both areas. Six years later, surveys indicated that decay levels in 6 year-old children (i.e. those born since fluoridation commenced) in Grand Rapids was almost half of that in Muskegon. In July 1951, city officials in Muskegon decided to fluoridate that town's water supply.

Other Pilot Programs Newburgh, New York, started fluoridating in May Evanston, Illinois, began fluoridating in January As with the Grand Rapids scheme, these towns were paired with nearby “control” towns (Kingston, New York and Oak Park, Illinois) in order to measure the effectiveness of the fluoridation scheme. In both cases, significant reduction in dental decay rates were described in the fluoridating towns, with little or no change found in the control towns.

Early studies reported reductions in decay on the order of 50% or more. This was at a time when fluoridated water offered the only significant source of fluoride available to people.

Utah Fluoridation History In 1970, only 2.5% of Utah’s population had access to community fluoridated water systems and served fewer than 30,00 customers. Naturally fluoridated water systems supplied fewer than 3,000 persons.

Only five artificially fluoridated water systems were in place: Brigham City Helper Hill Air Force Base Two Native American Reservations

Opposition to Fluoridation There has been opposition to artificial water fluoridation since its inception. Opponents were concerned about placing a chemical, mandated by the government, into water supplies and posed numerous arguments over the need and expense of implementation. Also, since fluoride did not treat the water for safety, although it had a population-wide positive health effect, it was viewed as an unwarranted government intrusion on personal rights.

Utah Freedom from Compulsory Medication Act of 1976 “Public water supplies…shall not have fluoride or any of its derivatives or compounds, or any other medication added thereto without the approval of a majority of voters in a duly constituted election in the area affected thereby.”

1976 Act The Act moved the debate away from cost to effectiveness and safety. Concern was expressed that the issue was one of free choice, mass medication and government interference in the lives of citizens. The Act was passed in a statewide election with a 51.6% majority.

Pro-fluoridation groups continued to work to implement fluoridation at the local level, mostly in Northern Utah. The most active efforts were in Salt Lake and Davis counties.

Current Fluoridation Programs In November 2000 the voters passed a ballot initiative in Salt Lake County approving the fluoridation of public drinking water supplies. At the same time, an advisory referendum for fluoridation was passed in Davis County.

Fluoridation Status In the wake of the 2000 votes Utah moved from 50 th in the nation, with 2.0% of the population fluoridated, to 39 th with 54.3% of the population receiving fluoridated water.

Safety of Water Fluoridation The question of the safety of water fluoridation has been investigated time and time again by numerous national and international commissions. One of the most recent, and arguably the best, is the United Kingdom’s National Health Service Centre for Reviews and Dissemination in 2000, also known as the York Review. This meta-study provides a systematic review of more than 3,000 studies relevant to dental and general effects of water fluoridation on humans. The main conclusion was that there was no clear evidence of any adverse effect from water fluoridation other than staining of enamel (dental fluorosis).

Adverse Effect Claims Claims have been made that water fluoridation is linked to almost every conceivable condition known to medicine - and some conditions beyond. The range of allegations covers such diverse items as cancer, Alzheimer's disease, effects on salmon spawning, and even increasing crime rates in American cities. The fact that none of these have so far been found to have any substance should not be surprising; there are populations that have been drinking naturally fluoridated water at around 1ppm for centuries for whom no obvious adverse effects have been demonstrated.

Other forms of community fluoridation used worldwide Salt Milk Toothpaste Food & Beverages

Fluoridated Salt Several other methods have been evaluated for providing community water fluoridation. Fluoridated salt is used quite successfully and widely in Europe and South America. In situations where all salt in the economy is fluoridated, including that used in food production, its effectiveness comes close to that of water fluoridation. However, where fluoridated salt is simply provided on sale along with unfluoridated salt, its effectiveness on a population basis has been shown to be limited.

Milk Fluoridation Milk fluoridation programs have been implemented most notably in the United Kingdom and in Chile. In the Manchester, UK area, the Borrow Scheme was set up to provide fluoridated milk to primary school children. In Chile, fluoridated milk is provided through the health service rather than through schools. This method of fluoridation is quite promising but, while beneficial, the effect does not appear to provide as strong an effect as does water fluoridation.

Fluoridated Toothpaste A major method of fluoridation is, of course, the use of fluoridated toothpastes. It is estimated that in excess of 95% of toothpaste sales are of fluoridated products.

Current Fluoridation Regulations After the November 2000 ballot initiative in Salt Lake County and advisory referendum in Davis County, both local health departments worked to implement their mandates.

The Salt Lake Valley Board of Health adopted implementation target dates of by November 1, 2001 for surface water sources and January 1, 2002 for groundwater sources. The Board also invited Salt Lake County water districts to a meeting to discuss the issues relating to implementation and agreed to form a Task Force comprised of representatives from each affected water district, SLVHD, UDOH, and UDEQ to work out implementation issues.

In July 2001 the Task Force recommended a new implementation date of October 1, 2003, which was accepted by the Board of Health. The SLVHD Water Quality Bureau staff and Davis County staff worked together to develop local regulations, which were discussed with, and modified by, the Task Force over a period of more than a year.

In Salt Lake County, SLVHD Health Department staff members met with personnel of several water systems to devise methods of reducing costs by fluoridating only certain water sources, rather than all of the system’s sources, in ways that would still provide uniform concentrations throughout their systems. In the case of one system, Holliday Water, this reduced their estimated costs by more than 80%.

There are 14 systems that are actively fluoridating in Salt Lake County. Four other systems: Bluffdale, Draper, South Jordan, and the University of Utah, all import their water from fluoridated systems. One system, Holliday Water Company, is not adjusting its fluoride levels above natural levels (of 0.4 ppm) as a result of legislative action that allows a privately held water company to decide its own fluoridation status. Another system with a population over 3,300, White City Water, is not fluoridating due to its recognized status as a functionally separate system. The health regulation was amended to add such an exemption status. The combined population served by fluoridated systems is approximately 96% of the county’s population that is served by water systems.

Fluoridation Chemical Impurities Much has been made of the source of, and impurities in, fluoridation chemicals (primarily hydrofluosilicic acid). Opponents have claimed that arsenic and lead are contaminants of concern.

Since implementation, opponents to water fluoridation have brought up a number of strategies to prevent or delay the implementation of community water fluoridation. One of the strategies is to question the quality and safety of chemicals used in the fluoridation process.

Hazardous Waste One claim regarding hydrofluosilicic acid used in water fluoridation is that it is a hazardous waste. The claim that hydrofluosilicic acid used in water fluoridation in the United States is a hazardous waste that has been redirected to water systems to avoid disposal issues is simply not true. The designation of hydrofluosilicic acid as hazardous material is due to its low pH (1.2). When considering the application rate of the chemical in drinking water supplies the pH hazard does not exist. There are numerous chemicals used in water purification, food production and preparation and the pharmaceutical industry that if discarded as waste would be classified as hazardous waste. None of these chemicals are designated as hazardous waste in their intended use.

Contaminants Two heavy metals, lead and arsenic, have been targeted as contaminants of fluoridation chemicals that would place the public at risk when the water is fluoridated. The question of arsenic contamination has been spurred with the lowering of the U.S. Safe Drinking Water Act maximum contaminate level (MCL) from 50 ppb (parts per billion or micrograms per liter [ug/L]) to 10 ppb.

Laboratory Analysis of Water at Weber Basin Treatment Plant ChemicalPre-fluoridationPost-flouridation Fluoride0.1 mg/L0.9 mg/L Arsenic<1.0 ug/L<1.0 ug/L Chromium<5.0 ug/L<5.0 ug/L Iron<0.02 mg/L<0.02 mg/L Mercury<0.2 ug/L<0.2 ug/L Silver<2.0 ug/L<2.0 ug/L Barium mg/L mg/L Copper<12.0 ug/L<12.0 ug/L Lead<3.0 ug/L<3.0 ug/L Selenium<1.0 ug/L<1.0 ug/L Jason, Karen, APC

Recent Legislative Action In 2013, the Utah legislature passed a law requiring original certification documents for fluoride chemicals added to community water systems. All of these chemicals are currently certified by NSF or UL.

Certification Documentation Original certification documentation for hydrofluorosilicic acid are readily available and have been obtained by water systems. Original certification documentation for sodium fluoride has been more difficult to secure.

Local History In 2010 the SLVHD and Board and Davis County Boards of Health, as a result of the biennial review and under recommendations by the CDC, decreased the targeted average annualized concentration of fluoride from 0.8 mg/L (ppm) to 0.7 mg/L (ppm).

The change to a lower annualized target concentration is to balance overall exposure to fluoride given the extraneous exposure now provided in the United States by processed foods and especially by soft drinks.

The change was also a response to an advisory that parents of infants under 6 months of age should consider reconstituting formula with unfluoridated water to reduce the already low possibility of dental fluorosis developing in deciduous teeth.

Dental fluorosis It is known that fluoridation of water supplies would be associated with low levels of enamel discoloration. Early studies predicted that very mild enamel fluorosis would affect a small proportion of a population receiving fluoridated water. The medical and dental communities have accepted that a low level of fluorosis is well worth the large reduction in dental decay brought about by fluoridation.

Dental fluorosis is a health condition caused by a child receiving too much fluoride during tooth development. The critical period of exposure is between 1 and 4 years of age; children over age 8 are not at risk. In its mild form, the most common, fluorosis appears as tiny white streaks or specks that are often unnoticeable to the untrained eye. In its severest form, also known as mottling of the tooth enamel, it is characterized by black and brown stains, and may include cracking and pitting of the teeth.

Mild case of dental fluorosis, visible as white streaks on the subject's upper right central incisor

Severe case of dental fluorosis

Dental fluorosis is not a health problem but is considered only cosmetic. When it occurs it is treatable by a dentist. The incidence of fluorosis associated with community water fluoridation concentrations is negligible.