Managing Challenges to Water Fluoridation Strategies and Resources Judith Feinstein, MSPH, Director Maine CDC Oral Health Program Augusta, Maine Chair, ASTDD Fluorides Committee

Objectives Describe effective strategies to use when CWF is challenged Discuss the role of a State Oral Health Program/State Health Department in a challenge Discuss the roles of partners and outside collaborators Identify ASTDD and web-based resources

Strategies Shift from “stealth” to proactive stance Issue specific as a tactic Variety of voices – not only the usual suspects Develop support apart from/along with responding to challenges

Community Water Fluoridation: Advantages and Benefits Judith Feinstein, Director Maine CDC Oral Health Program Augusta, Maine These next few slides summarize a presentation that was prepared for a specific audience and then used to create a template. This is only one of several templates that is available to you – you’ll hear more from Marcy shortly about other resources. A version of this presentation (with 26 slides) is available in the Members Only section of the ASTDD website as a template and resource for you: Purpose of presentation – explain why your organization supports CWF and why it is safe, effective and still important – even with multiple exposures and pending lower optimum level. The reason for developing this presentation was twofold – to have something for a technical training session at a state water utilities association meeting, and to create a template type approach to proactively present information about water fluoridation. As needed – start with an overview of your program/organization to give a context for your work around the promotion of CWF as one component of efforts around dental disease prevention. OVERVIEW: SAMPLE/TEMPLATE PPT (next 5 slides) Acknowledgements to the New York State Department of Health, Bureau of Dental Health for parts of this presentation.

Presentation to Water System Operators: Why CWF matters and why water systems are important Objectives Review history and extent of CWF in the state Demonstrate impact of CWF on health status * Demonstrate economic benefits * Acknowledge role of PWS operators * Topics Public policy and research (reviews) Why fluoridate? * Impact of tooth decay and dental disease (lifespan) * Action of fluoride * FAQs *: Health concerns; why fluoridation is still needed; fluorosis; changes in CDC & EPA recommendations

Background Public Policy on Fluoridation Reviews – Benefits & Safety Why Fluoridation? Fluoridated communities have 20%-40% less tooth decay (25%) Single most effective intervention Saves money: every dollar spent on water fluoridation avoids on average $38 - $42 in dental care Benefits all consumers across socio-economic status Benefits children and adults Benefits last a lifetime

Fluoride Action Systemic vs. topical and benefits to adults ---------------------------------- FAQs for water districts: Health concerns Why do we still need it Fluorosis, infant formula Changes pending from CDC and EPA

Why Fluoridation is Still Needed Water fluoridation is a population (community) level intervention Broad reach (equal opportunity) Safety, effectiveness, low cost Delivers a sustainable level of benefit in an inexpensive way (cost-effective) Changes in individual behaviors are difficult to accomplish

Conclusions Oral health status is improving We still have significant challenges Community water fluoridation is important Although it’s not an additive that makes water safer (as do other treatments), there is an important public health benefit Water systems and operators play an important role

Role of the State Oral Health Program Know your limits Work up through your organization Speak with one voice Provide/facilitate information and resources, data, and training Convene collaborating parties

Examples from states Maine: focus on issues raised by opponents framed by supportive arguments and information Iowa: countered public complaints with evidence of cost savings, public awareness campaign, and equipment grants program Alaska: in Bethel campaign, used previous experience to organize approach, with strong emphasis on data showing less decay

Partners and Collaborators New York experience… Iowa: partnered with Pew, Delta Dental of Iowa, and Iowa Public Health Association for public awareness campaign; with Delta Dental of Iowa Foundation for equipment Others

ASTDD Resources http://www.astdd.org/fluoridation-and-fluorides-committee/ ASTDD Statement in response to DHHS and EPA fluoridation announcements: Community water fluoridation remains the cornerstone of dental caries prevention in the United States and has been demonstrated to be safe, cost-effective and beneficial… Resources: Policies On Fluoride Best Practice Reports ASTDD Fluoridation Fact Sheet Organizations - General Fluoride Information Information by Topic Area Community Water Fluoridation ADA Links CDC Links

ASTDD Resources, continued Research Topical Fluorides, Gels, Foams Fluoride Supplements School Fluoride Programs Fluoride Toothpaste Members Only Section: Fluoridation Messaging Webinar, February 2012, “Rethinking How We Talk About Fluoridation” PowerPoint template Fluorides Committee

Judith A. Feinstein judith.a.feinstein@maine.gov Thank you Judith A. Feinstein judith.a.feinstein@maine.gov 207-287-3267