We just celebrated the 72nd anniversary of children's dental health initiatives in the United States. In recognizing this, it is important to look at one of the most, if not the most, significant accomplishments in the prevention of dental disease — optimally fluoridated community water supplies.
Prior to 1941, extensive dental decay was common in the United States. No effective measures existed for preventing this disease, and the most frequent treatment was to pull teeth. Interestingly, right around this time, an inverse relationship between naturally occurring fluoride in the water and the prevalence of cavities was noted. The number of cavities among children with more fluoride in their community water supplies was lower than in communities that had low levels of fluoride. Grand Rapids, Mich. was among the first cities to add fluoride to its community water system to achieve levels considered to be optimal for cavity prevention.
The program resulted in a dramatically reduced incidence of dental disease and was copied by many other densely populated areas, increasing in number over time to protect about 70 percent of the U.S. population. Today, over 200 million U.S. residents are served by optimally fluoridated water, and this number continues to steadily increase. Scientific evidence compiled over more than 60 years since demonstrates that fluoridation is a safe, effective, and cost-effective intervention. The tremendous success of fluoridation has led the Centers for Disease Control and Prevention to label it one of 10 great public health achievements of the 20th century.
Once the benefits of fluoride through community water fluoridation became clear, researchers began to explore other methods to deliver fluoride and by the 1960s manufacturers had developed additional methods. Exposure to other sources of fluoride, such as fluoride toothpaste, rinses, supplements and professionally applied gels and varnishes, has increased in all communities. In spite of these additional methods of fluoride delivery, optimal levels must be achieved through the adjustment of the fluoride levels in the water to appropriate levels for dental health.
Those opposed to community fluoridation, although relatively few in number, capitalize on public anxiety, distrust of government, environmental concerns, and fears of additives or contaminants in food and water. They have exaggerated links between community water fluoridation and bone fractures, and erroneously linked fluoridation to Alzheimer's, AIDS, cancer, thyroid, and kidney disease.
As a public health dentist, I see the consequences of these unfounded fears every day. Recently, the mother of a child I was treating voiced concerns about the health effects of fluoride. Her source was something she read on the Internet. She made sure her 5-year-old daughter used only "all natural" toothpaste and avoided anything that might contain fluoride. She made sure her daughter did not eat too many sugary foods and that she brushed regularly. You can imagine her dismay when I pointed out all of the cavities in her child's mouth.
Fortunately, she was open to discussing the concerns she had about fluoride, and she consequently understood that the scary things she heard were related to ingesting very high amounts of fluoride, the equivalent of two tubes of toothpaste in one sitting.
Strong, independently reviewed scientific evidence, studied innumerable times, consistently supports claims that the benefits associated with water fluoridation greatly outweigh the risks. Over 100 national and international health organizations endorse water fluoridation yet the public debate over this issue continues.
Cavities are expensive to treat, and there is a cost in lost work time and lost school time, not to mention pain and suffering associated with cavities. The good news is that optimally fluoridated water can inexpensively and easily prevent cavities. The average annual cost for a community to fluoridate its water is estimated to range from approximately 50 cents a year per person in large communities to about $3 a year per person in small communities. For most cities, every $1 invested in water fluoridation saves $38 in dental treatment costs. And all residents have to do is consume it.
Although no Hernando County public water systems are currently fluoridated, we sit in the enviable position of having the capability of fluoridating 90 percent of our population by just activating three of the 15 water treatment plants. Not only would this benefit the majority of our residents, it would assure that children and adults in lower socioeconomic areas of the county, those least likely to receive regular dental care, would receive this preventive without having to do anything. Further, because community fluoridation grants cover most of the cost of program implementation, very little, if any, financial contribution is required of local residents.
Of course, the annual maintenance of community fluoridation programs is not without cost. At about 50 cents per resident served, Hernando County could expect to invest about $79,000 per year. Granted, $79,000 is nothing to sneeze at but given the estimated $3 million savings in restorative care, hospital emergency room visits, work and school absenteeism and the impact dental disease has on overall wellness in one year, it is money wisely spent.
Dr. Pedro Lense is the senior dentist at the Hernando County Health Department.