Local Education About Fluoride and Fluoridation

We are hearing from many people on our Facebook page. While there have been a number of comments that are rude and from people from as far away as Australia who are associated with various anti-fluoride campaigns, most are from locals who raise excellent points for discussion and ask good questions, and do so in a civil manner that promotes good exchange of information. We will continue to work hard over the coming months to provide scientifically accurate information and answers to questions from people in  and around Bennington.

There was a recent article in the journal of the American Academy of Pediatrics that has been brought to my attention. (Clark, MB et al; Fluoride Use in Caries Prevention in the Primary Care Setting; Pediatrics 2014;134:626-633.) The American Academy of Pediatrics is dedicated to the Health of All Children. The article was presented in the Clinical Reports section which provides guidance to clinicians rendering pediatric care.

The following is excerpted from the article and provides an up-to-date overview of the tragedy of dental disease as well as a clear explanation of how dental caries form and how fluoride works on the teeth. The full article is available on-line at link: http://pediatrics.aappublications.org/content/134/3/626.full.html.

“Dental caries (ie, tooth decay) is an infectious disease in which acid produced by bacteria dissolves tooth enamel. If not halted, this process will continue through the tooth and into the pulp, resulting in pain and tooth loss. This activity can further progress to local infections (ie, dental alveolar abscess or facial cellulitis), systemic infection, and, in rare cases, death. Dental caries in the United States is responsible for many of the 51 million school hours lost per year as a result of dental-related illness, which translates into lost work hours for the parent or adult caregiver.1 Early childhood caries is the single greatest risk factor for caries in the permanent dentition. Good oral health is a necessary part of overall health, and recent studies have demonstrated the adverse effects of poor oral health on multiple other chronic conditions, including diabetes control.2 Therefore, the failure to prevent caries has health, educational, and financial consequences at both the individual and societal level.

Dental caries is the most common chronic disease of childhood,1 with 59% of 12- to 19-year-olds having at least 1 documented cavity.3 Caries is the “silent epidemic” that disproportionately affects poor, young, and minority populations.1 The prevalence of dental caries in very young children increased during the period between the last 2 national surveys, despite improvements for older children.4 Because many children do not receive dental care at young ages, and risk factors for dental caries are influenced by parenting practices, pediatricians have a unique opportunity to participate in the primary prevention of dental caries. Studies show that simple home and primary care setting prevention measures would save health care dollars.5

Development of dental caries requires 4 components: teeth, bacteria, carbohydrate exposure, and time. Once teeth emerge, they may become colonized with cariogenic bacteria. The bacteria metabolize carbohydrates and create acid as a byproduct. The acid dissolves the mineral content of enamel (demineralization) and, over time with repeated acid attacks, the enamel surface collapses and results in a cavity in the tooth. Protective factors that help to remineralize enamel include exposing the teeth to fluoride, limiting the frequency of carbohydrate consumption, choosing less cariogenic foods, practicing good oral hygiene, receiving regular dental care, and delaying bacterial colonization. If carious lesions are identified early, the process can be halted or reversed by modifying the patient’s individual risk and protective factors. Certain American Academy of Pediatrics (AAP) publications (Oral Health Risk Assessment Timing and Establishment of the Dental Home6 and Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents7) discuss these concepts in greater depth and provide targeted preventive anticipatory guidance. The Medical Expenditure Panel Survey demonstrated that 89% of infants and 1-year-olds have office-based physician visits annually, compared with only 1.5% who have dental visits.8 For primary prevention to be effective, it is imperative that pediatricians be knowledgeable about the process of dental caries, prevention of the disease, and available interventions, including fluoride.

Fluoride is available from many sources and is divided into 3 major categories: tap water (and foods and beverages processed with fluoridated water), home administered, and professionally applied. There has been substantial public and professional debate about fluoride, and myriad information is available, often with confusing or conflicting messages. The widespread decline in dental caries in many developed countries, including the United States, has been largely attributable to the use of fluoride. Fluoride has 3 main mechanisms of action: (1) it promotes enamel remineralization; (2) it reduces enamel demineralization; and (3) it inhibits bacterial metabolism and acid production.9The mechanisms of fluoride are both topical and systemic, but the topical effect is the most important, especially over the life span.10