Saturday, January 8, 2011

Government recommends lowering fluoride levels in U.S. drinking water.

According to the Department  of Health and Human Services and The Environmental Protection Agency a proposed  change in the levels of fluoride  will be made to about .7 parts per million from the range of .7 to 1.2 ppm created in 1962. This is due to an increase in dental fluorosis seen in teenagers aged 12 to 15.

Decay rates have dropped dramatically in the past 5 decades in "westernized countries"

"Since the 1960s and 70s, however, a continuous reduction (in tooth decay) has taken place in most 'westernized' countries, it is no longer unusual to be caries-free... During the decades of caries decline, a number of actions have been taken to control the disease, and the literature describes numerous studies where one or several factors have been evaluated for their impact. Still, it is difficult to get a full picture of what has happened, as the background is so complex and because so many factors may have been involved both directly and indirectly. In fact, no single experimental study has addressed the issue of the relative impact of all possible factors, and it is unlikely that such a study can ever be performed."
SOURCE: Bratthall D, Hansel-Petersson G, Sundberg H. (1996). Reasons for the caries decline: what do the experts believe? European Journal of Oral Science 104:416-22.

The influence of fluoride is definitely a major factor. The problem however is knowing just how much fluoride a person is actually getting. Fluoridation of the public drinking water is banned in many European countries and the decay rate has still dropped dramatically. These same countries have fluoride available to them in fluoride supplements, toothpaste, rinses, and possibly in processed  foods and drinks from places where the water used is fluoridated.  

Fluoride toxicity

Anti-fluoridationists have made a lot of claims against the use of fluoride which I will not cover, but it is true that fluoride (as are many other chemicals and compounds), is toxic in sufficient doses.

 It is also true that teeth with fluoride incorporated in them during development or subjected to regular proper fluoride treatments have significantly less decay when all other conditions remain the same.

Mild dental fluorosis can be a cosmetic problem ,and should not be taken lightly.  I support a lowering of the level of fluoride in drinking water if it will help prevent fluorosis.

The tooth decay process and fluoride

Tooth decay is a very complex process involving bacterial plaque, saliva, a nutrient source, time, and the tooth. It can be slowed, stopped and even reversed through several methods. One method is to make the tooth less susceptible to acid attack by incorporating fluoride into or onto the tooth. Fluoride is a negative element which bonds strongly to other positive compounds like those in teeth. In this way it helps prevent the tooth from dissolving in the acid formed by bacteria.

Your rights

 I respect the right of parents to choose a fluoride free lifestyle since we are bombarded with chemicals whose ultimate  combined effects are hard to determine. Allergies and other inflamatory conditions are on the rise, and much is unknown about some of the causes.

My Soapbox

Everything we do as a preventive measure is based on risk versus benefit. If the decay fighting effects of fluoride helps children have more decay free dental visits, I think it is worth it. 

How much fluoride

This is a good question as the current water fluoridation guidelines is .7 to 1.2 parts per million. This is based on the amount of water one drinks. In a warmer climate, one would theoretically drink more water and require a lower concentration of fluoride (The regulation was written before the general use of air conditioning in the southern states). 
Since we now have a greater availability of bottled water and  use of prepared foods and bottled drinks, the amount of fluoride ingested is difficult to determine. 
Also use of fluoridated toothpaste, rinses, and dental fluoride treatments, increases the ingestion of some fluoride.

Measurements of fluoride are confusing as toothpaste, fluoride rinses, and fluoride treatments are based on % of fluoride by weight. Water fluoridation levels based on mg/liter. All of these factors are complicated by the size and age of the person ingesting the fluoride.

Bottom line

One cannot easily determine how much fluoride is needed for the benefit.

We need standardization, clarification, and disclosure on the part of all manufacturers and agencies. 

Parents and dentists need simple clear guidelines on recommended fluoride consumption for children.

More fluoride toothpastes for children need to be developed with age dependent formulas.

Parents must be judicial in monitoring children under the age of 8 using fluoride toothpastes to make sure they do not swallow it.

I welcome your comments.

Phillip C. Neal DDS
Crystal Lake Dental Associates
280 B Memorial Court
Crystal Lake, Illinois 60014
815 459 2202

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Born in the Midwest. Married with 6 children and 3 grandchildren. Attended Maine West High School, Harper Jr College, Northern Illinois University, the University of Illinois College of Dentistry. Practice in Crystal Lake, Illinois.

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