Fluoridation of Municipal Water Supplies - Essay Example

Fluoridation Fluoridation of Municipal Water Supplies Fouzia Shahabzada Research Project Principles of Dental Hygiene II Fluoridation 2 Abstract Fluoridation is the practice of adding fluoride to an existing substance. Fluoride is most commonly added to public water supplies, toothpaste, and salt. The goal of fluoridation is to reduce dental decay, especially in young children. Usually a compound containing or producing fluoride is added to water in order to reach a level of one milligram of fluoride ion per liter (1 part per million). A Maximum Contaminant Level (MCL) was set in 1986 by the EPA at 4 ppm to avoid skeletal fluorosis, a bone-decaying disease. Fluoridation has been under scrutiny for the past 50 years and has come under severe criticism from many quarters in the last decade. Critics of fluoridation say that past research is biased and outdated. Proponents of fluoridation cite their own research and insist that fluoridation has proven itself useful and safe in preventing dental decay. Both sides have creditable supporters and the conflict has no straightforward solution. With the question of whether fluoridation has a proven health benefit to people, comes the issue of individual rights. There exists argument that the rights of individuals are violated when they are forced to consume fluoridated water. Some have gone so far in protest as to acquire their own sources for unfluoridated water. As a result of the debate over the effectiveness and health risks of fluoridation, there is a belief that the Fluoridation 3 public water supply should be free of fluoride. And there is evidence to support this belief. By 1992, nearly 60% of the American public consumed water from fluoridated sources. Fluoridation began in the US in 1945 and has since been implemented in almost every major city. The Center for Disease Control (CDC, 1999) lists the fluoridation of drinking water as one of the top ten advancements made in American public health since 1900. Evidence suggests that ingested fluoride systemically prevents tooth decay while teeth develop. Topical application to mature teeth has also shown to reduce tooth loss in adults. . Fluoride strengthens teeth and makes them more decay-resistant. Fluoride acts on the enamel of teeth. The enamel is made less soluble and plaque-forming organisms have a reduced ability to produce acid. Remineralization also occurs in areas where acids have caused demineralization. The ADA fully endorses fluoridation of community water sources and recommends dietary fluoride supplements for children aging from six months to sixteen years old living in non-fluoridated areas. Tooth decay, also known as dental caries, is a health problem that has plagued human kind for centuries. Up until 60 years ago, the damage caused by Fluoridation 4 caries was an inevitable fact of life for most people. The disease often meant many visits to the dentist where damaged and painful teeth were repaired or removed. Today, primarily as a result of fluoride, damage caused by decay can be reduced and, in many instances, prevented. Fluorides' benefits for teeth were discovered in the 1930's. Dental scientists observed remarkably low decay rates among people whose water supplies contained significant amounts of natural fluoride. Several studies conducted during the 1940s and 1950s confirmed that when a small amount of fluoride is added to the community water supply, decay rates among residents of that community decrease. Although these studies focused primarily on the benefits of water fluoridation for children, more recent studies demonstrate that decay rates in adults are also reduced as a result of fluoride in the drinking water. Water fluoridation prevents tooth decay in two ways. The first is through direct contact with teeth and the second is by systemic absorption in the body. The most inexpensive way to deliver the benefits of fluoride to all residents of a community is through water fluoridation. All water naturally contains some fluoride. When a community fluoridates its water, it adjusts the level of fluoride in the water to the optimal level for preventing tooth decay. Currently, more than 170 million Fluoridation 5 people in the United States are using public water supplies that contain levels of fluoride thought to protect teeth from decay. One of the health objectives contained in Healthy People 2010 (the plan that sets health goals for the nation for the year 2010) calls for, at least, 75 percent of the population served by community water systems to receive optimal levels of fluoride. The current level is 67 percent. To reach this goal, approximately 14.3 million more people must gain access to fluoridated water through public water systems. Other sources of fluoride are also available. Fluoride can be applied directly to teeth through toothpaste, mouth rinses, and treatments available in the dental office. Children who are at high risk for tooth decay and whose home water supplies contain low amounts of fluoride can take dietary fluoride supplements. This daily supplement, which can be prescribed by a dentist or a physician, should be taken only by children if the home water supply has been verified to contain a low concentration of fluoride. These methods of delivering fluoride are more expensive than water fluoridation and require a conscious decision to use them. However, the widespread availability of fluorides, via water fluoridation, toothpaste, and other sources, has resulted in the steady decline of dental caries throughout the United States. Fluoridation 6 Dental caries is an infectious, transmissible disease in which bacterial by-products (i.e., acids) dissolve the hard surfaces of teeth. Unchecked, the bacteria can penetrate the dissolved surface, attack the underlying dentin, and reach the soft pulp tissue. Dental caries can result in loss of tooth structure, pain, and tooth loss and can progress to acute systemic infection. Cariogenic bacteria (i.e., bacteria that cause dental caries) reside in dental plaque. A sticky organic matrix of bacteria, food debris, dead mucosal cells, and salivary components that adheres to tooth enamel. Plaque also contains minerals, primarily calcium and phosphorus, as well as proteins, polysaccharides, carbohydrates, and lipids. Cariogenic bacteria colonize on tooth surfaces and produce polysaccharides that enhance adherence of the plaque to enamel. Left undisturbed, plaque will grow and harbor increasing numbers of cariogenic bacteria. An initial step in the formation of a carious lesion takes place when cariogenic bacteria in dental plaque metabolize a substrate from the diet (e.g., sugars and other fermentable carbohydrates) and the acid produced as a metabolic by-product demineralizes (i.e. begins to dissolve) the adjacent enamel crystal surface. Demineralization involves the loss of calcium, phosphate, and carbonate. These minerals can be captured by surrounding plaque and be available for reuptake by the enamel surface. Fluoride, when present in the mouth, is also retained and concentrated in plaque. Fluoride works to control early dental caries in several ways. Fluoride concentrated in plaque and saliva Fluoridation 7 inhibits the demineralization of sound enamel and enhances the remineralization (i.e. recovery) of demineralized enamel. As cariogenic bacteria metabolize carbohydrates and produce acid, fluoride is released from dental plaque in response to lowered pH at the tooth-plaque interface . The released fluoride and the fluoride present in saliva are then taken up, along with calcium and phosphate, by de-mineralized enamel to establish an improved enamel crystal structure. This improved structure is more acid resistant and contains more fluoride and less carbonate. Fluoride is more readily taken up by demineralized enamel than by sound enamel. Cycles of demineralization and remineralization continue throughout the lifetime of the tooth. Fluoride also inhibits dental caries by affecting the activity of cariogenic bacteria. As fluoride concentrates in dental plaque, it inhibits the process by which cariogenic bacteria metabolize carbohydrates to produce acid and affects bacterial production of adhesive polysaccharides . In laboratory studies, when a low concentration of fluoride is constantly present, one type of cariogenic bacteria, Streptococcus mutans, produces less acid . Whether this reduced acid production reduces the cariogenicity of these bacteria in humans is unclear . Saliva is a major carrier of topical fluoride. The concentration of fluoride in ductal saliva, as it is secreted from salivary glands, is low --- approximately 0.016 parts per million Fluoridation 8 (ppm) in areas where drinking water is fluoridated and 0.006 ppm in non-fluoridated areas. This concentration of fluoride is not likely to affect cariogenic activity. However, drinking fluoridated water, brushing with fluoride toothpaste, or using other fluoride dental products can raise the concentration of fluoride in saliva present in the mouth 100- to 1,000-fold. The concentration returns to previous levels within 1--2 hours but, during this time, saliva serves as an important source of fluoride for concentration in plaque and for tooth remineralization . Over 170 million people, or 67 percent of the United States population served by public water supplies, drink water with optimal fluoride levels for preventing decay. Of the 50 largest cities in the country, 43 are fluoridated. Although water fluoridation reaches some residents in every state, unfortunately, only 24 states are providing these benefits to 75 percent or more of their residents. A significant advantage of water fluoridation is that all residents of a community can enjoy its protective benefit-at home, work, school, or play-simply by drinking fluoridated water or beverages and foods prepared with it. A person's income level or ability to receive routine dental care is not a barrier to receiving fluoridations' health benefits. Water fluoridation is a powerful strategy in our efforts to eliminate differences in health among people and is consistent with my emphasis on the importance of prevention. Water Fluoridation 9 fluoridation has helped improve the quality of life in the United States by reducing pain and suffering related to tooth decay, time lost from school and work, and money spent to restore, remove, or replace decayed teeth. An economic analysis has determined that in most communities, every $1 invested in fluoridation saves $38 or more in treatment costs. Fluoridation is the single most effective public health measure to prevent tooth decay and improve oral health over a lifetime, for both children and adults. Despite this, there is a growing belief and push to eliminate water fluoridation. Edward Bennett (2001) supports the idea that water fluoridation is not about helping teeth. Instead, it is a method for industry to profit from dumping its hazardous waste in the form of silicofluorides into water supplies. Silicofluorides are 85% more toxic than natural fluorides. In terms of individual rights, he makes the point that there is no RDA for fluoride and it has never been approved by the FDA as a dietary supplement. Fluoride, he argues, must be considered a pharmaceutical and millions of people are being forced to take this toxic medicine. EPA scientists suggest, after reviewing the evidence, that public water supplies should not be used "as a vehicle for disseminating this toxic [fluoride] and prophylactic ally uselesssubstance." (2004). Further Fluoridation 10 evidence suggests that dental fluorosis has increased from15% to 65% in fluoridated areas and from 5% to 40% in non-fluoridated areas in North America (Bennett 2001). The Medical Research Council (MRC) has published a comprehensive study of fluoride where recommendations are made to both consumers and government to reduce fluoride consumption. Dr. Peter Mansfield, head of the organization, Health Otherwise suggests that many common health complaints such as indigestion, backache, and joint stiffness can be eliminated with the cessation of fluoride use (2006). Alternatives exist to water fluoridation. In fact, over 30 countries use salt that has been fluoridated much like iodine is added to salt in the U.S. The ADA has evaluated the effects of salt fluoridation and has found it to be as effective in decay reduction when compared to water fluoridation. However, there are concerns over the use of salt fluoridation in areas that also have fluoridated water supplies. Although there had been an overall reduction of dental decay with the use of fluoride in water supplies. Research is lacking in the comparison of natural fluoride to silicofluorides' ability to reduce tooth decay and their Fluoridation 11 respective risks. Although the ADA fully endorses water fluoridation, they welcome all new research about fluoride. Conclusion Despite concern, fluoride-treated water systems have shown benefit for overall oral health. The issue remains if people should have a choice in whether they receive fluoride through municipal water systems. The argument against adding fluoride to water rests in the notion that fluoride is not a nutrient, it is a chemical drug. The argument may be clear but it is far from over. For those concerned about the effects of fluoride on their health, there are alternatives but they are costly. Recommendations for practices involving the cessation of fluoride use can be found for those wanting to reduce their exposure to fluoride (Bennett 2001). These practices include a proper diet and good oral hygiene. Something we all should be doing anyway. Fluoridation 12 References American Dental Association. (1995-2006). February 12, 2006 from http://www.ada.org. Bennett, E. (2001). The Fluoride Debate. February 12, 2006 from http://www.fluoridedebate.com. Bratthall D, Hnsel Petersson G, Sundberg H. (DATE). Reasons for the caries decline: what do the experts believe Eur J Oral Sci 1996;104:416--22. Centers for Disease Control. (1990). Top Ten Advances in Public health since 1900. February 12, 2006 from http://www.cdc.com Finn SB, McCaffrey I. (1950). The Newburgh-Kingston Caries Fluorine Study. I. Dental findings after three years of water fluoridation. Am J Public Health;40:716--24. The Fluoride Debate (2006). February 12, 2006 from http://www.whatreallyworks.co.uk. Read More