Fluoride: Should it be used in our Water Supply?
September 05, 2008
Fluoride has been a widely disputed element since its introduction as an agent to prevent cavities. It was initially added to the water supply starting in some areas in the 1940’s and has had a marked history of being added and removed from the supply of many jurisdictions since. From the beginning there was great debate whether the evidence of cavity prevention outweighed the risk of unaesthetic fluorotic change in the appearance of the teeth. Later the debate has widened to include such claims increased risk of some cancers like osteosarcomas and IQ deficits in children although these claims have yet to be substantiated in the literature.
The concerns regarding fluorosis are highly over weighted. Recent literature published by the CDC in 2002 suggests that 11.8% of the population has questionable fluorosis, 19% has very mild fluorosis and 5.83 % has mild fluorosis. Given the epidemic of early childhood caries (a 20% increase in the past 5 years) one must consider that the risks of fluorosis compared to the benefit of proper use of supervised and dosed fluoride toothpastes cannot be under scored. Moreover, the risk of fluorosis from using fluoridated toothpaste decreases from 8% to 6% when fluoridated toothpaste is utilized once a day after the age of 2 versus 3. (Risk of Enamel Fluorosis in Non Fluoridated and Optimally Fluoridated populations: Consideration for the dental professional. JADA 131:741-53, 2000).
When looking at the issue from a cavity prevention prospective, there have been decades of evidence-based clinical and epidemiological research performed, all which conclude that the use of fluoride is conclusively associated with a decrease in caries risk. This conclusion has been supported by Health Canada, the Canadian Dental Association, the U.S. Surgeon General and the Centre for Disease Control all powerful experts in this field.
Despite all the supporting evidence of the benefit of fluoride use, particularly in the water supply, Canada has only 38% of the population able to enjoy the benefit of fluoridated tap water. This is the most cost-effective method to reduce the impact of the debilitating disease know as dental cares. Remembering that cavities can affect anyone at anytime regardless of culture, gender or socio-economic status and when it does the financial, time and emotional cost is extraordinary.
Let’s take this opportunity to remind ourselves how and why fluoride is a mainstay of the dental profession. We should consider promoting the availability of lower fluoride toothpastes for children, but let’s not eliminate the endorsement of its use entirely.
Editorial submitted by:
Sarah Hulland, BSc, DDS, Cert. Ped. Dent., MSc, FRCD(C), FRSM, FICD
President, Alberta Academy of Pediatric Dentistry