Fluoride: What’s old is new again

Community fluoridation has been common in the US for 70 years, but several communities debate the safety of the practice. Promote patient education and public health with these resources for oral health-care professionals.

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Some people view community water fluoridation as a debatable practice. Several cities have blocked the introduction of fluoride, and numerous activism groups call for fluoride to be eliminated totally. (1) These groups often argue that fluoridation is an outdated form of mass medication, and is unnecessary, ineffective, and unsafe. This article will look at the science of fluoride as a safe an effective means of preventing tooth decay, and share some new resources available for public education.

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Fluoride’s topical mechanism of action plays a significant part in the prevention of dental decay. It enhances remineralization and inhibits demineralization of tooth enamel, and decreases the production of acids by cariogenic bacteria. Fluoride has been available in the United States since the mid 1940s. (2) In 2008, 64.3% of the population served by public water systems received optimally fluoridated water, and public water fluoridation practices vary by city and state. (2)

There are many individuals and groups that support water fluoridation, such as the Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP), and the American Dental Association (ADA). (3) It is a safe, effective way to improve dental health. Water fluoridation was recognized by the CDC as one of the 10 greatest public health achievements of the 20th century. (4)

READ MORE | Standing up for community fluoridation

Fluoride Sources
The US Environmental Protection Agency (EPA) requires that all community water supply systems provide customers an annual report on the quality of water, including fluoride concentration. Families or providers can contact the local water authority for this information. Also, fluoride content of a town’s water can also be found by visiting CDC’s My Water's Fluoride web site. Well water sources vary widely in natural fluoride concentrations, and private wells should be tested by a public health department or private laboratory before prescribing supplements.

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Fluoride can be consumed through water (either naturally occurring or added), other beverages like some teas, foods (e.g., seafood), and dietary supplements. Water filters may modify the fluoride content of community water. Activated charcoal filters and cellulose filters remove a negligible amount of fluoride, but reverse osmosis filters and water distillation remove almost all fluoride from water. Some bottled waters may contain fluoride, but most do not. The US Food and Drug Administration (FDA) does not require that fluoride content be listed on the labels of bottled waters. It is safe to assume that children ingesting only bottled water are not receiving optimal amounts of fluoride from that source.

Patient Education for Oral Health Care Professionals
The effects of toothpaste are mainly topical, but some toothpaste can be swallowed accidentally, usually by children, and can result in systemic fluoride exposure. Minimize toothpaste ingestion by limiting the amount on the toothbrush, discouraging children from swallowing toothpaste, encouraging spitting of toothpaste, and supervising brushing until spitting is a learned habit.

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We Support 70 Years FocusThe CDC has developed materials for partners to download and use to help educate a variety of audiences on the value of water fluoridation. (5) Building Blocks comes a variety of forms (e.g., poster, letter, infocard) that highlight the importance of fluoridated water as part of a simple strategy for caring for your teeth. Meet John & Joe, a poster, recognizes how communities benefit from water fluoridation. The infographic How Fluoride Works shows how fluoride protects the teeth and mouth. Smile, Because You Can also comes in many formats and highlights the history of water fluoridation to improve oral health. The CDC also provides a web button that can be placed on an organization's website. Visit the site to view and download them all.

References
1. Kost R. Portland fluoride: Measure to add fluoride to Portland’s drinking water fails. The Oregonian. May 21, 2013. http://www.oregonlive.com/portland/index.ssf/2013/05/portland_fluoride_measure_to_a.html. Accessed March 17, 2015.
2. PACT educational materials—Fluoride. American Academy of Pediatrics website. http://www2.aap.org/oralhealth/pact/index-materials.cfm. Accessed March 17, 2015.
3. Clark MB, Slayton RL. Fluoride use in caries prevention in the primary care setting. Pediatrics. 2014;134:626-33. doi: 10.1542/peds.2014-1699.
4. Ten great public health achievements in the 20th century. Centers for Disease Control and Prevention website. http://www.cdc.gov/about/history/tengpha.htm. Accessed March 17, 2015.


Maria Perno Goldie 2014b FoMaria Perno Goldie, RDH, MS, is the editorial director of RDH eVillage FOCUS.

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