Thursday, November 10, 2011

To fluoridate or not to fluoridate, that is the question. Next Tuesday at my Water District Board meeting

I'll reproduce below most of an old post about fluoridation. I had previously expected to see an identical situation with climate change in terms of the debate, but it's not. I think factors overall favor fluoridating, but not quite as overwhelmingly as I expected. On Tuesday, my fellow Directors and I get to figure out next steps.


Fluoridation opponents have made lots of mistakes in my opinion, but supporters have overstated the consensus. In particular, fluoride levels four to eight times the recommended level do have rare adverse effects, which isn't a huge safety margin in toxicity issues (UPDATE: I mean rare and severe effects - some cosmetic problems to teeth are common). Very slight adverse effects on larger groups would also be hard to rule out.

The Center for Disease Control recommends mixing non-fluoridated water in formula for babies that use formula exclusively. I can also attest to hearing from the significant number of people, if still a minority, who are just anguished that we're putting something they consider toxic in their water. Home-based reverse osmosis systems can remove their fluoride, I think.

And then there's the money cost - over $4m to construct and $800k to operate. We might get funding to construct but get stuck with operating, which people forget is the bigger cost.

So. The staff recommendation is to proceed if someone else pays for it. We'll see. If we do go forward, we may need to educate people about infant formula and let people know they can get reverse osmosis kits if they want.

Anyway, here's most of the old post, with the science:

Fluoridating water, or a funny thing happened on my way to backseat driving

I originally labelled this blog Backseat Driving back in 2004 because I anticipated it to be a blog where I would second-guess decisions made by politicians and other people. That worked out fine more or less until November 2010, when for some reason I was elected to the Santa Clara Valley Water District Board. Turns out that San Jose is the largest city in the US without fluoridated water supplies (in much of the city, anyway), and the seven of us directors have to decide whether we'll help or hinder the fluoridation process. So I'm pushed into the front seat for this one.

We've got some legal and economic issues to handle (it's not quite as cheap as everyone says, I want to know where the money's going to come from), but the relevant issue here is science. I read the guest post at climate blogger Coby Beck's place, The Case Against Fluoride, fairly closely a while back, especially the raucous debate in the comments. As a spectator with some, limited reading of the available information, I'd say the fluoridators seemed more persuasive than skeptics, but it wasn't the absolute demolishing that I expected.

The fluoride skeptics really hurt their cause when say fluoride doesn't prevent cavities - it's so obviously effective that people making this claim are damaging their own credibility. I'd consider it comparable to denying that the planet has warmed in the last 50 years.

The closer issue is adverse effects, and whether a substantial number of people are very slightly harmed by fluoridation, or if a small number of people are substantially harmed. The 2006 National of Sciences report doesn't condemn fluoridation, but it doesn't absolve it, either:
Bone Fractures

....Overall, there was consensus among the committee that there is scientific evidence that under certain conditions fluoride can weaken bone and increase the risk of fractures. The majority of the committee concluded that lifetime exposure to fluoride at drinking-water concentrations of 4 mg/L or higher is likely to increase fracture rates in the population, compared with exposure to 1 mg/L, particularly in some demographic subgroups that are prone to accumulate fluoride into their bones (e.g., people with renal disease)....There were few studies to assess fracture risk in populations exposed to fluoride at 2 mg/L in drinking water. The best available study, from Finland, suggested an increased rate of hip fracture in populations exposed to fluoride at concentrations above 1.5 mg/L. However, this study alone is not sufficient to judge fracture risk for people exposed to fluoride at 2 mg/L. Thus, no conclusions could be drawn about fracture risk or safety at 2 mg/L....


(In California, 2 mg/L was the limit, and 0.7 is the new proposed goal. -Ed)

Neurotoxicity and Neurobehavioral Effects

Animal and human studies of fluoride have been published reporting adverse cognitive and behavioral effects. A few epidemiologic studies of Chinese populations have reported IQ deficits in children exposed to fluoride at 2.5 to 4 mg/L in drinking water. Although the studies lacked sufficient detail for the committee to fully assess their quality and relevance to U.S. populations, the consistency of the results appears significant enough to warrant additional research on the effects of fluoride on intelligence....


Endocrine Effects

The chief endocrine effects of fluoride exposures in experimental animals and in humans include decreased thyroid function, increased calcitonin activity, increased parathyroid hormone activity, secondary hyperparathyroidism, impaired glucose tolerance, and possible effects on timing of sexual maturity. Some of these effects are associated with fluoride intake that is achievable at fluoride concentrations in drinking water of 4 mg/L or less, especially for young children or for individuals with high water intake. Many of the effects could be considered subclinical effects, meaning that they are not adverse health effects. However, recent work on borderline hormonal imbalances and endocrine-disrupting chemicals indicated that adverse health effects, or increased risks for developing adverse effects, might be associated with seemingly mild imbalances or perturbations in hormone concentrations. Further research is needed to explore these possibilities....

(Removed discussion of bone cancer as not very troubling given its rarity. Ed.)

These were the most troubling findings, mostly about what hasn't been proven, and mostly dealing with levels that are five times what's planned for drinking water. The report expressly ignored the benefits of fluoridation. It's important to balance out potential concerns over rare, severe complications related to fluoride with the certainty that rare, severe complications can result from cavities.


The bottom line as a policy maker in my little arena is that I shouldn't try and figure out the science myself, but I should try to figure out what the scientific consensus is, figure out where the consensus doesn't yet exist, and then plug that information into everything else we have to balance.


The science seems to favor fluoridation, but it's not a slam dunk. And we still have potential policy barriers, and the overall cost issues. Figuring this all out will be interesting.

49 comments:

coby said...

"The fluoride skeptics really hurt their cause when say fluoride doesn't prevent cavities - it's so obviously effective that people making this claim are damaging their own credibility."

I would just like to point out that the position taken in "The Case Against Fluoride" is not that fluoride does not prevent cavities, but that topical fluoride treatments do prevent cavities whereas oral fluoride treatments probably do not. This is far more credible.

Plus, I still find it surprising that the ethical argument about administering medicine without consent is so easily brushed aside.

Not that I wish to relive any of those two weeks...

Brian said...

Hi Coby, my argument concerning preventing cavities was about claims often made, not about your father's book specifically.

Kooiti Masuda said...

I am not sure whether fluorides in drinking water is useful or harmful.
But, even if it is useful and harmless, fluoridizing water for washing clothes, for example, is useless.
And the material containing fluorides must be dug out somewhere (though it may be wastes of other products), and runs off somewhere (perhaps in the ocean) and is probably not effectively recycled execpt in the very slow geological cycle.
So, fluoridization of tap water is a great loss of natural resources (or natural capital, in terms of Herman Daly).
If fluoridization is beneficial for health of teeth, consider put fluorides in toothpastes.

Martin Vermeer said...

> that the ethical argument about administering medicine without consent

Hmmm, the product coming out of the pipes is drinking water, not H2O... trace minerals are a part of good drinking water. Nobody demands that food is offered without vitamins either.

Jaydee said...

(Anecdote) My new dentist told me I must have been in an area where flouride in drinking water was tested in the UK. He was correct, this was 30 years after I'd lived there.

On the other hand...

http://www.youtube.com/watch?v=OcHNYenN7OY
http://www.youtube.com/watch?v=eB5Vvs2cdqY&feature=related

Anonymous said...

Man that was a made interlude at Coby's place. My one contribution to that thread was to point out that anyone commenting on the effects of fluoride on the body - be they negative or benign is speaking beyond the evidence. I linked to Ben Goldacre's piece on fluoride which I still think is very cogent:

http://www.badscience.net/2008/02/foreign-substances-in-your-precious-bodily-fluids/#more-611

Chris S.

Anonymous said...

Oops! made = mad

Chris S.

Kooiti Masuda said...

I reiterate. Fluoridaiztion is not a sustainable practice.

Hank Roberts said...

Kooiti, it's not sustainable in the long run, but in the short term it's a workaround that did solve a major problem. So far all the alternative ways to make fluoride available also are risky:
-- any concentrated form (like toothpaste) would be concentrated enough to be immediately toxic if ingested, as kids will do. (It took the US forty years to cut the total amount of aspirin in candy-flavored "children's" bottles down to where eating one bottle isn't fatal to young children.)
-- At US poverty levels many children don't get dental care regularly.

On the Chinese reports, I'd look hard at the background levels in light of recent reports: "Excess heavy metals in 10% of China's land: report
(AFP) –

BEIJING — About 10 percent of China's farmland contains excessive levels of heavy metals due to contaminated water and poisonous waste seeping into the soil, state media said Monday, citing a government survey..... in the Southern Metropolis Daily said the survey organised by the environmental protection ministry found about 10 percent of farmland had "striking problems of heavy metal levels exceeding (official) limits".

Anonymous said...

I live in a community without fluoride in the water. My middle-class kids get topical F- when they go to the dentist. The dentist explained to me once how he volunteers at a clinic pulling poor kid's teeth.

John said...

I live near Las Vegas, which for a long time had non-fluoridated water. The local dentists were passionately supportive of fluoridation because they saw the bad results in the teeth of their child patients. My wife and I gave our kids fluoride drops, but not everybody did.

The authorities fluoridated the water, and then held a popular vote six months later. Since the voters had been drinking fluoridated water for 6 months later and had no adverse reactions, fluoridation passed at the ballot box.

Anti-fluoridation was a pet cause for decades of the John Birchers, who have been joined recently by some liberals and leftists.

See the excellent article on Quackwatch

http://www.quackwatch.org/03HealthPromotion/fluoride.html

Aaron said...

People do not need fluoride if everybody brushes after every meal.

Ask the anti-fluoridation folks if their kids brush after every meal (and snack). Then, check on the kids at school. Do the kids have their toothbrushes handy, so they can brush after lunch?

One alternative would be to have a good oral health program in the schools. Are there facilities so that every child in the schools can brush their teeth after lunch? Given the number of wash basins, how long would the lines be?

Anonymous said...

When people boil water, does the fluoride evaporate? I ask because, who drinks tap water these days? One expects that the poor kids should, but I would think an important consideration would be to confirm that the fluoride will reach the intended target. In Vancouver we have (we're told) some of the best tap water in the world. I never see kids drinking from the fountain at the community centre. Steve

Dallas said...

That's a tough call Eli. With bottle water and home water treatment, it would not have the impact it once had. It would be more beneficial to the less affulent that still drink tap water. So that is a consideration.

Health wise, most of the concerns are over stated it appears. Infant forumla that are mixed with water are not that popular, but some cerials are. I think research on actual sales of infant products that use tap water and local sales of bottle water should be considered.

Good luck

bigcitylib said...

Interesting post. I have always thought that anti-fluoride people were like Gen. Jack Ripper in Dr. Strangelove. Basically kooks. I had no idea there was a real debate over this. Since its an issue that's coming up in a Canuck context again, thanks.

David B. Benson said...

Lots of data. Floride is good for one in moderation.

I'll point out that it used to be law to be vacinated against small pox despite the potential for harm. This establishes, by precedent, the right of the state to 'practice medicine' on all.

Russell said...

Thanks for reopening another rich vein of absurdity.

It is an existential pleasure to watch those terrified lest a single atom of mercury or molecule of smoke send them to their graves insist on spiking the mains with a commonplace rat poison in the name of the Precautionary Principle.

Given fluorine's place in the geochemical substrate of vertebrate evolution , it seems reasonablr to aim for the mean concentration in the world's rivers as a minimal tapwater norm.

Otherwise we risk growing up with skulls too soft to explode properly when listening to common scolds rant about the ravages of third hand electronic cigarette smoke on their vital bodily fluids.

Russell said...

Since fire is as elemental as fluorine, surely a minimum daily requirement is in order.

One reads in Conservation Ecology (http://www.consecol.org/vol2/iss1/art1/) that here in the US fire swept :" 35 - 86 x 106 ha (megahectares) annually in the pre-industrial era, consuming 530 - 1230 teragram (Tg) of biomass. At present, in comparison, 5-7 Mha/yr burn, consuming 77 - 189 Tg of biomass annually." Which is to say the average American emits roughly a thousand pounds of smoke a year.

Since smokers additionally emit at most one per cent of this figure, non-smokers are clearly responsible for >99% of the second hand smoke abroad, witness their owing and operating most of the nation's diesel engines, Viking stoves, candlesticks, andirons, saunas, incense burners and other smoke generating paraphenalia.

As smoke is naturally mutagenic, its depletion in natural habitats must inevitably impact biodiversity.

Environmentalists, tort attorneys and the lurid warning label designing classes should according mount a campaign of disparagement and barratry against perpetrators of smoke decline, while WHO & UNESCO establish a MDR of fire for addition to dietary supplements, homeopathic remedies and political harangues.

Sou said...

Wish the water (or toothpaste) had been fluoridated when I was a child - it would have saved me heaps in dental bills. Everyone under 35 or so today who doesn't live on tank or bottled water seems to be caries free.

Anonymous said...

What Sou said

Billy T

Neven said...

Where does the fluoride come from? I once heard it was an industrial byproduct that was expensive to get rid of. From the production of aluminium or something like that.

The alleged advantage of fluoridating drinking water is because it prevents caries. Is it taking away the cause of caries? No, it doesn't. It helps cure a symptom. Wouldn't it better to take away the cause? Those millions would be better spent on teaching people how to eat properly, instead of stuffing themselves with processed foods full of sugar and additives. The sugar disturbs hormonal balances in the body, causing the ratio of calcium and phosphorus to get out of whack, forcing the intestines to take calcium out of bones and teeth for compensation. This weakens teeth and makes them susceptible to damage caused by bacteria in the mouth. And it causes overcrowding of teeth in children, because their jaws don't fully develop.

Adding fluoride to drinking water is 1) unsustainable as Kooiti Masuda points out, 2) combating symptoms that allows people to not to have take responsibility, 3) possibly at the cost of other health problems that are difficult to link to fluoride.

Sou and Billy T, how old are you and what did you eat and drink as children? Was a lot of it processed, ie white flour, white sugar, pasteurized milk?

Sou said...

Hi Neven - I'm older and was brought up before the days of junk food and take away food places, in a small country town.

No lollies (candy) allowed, no lemonade (soda), no bought snacks - home made baking only (bought biscuits (ie cookies) were a special treat), wholemeal bread, lots of fruit and veges, milk, tooth brushing ritual, no television, radio for an hour a night, outdoors most of the time except when doing chores or had my head stuck in a book - threepence a week pocket money if we didn't get any bad marks :D. (I was a pre-television, mostly pre-sliced bread, definitely pre-glad-wrap, pre-teflon, pre-McDonalds child).

My nieces (now in their thirties), had lots of good food but lots of junk food as well when children - their teeth are cavity free. They were brought up with fluoridated water and probably fluoride toothpaste.

(I feel for all those who can't drink their tap water. Where I live it's pure, fresh, chlorine free and I can't think of anything better than a nice glass of water from the tap. If I have to buy bottled water I tip out what's left when I get home and refill the bottle from the tap!)

Sou said...

PS - For the first few years no pasteurised milk either. We hung the billy on the gate at night and the milkman filled it up first thing in the morning. We used to have fun/show off swinging the billy full of milk over our head without spilling a drop!

(A billy is a tin can with a handle. These days used to boil water on a camp fire.)

Neven said...

Thanks for elucidating, Sou. What do you think was the cause of your poor dental health, and when did it start?

I hope you don't mind my asking these questions. I've read into the work of Weston A. Price, which led me to doubting conventional wisdom on dental practices. I'm 37 now and never had a cavity, despite not so great eating habits up until 10 years ago. I did suffer from overcrowding though and have had many bad experiences with puller happy dentists.

I have a 7 year old daughter, and we don't eat any white sugar or processed foods. Up till now she has very good dental health. When my wife comes back from the playground more often than not she comes back with these horror stories mothers tell each other about their children's visits to the dentist (teeth disintegrating, pulled milk teeth, pain, etc). Most of these children eat very unhealthily. I see this a lot around me, with children of friends and family.

They aren't putting any fluoride in the water here in Austria, but again, I'd much rather see those children eat normally for a while.

Anyway, I'd still like to know where that fluoride comes from. Is it minded or is it a byproduct? If it's a byproduct, I involuntarily get reminded of depleted uranium, that wonderful byproduct that is used in bullets and anti-tank missiles etc. Doing a great job in Iraq for tens of generations to come.

Sou said...

Re the cause of poor dental health - I've no real idea, Neven. Have been assuming it's the lack of fluoridation back then. Haven't had much trouble since fluoridation was introduced. Could be partly the luck of the genes. Don't know.

I lived in the same region when I was a child (next valley over) and the water here is very pure - probably few minerals of any kind. I doubt it has any natural fluoride. The main difference between today and back then is the use of fluoride in toothpaste and drinking water - and the greater abundance of junk food now.

I worked as a dental assistant for a while when studying at Uni (this would have been in the late 1960s-early 70s). Only once did we have a visit from a woman who had no cavities. It was mind-blowing to see. I didn't know such a thing could happen. (IIRC she was from Germany.)

Some children at school with me even had all their teeth pulled (while young children) and replaced with false teeth. Awful!

I would have been less than 10 years old when I had my first filling. My niece's daughter had a problem with one of her teeth when she was just five. My niece is a healthy food, healthy living freak - even more so than my parents - but they were living in the hills and only had tank or bottled water, no town supply - so no added fluoride.

PS - we need added iodine in this part of the world too, to avoid thyroid problems. It's added to table salt.

(Is it possible that some of your food comes from places that have fluoride available in the water? Or is it added in your toothpaste? That could explain your good fortune.)

PPS Apologies to all am wasting cyber space with non-scientific speculation. There are lots of studies on fluoridation and risks and benefits as Eli pointed out.

Anonymous said...

Neven - I'm afraid I don't fit your hypothesis either - I grew up with extreme health-conscious parents (60s/70s) with no white sugar, wholemeal bread, no lollies, few cakes, home grown food, fresh (unpasteurised) milk. We were even given oral flouride tablets, which didn't seem to do much good (so much for that hypothesis) - although maybe my compatriots ended up even worse than me.

Billy T

Anonymous said...

Neven, I'm much the same age as Sou obviously. Though I didn't live in the country but a city suburb. We still had milk delivered by the milkman refilling our billy on the front verandah, bread delivered still warm from the bakery by a bloke on a horsedrawn cart, chooks for eggs as well as veggies and fruit from the backyard. Homemade school lunches as well as all home cooked meals. No TV of course. We didn't get one until I was 15 or so, before that we visited neighbours for a communal viewing of Friday night tele for a few years. Fish'n'chips was a rare takeaway meal, usually on hot evenings on a trip to the beach to cool down.

And our teeth were absolutely awful. When my children were born in the early 80s, we didn't have to take them along for regular fillings and extractions like I and everyone else in my school did. Fluoridation is a great boon to all of us. (Especially now that the evidence is accumulating that poor mouth condition is strongly associated with heart disease.)

MinniesMum

coby said...

Just as anti-fluoridation activists hurt their cause denying topical fluoride reduces dental caries, so do pro-fluoride folks damage their credibility by exagerating the benefits of fluoridated water. The more recent and better studies which do find a benefit, find one on the order of .6 fewer cavities per person (I believe this is only demonstrable in baby teeth). So the anecdotes about everyone having tons of cavities until fluoride arrived are evidence that anecdotes are not scientific evidence and they are not evidence of anything else.

The criticism of these studies claims that fluorideated water delays the eruption of baby teeth (which I think is not a controversial claim, but not sure...) and this is enough to explain the difference. There are many studies that have been unable to find a difference, though absence of evidence is not evidence of absense.

Don't forget that there are plenty of major cities in developed countries (hello, Vancouver, my home town!) that do not have fluoridated water and they do not have piles of decayed teeth lining their streets. *If* the benefit is there, it takes carefully constructed studies and lots of statistical analysis to find it.

Neven's point above is a good one to my mind. If you want to look at cost/benefit analysis of public policy options, I am very sure education about dental hygene and school programs that promote healthy food instead of junk food would get far more bang for the buck.

Sources of fluoride for fluoridation programs vary, but the origin of the practice and many present instances do involve industrial waste products.

David Benson, I think a communicable disease is in a different class of ethical question, there is a clear danger to the public to be balanced. Can you think of any other, more analogous precedent? I don't think vitamins of nutritional supplements are a serious contender, as no one claims that you have to have some fluoride in your body to survive, whereas vitamins and minerals, yes.

Anonymous said...

I have never had a cavity in over 50 years and have not lived in a flouridated water district. I don't drink soda pop either. I really enjoy my non flouridated tap water.

Holly Stick said...

I grew up on a farm, drinking well water. My sister and I both had to have various fillings while we were growing up, but my brother never needed one until he was in his twenties. We used to joke that it was because he kept eating the brownies and cookies in the freezer, but I'm pretty sure I ate some too. We used Colgate toothpaste which may have had fluoride in it.

Calgary water was fluoridated until within the past year when City Council voted to stop. Though I have lived in Calgary for decades and drunk the water, I still have to have fillings from time to time.

coby said...

BTW, I heartily recommend the link Chris S provided above. It made me realize I misrepresented the body of research indicating efficacy of fluoridation. The case I discussed should not be taken as representative. The approaches are varied as are the alleged problems.

That QuackWatch link is very hard to take seriously. This time I read past "How Poisonmongers Work - The antifluoridationists' ("antis") basic technique is the big lie. Made infamous by Hitler, it is simple to use, yet surprisingly effective." but I still found no evidence of scientific thinking or seriousness of any kind. It is pure, over the top advocacy.

Sou said...

A bit of a googling suggests that some European nations opted for salt fluoridation rather than water fluoridation - including Austria. I don't know if all salt contains a fluoride or if it's marked on the packet and consumers have a choice, but it could be that it's in a lot of processed food manufactured there. (Might explain the lack of teeth cavities in Austria if it's in all table salt, or if food manufacturers use fluoridated salt.)

Makes you realise that these days of global food supply (especially processed food and soft drinks) there are probably lots of sources of fluoride - not just water and toothpaste.

Russell said...

Enough of fluorine- has as no one quantified the aesthetic downside of banning bromides from over the counter remedies?

Ineffectual as Bromo-Seltzer may have been as a headache remedy, and hepatotoxic to boot , it made the nation's shores more cheerful by providing a constant trickle of cobalt blue sea glass to the otherwise pastel eroded bottle supply.

There ought to be a law mandating that the more useless the nostrum , the brighter the bottle, so as to wring an iota of return from suffering homeopaths to practice in our midst.

David B. Benson said...

Coby --- Other than the admonitions in the preamble to the US Constitution, nothing comes to mind. However, there is the precedent of adding iodine [a deadly poison] to table salt; if adding florides to table salt work as well as adding to drinking water, using the table salt method seeems, on the face of it, superior.

Hank Roberts said...

> communicable disease

You rang?
https://www.google.com/search?q=tooth+decay+bacteria+transmission

> no tooth decay
Some people are lucky; some areas have naturally occurring fluoride levels that are protective. Your mouth may vary.
http://www.env.gov.nl.ca/env/waterres/cycle/groundwater/well/fluoride.html

Hank Roberts said...

whoah!

"... consumption of sugar free chewing gum sweetened with the naturally occurring sweetener xylitol, could reduce the transmission of harmful mutans streptococci (MS) bacterial from mother to child and thereby reduce the risk of dental caries in their children. Earlier published studies have demonstrated that prevention of colonization by these bacteria in early childhood can lead to reduction of dental decay and that mothers are the primary source of infection with mutans streptococci. These bacteria are passed from mother to child through everyday contacts such as kissing and tasting of food.

The study measured the occurrence of tooth decay in children at the age of five years: dental caries (dmft) in the xylitol group was reduced by 71-74% as compared with the two control groups. Thus, the mothers' use of xylitol chewing gum prevented tooth decay in their children by significantly reducing the transmission of mutans streptococci from mother to child in early childhood.

"The results of this study suggest that intervention against MS colonization may lead to better caries prevention than traditional preventative measures that concentrate on increasing the resistance of the teeth," stated Dr. Eva Söderling, the lead researcher of the Mother-Child study.

http://www.essology.com/Transmission.html

Neven said...

Or don't kiss your kid on the mouth? I always wonder why people do that, but maybe I'm too prudish.

And don't buy table salt. Sea salt is much better/healthier. Mined salt is even better in my opinion.

Brian, will you let us know what your water district board decides?

Hank Roberts said...

In other water supply news, if you _do_ want something to worry about:
http://www.bbc.co.uk/news/health-15639440
http://www.mv-voice.com/morgue/2005/2005_02_11.tce.shtml

Hank Roberts said...

By the way, I recall reading somewhere that as with other ecosystems, the species coming in occupy niches in a predictable order. The infant starts off free of bacteria and begins to accumulate an ecosystem quite predictably; the particular one that causes tooth decay has only a limited opportunity to get established -- and if it's not transmitted, others that don't cause decay take that niche.

Out of some hundreds (thousands?) of species occupying the mouth, that one's the problem. Block its success getting established in teeth with fluoride; block its transmission with xylitol.

The tradeoff for society ('government') is the cost over time of having these problems, which include heart disease and stroke.

Hank Roberts said...

http://www.lurj.org/article.php/vol2n2/caries.xml

Hank Roberts said...

so, instead of fluoride, you could add a different species of bacteria to the water supply (grin):

"Filling the ecological niches once dominated by Streptococcus mutans with less virulent species has also been proposed as a treatment method. The development of avirulent mutant strains of the bacterium shows promise as a pre-emptive colonizer, which would be introduced into the mouth before natural S. mutans colonization and occupy the ecological niche that would be available to virulent strains (Marsh 1994). Becker et al. (2002) found that Streptococcus sanguinis was present in the mouths of caries-free individuals, but was absent in the mouths of those with dental disease. The relationship between S. sanguinis and oral health could be exploited by the implantation of S. sanguinis strains before an initial diagnosis of caries. Alternately, a mutant strain of Streptococcus Salivarius has been shown to displace S. mutans from the mouths of caries-active rats and shows promise as a treatment for humans (Marsh 1994)...."
http://www.lurj.org/article.php/vol2n2/caries.xml

Neven said...

Thanks, Hank. I was just experiencing a rare minute of not worrying. ;-)

Brian said...

Adding fluoride to salt is more expensive than to water. I suspect (but don't know) that the resulting dosage would vary more because individual consumption varies more. The one advantage is that it might be easier for someone who wants to avoid it to find non-fluoridated (fluoridized?) salt than to buy bottled water or set up a reverse osmosis system.

Overall I don't see an advantage. Either put it in the water or don't do it at all.

Hank Roberts said...

Brian, you can figure the lifetime burden for the kids growing up without sufficient fluoride (is there any fluoride at all in your current water supply? I assume likely not, unless you draw on deep wells).

Even taking the economists' route of discounting future costs drastically, even counting only the municipal employees who may have health care costs, I bet it will cost to provide the fluoride than to take care of those employees' families' kids' teeth and later on their cardiovascular problems arising from pyorrhea.

Done any numbers? The dentists and your insurance provider will know.

Alternatively -- if you don't do fluoride, spend a tenth of that sum on informing mothers about what _is_ known to help that they can do and making the xylitol gum available. Hell, hand it out at school too, with school breakfasts and lunches if the schools still feed kids at all.

http://www.essology.com/GrapicImages/XylitolGraph.jpg

DSL said...

Interesting stories. My teeth had slowly disintegrated over the course of about 20 years, between 20 and 40. I'd brush every day, and I drank flouridated water. About five years ago, I was diagnosed with GERD (bad acid reflux). I didn't change my dental habits, but I did start drinking water only--no pop, no tea, some low-acid juice. I also started sleeping on my left side or occasionally on my back. I haven't had any dental problems in the last five years, and my teeth feel healthier than they ever have.

Captcha: "lasur" (quotes for allusory correctness)

David B. Benson said...

So what was the decision?

Brian said...

We voted 7-0 that we wanted fluoridation, but booted down the road for a later time whether we would facilitate fluoridation by paying for it Water District money.

I'll do a brief follow-up blog post.

Anonymous said...

Interesting to see the anecdotes, and wonder to what extent incompletely accounted-for cofactors influence caries formation.

My father grew up without fluoride and his dad had a sweets business, and dad had no cavities. My mother grew up with fluoride, ate few sweets, had all of her vegetables and meat raised and prepared by her father, and she has a mouthfull of cavities (now replaced by false teeth).

After about age 6 I grew up with fluoride, and had few sweets until just before my teens, when we used to collect cans and bottles for cash, which was spent on sweets. About two years later, within the space of six months, I had over half a dozen cavities, where I'd had none for the 10 - 12 years prior.

My nephew and niece, who have lived on rainwater since they were younger than school age but who were fluoridated until ages 1 1/2 and 3, and who are atrocious gluttons of anything sweet, have no cavities.

Another nephew, on tank water and 4 years old, has a deplorable sugar-filled diet, and multiple cavities. My eldest, also on tank water and four years old, is prohibited sweets except fruit, and she is spotless.

Throw that into the mix!


Bernard J. Hyphen-Anonymous XVII, Esq.

Anonymous said...

And a PS - I have significant dental fluorosis.

I didn't win a trick.


Bernard J. Hyphen-Anonymous XVII, Esq.