Missoula, Montana, opts out of fluoridation in favor of attacking sugar consumption
Health board rooting out tooth problem
Young people should eat no more than a cup and a half of sugar each week. But the average American child gets 7 cups, much of it in soft drinks that he buys from his school vending machines, nutrition specialist Mary Pittaway told the Missoula Health Board on Thursday. Tackling that problem may take less time and require less political argument than community water fluoridation in an attack on Missoula's severe tooth decay, Health Board members said.
While studies have found that water fluoridation can reduce tooth decay by as much as 50 percent, board member and chemist Garon Smith said the evidence pales when compared to the effort it would require. "I'm just saying if we have to put our efforts somewhere," he said, "I'm guessing that our time will be better spent on the other things."
Both community water fluoridation and improving the nutritional content of foods offered in school vending machines were among seven recommendations of a group of specialists who met for the past five months as the Preventive Oral Health Advisory Health Committee. They included physicians, dentists, a dental hygienist, nurses, an environmental health advocate and Pittaway, who is the Missoula City-County Health Department's nutrition services director. The committee's work is finished, and the Health Board will consider its recommendations in moving forward against Missoula's severe oral health problem.
Instead of making headway against decay and disease, Missoula is losing ground, said dentist Ryan Huckeby. Huckeby began work last July as the half-time dentist at Partnership Health Center, Missoula's community health clinic. When he began, the waiting list stood at about 1,500. Now, it's about 2,000. More people began calling when they learned the clinic had hired a dentist.
Huckeby typically gets 40 calls a day from people in dental pain, he said. He is able to see two or three emergencies, working them in around people who have appointments after waiting one to two years. The six regular volunteer dentists and Missoula's oral surgeons and endodontists who do volunteer work in their offices are "maxed out," Huckeby said. The dental clinic's receptionist is often emotionally broken down.
In 2000 in Missoula, 7,287 children were eligible for Medicaid-paid dental care. Only 1,368 children through age 17 received that care. Dentists say they can see only limited numbers of Medicaid patients because of the low rates paid for the care, at cost or below for most dentists.
"We're not meeting the needs of the community," Huckeby said. "A lot of these people are waiting in pain for one to two years." In what the U.S. Surgeon General calls "a silent epidemic," 80 percent of the dental decay in permanent teeth in children 5 to 17 occur among 25 percent of the children. Missoula mirrors those numbers, the oral health committee writes in its report.
Decay is concentrated in households where the incomes and levels of parental education are low and where there is often no dental insurance. Among low-income children, the report says, almost 50 percent of tooth decay is untreated.
"Most of the children I see, they don't need just one or two little cavities filled," Huckeby said. "They need most of their teeth removed. And they've been living in pain."
Missoula health and human services specialists have wrestled with the problem during the past few years. Two years ago, the Health Board heard an afternoon of testimony from people who were unable to access dental care and people who worked with them. Among the suggestions the oral health committee includes in its report is bringing the dental care to the children who need it. That could mean lobbying to increase the state's Medicaid payments to dentists and providing a mobile dental van that could visit schools.
Missoula's 2nd District Dental Society members are unconvinced that such a van could be more helpful than simply putting the money that would pay for it toward hands-on dental care, said dentist Lori Aleksic, a member of the oral health committee.
Missoula children could also benefit from tooth sealants, varnishes and oral fluoride treatments, the committee said. Education of parents and of students in schools could also help.
Linda Simon, elementary school nurse for the Missoula Public Schools District, is the nurse for 5,000 children in 14 schools. Working with just two assistants, Simon can't put dental education at the top of her list of priorities, she said. When she and her staff make presentations, they're well received by students and teachers, she said. "My guess is there are a lot of kids out there with unmet dental needs," she said. "What we see is just the worst cases. We see it at schools all across the board, not just the reduced-price-school-lunch schools."
Pittaway made a vivid presentation to the board using plastic bags of sugar to illustrate the committee's recommendation that healthy foods replace the soft drinks and other low-nutrition, high-fat foods in school vending machines. A 20-ounce bottle of Coca-Cola, she said, contains almost 17 teaspoons of sugar. The average adolescent boy drinks three cans a day. American youths drink twice as much pop as milk. "All of the high schools in Missoula are now covered with vending machines," she said. "Most middle schools have them and many grade schools. All the foods are high sugar, high fat, low nutrition."
The dental van, the vending machines and tooth varnish programs seem the top priorities, said Health Board and oral health committee member Beth Metzgar.
While community water fluoridation is endorsed by nearly all medical authorities, including the U.S. surgeon general, it presents challenges in Missoula, said Missoula physician Hal Braun, also a member of both the board and the committee. Even if Mountain Water Co. cooperated with a program, its wells supplies water to only about half of Missoula's children. And, Braun said, "We do know there is going to be a vocal and flamboyant opposition."
Missoula environmental health advocate Bryony Schwan, also a committee member, earlier this spring presented research that questions fluoridation's safety and effectiveness. The evidence, Schwan said in an interview Thursday, says that fluoride works better to prevent tooth decay when it's applied to the teeth than when it's consumed in water. Among the papers she presented to the Health Board was one by New Zealand dentist John Colquhoun, who was once an ardent advocate but now worries about fluoride's health effects and effectiveness.
"It absolutely convinced me that water fluoridation is not the way to go," Schwan said. The Health Board and health department director Ellen Leahy will continue to look for funding to find a community health specialist to implement the dental recommendations. "Of all the health problems there are and all the funding problems, there are some we're not going to let go of," Leahy said. "The dental issue, we're not going to let go of it."
Reporter Ginny Merriam can be reached at 523-5251 or at firstname.lastname@example.org.