October 29, 2000

Fluoride: The Hard Truth

You probably heard it first from your pediatrician or dentist: Give your kids fluoride while their teeth are forming and they will be more cavity-resistant for life. That explains why fluoridating water makes so much sense on the surface.

The cover story in July's issue of the Journal of the American Dental Association, however, unequivocally states that fluoride ingested during the formation of teeth -- before they break through the gums -- does not create teeth that are more resistant to decay. Fluoride is an effective means of preventing cavities, but only when splashed directly and regularly on the surface of existing teeth (topically). It does not help children more than adults.

The benefits of fluoridated water have been overstated by many proponents, according to the article's author, John D.B. Featherstone, head of the Department of Preventive and Restorative Dentistry at the University of California, San Francisco. "The extreme pro-fluoridation proponents and the [extreme opponents] should be grabbed by their heads and bashed together," he told The Tribune on Wednesday. Both sides have been guilty of gross hyperbole. The truth is that when it comes to preventing cavities, "brushing with fluoridated toothpaste twice a day is as good or better than fluoride in the drinking water," he said.

Your dentist probably told you something different, but Featherstone is a respected researcher and an authority on the subject. The American Dental Association chose his article for its "Continuing Education" series because it is basic information that it wants all dentists to have.

This might read like heresy, because conventional wisdom says only nutty folks oppose fluoridation, but in light of Featherstone's information a key question should be asked: Are the benefits of fluoridation worth the costs? There is no easy answer, which explains the record length of this article. But fluoridating the water in Salt Lake and Davis counties will be expensive. One estimate in Davis has suggested as much as $1 per week per water bill.

Featherstone is solidly pro-fluoride. In fact, he supports fluoridation on the grounds that every little bit helps, which is why most dentists support it. But to much of the health care profession, price is appropriately not an object, and that's why everyone else needs to consider the issue carefully.

Yet Featherstone is also adamant that fluoride delivered topically -- with toothpaste, mouth rinses and pills that are chewed slowly and swished around the mouth -- is far more effective than when it is swallowed. "Fluoridation is not the panacea [proponents] say it is," he said. "It is just one of the tools" for fighting cavities.

Utah proponents are selling fluoridation as the primary tool, contending that the substance re-emerges in the saliva to bathe teeth "all day long." But Featherstone explained that fluoride's effectiveness peaks a mere 15 minutes after it is swallowed; 45 minutes later, the benefit is gone. Toothpaste is more effective during the hour after it is used because of the vastly higher concentrations of fluoride left behind in the mouth. You don't have to be a scientist to understand why: Fluoridated water has 1 part fluoride per million compared with the 1,000 parts per million in most fluoridated toothpastes.

It is important to note that regardless of the delivery method, fluoride can't overcome poor diets and poor dental hygiene. Featherstone pointed out that while 75 percent of U.S. children ages 5-11 were cavity-free in the late 1980s, 70 percent of children ages 12-17 had decayed teeth. He said the cavity rates soar because older kids frequently drink sugary sodas and snack on junk food, which boosts the bacteria that cause tooth decay and inhibits the remineralization process that protects teeth. He described the bacteria as "caries challenge" and stated that "no amount of fluoride can overcome big caries challenge."

That fact alone might explain why sugar-loving Utahns have an average of nine-tenths of one cavity more than the rest of the nation.

The most effective means of reducing cavities in children, then, might be to remove the soda and candy machines from Utah's schools and to educate children on brushing their teeth. If government must get involved, maybe schools could serve a cup of fluoride mouthwash with lunches or breakfasts. Those three simple steps would cost millions less and be far more effective than merely fluoridating the water.

The pro-fluoridation folks aren't going to like reading this, and they will be ready tomorrow with soothing responses to every issue raised above. But after they respond, ask them why they didn't volunteer any of this information before.

It's going to be hard to jump off the bandwagon, particularly when it looks so logical and so many smart folks are supporting it. Pride alone might keep you riding for a while longer. But on Nov. 7, when you are alone with your thoughts in the voting booth, ask yourself if it is really worth spending millions of dollars for something that is at best no more effective than a tube of toothpaste.

Then vote no.


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