Despite what
dentists keep telling us about the protective effects of fluoride on people's
teeth, virulent myths insisting otherwise somehow manage to persist.
These kinds
of mistaken beliefs might be false, but their consequences are very real. Like
when, in 2007, the people of Juneau, the capital of Alaska, voted to stop
putting fluoride in their drinking water, over concerns about what harms it
might be doing to them.
The
decision, coming after years of debate in Juneau between dentists and other
groups, resulted in a massive, immediate change in public health policy for the
city and borough's residents.
But while
research into the benefits of water fluoridation has existed for decades - and
suggests fluoride reduces cavities (aka caries) and associated dental disease -
less is known about the effects of fluoride cessation.
In other
words, what happens when a population suddenly stops taking fluoride in their
drinking water, like Juneau's citizenry did?
Now, thanks
to a new study led by first author and public health researcher Jennifer Meyer
from the University of Alaska Anchorage, we've got new insights into the
subsequent effects.
In the
study, Meyer assessed Medicaid dental claim billing records for two groups of
children and adolescents aged 18 or under.
One of these
groups represented what the researchers call "optimal" community
water fluoridation (CWF) exposure: 853 non-adult patients on behalf of whom
Medicaid dental claims were filed in 2003, years before the fluoride cessation
began in 2007.
The other
group was made up of 1,052 non-adult patients from families who similarly met
Medicaid income requirements, and who made the same kind of dental claims
almost a decade later, in 2012.
Of course,
that's five years after the fluoride was taken out of Juneau's tap water, so
that group represents what the researchers describe as "suboptimal CWF
conditions".
That time
gap resulted in a statistically significant difference in children's cavity
levels, the researchers say.
"By
taking the fluoride out of the water supply… the trade-off for that is children
are going to experience one additional caries procedure per year, at a ballpark
(cost) of US$300 more per child," Meyer explained to KTOO News.
Those
figures are based on the youngest children assessed in the study, aged under
six years of age.
Among those
patients, kids who were exposed to fluoride in their tap water had on average
1.55 caries procedures annually - but this jumped to 2.52 procedures annually
for the children in the suboptimal group.
The effect
was more subtle for age groups older than the 0 to <6 age group, but
nonetheless, every age group analysed in the study (0 to <6, 0 to <7, 7
to < 13, 13 to 18, and 0 to 18) experienced higher levels of cavity
procedures if they didn't have fluoride in their drinking water.
It's not
known for sure why the cessation demonstrated less of an effect on older
children, but the researchers suggest the older kids in the suboptimal cohort
may have received a partial protective effect from any fluoride exposure when
they were younger (ie. before 2007, when the fluoride ban kicked in).
"Previous
research indicates that without the presence of optimal levels of fluoride in
drinking water, and thus in the mouth and saliva, teeth may form with weaker
enamel and lack the ability to remineralise early signs of decay," the
authors explain in their paper.
"We
expected to observe more significant impacts among patients with the lowest
exposure to optimal CWF."
Of course,
more cavities necessitating dental procedures means more money is needed to fix
the damaged teeth.
After
adjusting for inflation, those increased costs represented anywhere between a
28 percent to a 111 percent jump for the various age groups, with the maximum
increase being just over $300 annually for children in the 0 to < 6 age
group who grew up with suboptimal CWF exposure.
Basically,
according to the researchers, the cessation was a very expensive move.
"The
cost to have a fluoride management program, to actually fluoridate the water,
is pennies by comparison to what it costs to treat a cavity," Meyer told
KTOO, pointing out that voluntary alternatives like pharmacy fluoride tablets
can also prevent decay, but come with their own problems.
"I
think that's a great option for people, but it's also a headache. You gotta get
the prescriptions filled, you gotta remember to give it, you've gotta make sure
kids don't take more than one - you know, there's risks to that… It sets up a
precedent for inequity."
It's unknown
whether the latest findings will be enough to sway the minds of other local
city assemblies considering enacting their own fluoride bans - but for those
who do the actual science, the science on fluoride remains perfectly clear.
"These
results support current evidence that even in modern conditions with widely available
fluoride toothpaste, rinses, and professionally applied prophylaxis, CWF is
associated with population benefits," the authors write, "including
cost effectiveness and caries prevention."
The findings
are reported in BMC Oral Health.
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