Water Fluoridation
There are few topics in dentistry more divisive to the general public than that of water fluoridation. Canada remains as one of the countries with the highest number of communities with water fluoridation in effect. British Columbia, however, has very few communities remaining that still participate in water fluoridation, Kelowna having stopped this practice since 1996. Although the pros and cons of water fluoridation are still being debated to this day, I believe only a very small percentage of the population are actually know very much about either side of the debate. This article is meant to help illuminate the health benefits so that you, as a reader, can get a better feel for why most dentists continue to encourage the usage of fluoride for the improvement of oral health.
Fluorides are a group of naturally occurring compounds that contain the element fluorine. They can be found in water and soil at varying levels. Interest in fluoride began in the early 1900’s when a dentist, Dr. Frederick McKay noticed there was an increased prevalence in teeth that showed a mottling or staining of the enamel of the teeth. What was interesting about these teeth, however, was the absence of tooth decay. Clearly something that was shared by these people was affecting the presentation of their teeth and increasing the resistance of these teeth to cavities. With further study, it was found that the source of this was the drinking water and that fluoride was the variable. Fluoride acts by binding to the mineral structure of the tooth to make it more resistant to acid breakdown, while enhancing remineralization of enamel once decay has started. Recently, It has also been discovered that it reduces the ability of decay causing bacteria to adhere to the surface of the tooth, thereby creating another method of minimizing cavities.
In the 1940s, Dr H Trendley Dean found that the ideal amount of fluoride was one part per million parts of water (1.0 ppm). This concentration was found to result in healthy, attractive teeth lacking the mottling and staining (now known as fluorosis staining) while still having one third as many cavities as might otherwise be expected. Gradually, more communities in the US and Canada began to adopt water fluoridation in order to control the incidence of tooth decay, leading the CDC (Center for Disease Control and Prevention) to consider water fluoridation as one of the greatest achievements in public health in the 20th century.
So if Fluoride has been shown to be so beneficial, what is the controversy? One that I hear often at the dental office is that fluoride is also used as a rat poison. While it may seem inconceivable that we would actively contaminate our water supply with something used to kill rodents, it needs to be pointed out that this is a matter of concentration. In large dosages, many substances can be found to be toxic to people, even something as benign as pure water. In the trace amounts that are present in fluoridated water, however, there have been no credible studies showing an association between fluoridated water and toxicity or an increased risk of cancer.
The main argument against water fluoridation, however, is one that I can agree with. Although I am convinced of the safety and efficacy of fluoride as an aid in the prevention of dental decay, fluoridating the drinking water removes the choice of the individual from the equation. As well, with the topical usage of fluoride in toothpastes and dental applications, the overall benefit of water fluoridation is reduced. As we live in an area where water fluoridation is not administered, these two sources remain the best methods of obtaining this beneficial ingredient.