As a paediatric dentist, I am presented with young patients having multiple carious lesions on a daily basis. In my discussion of risk factors with the patient/parent(s), the use of fluoride is always brought up. I am shocked at how many families don’t drink tap water and are therefore not benefiting from the preventative effects of water fluoridation. Whether they drink bottled water or have reverse osmosis systems in their homes (that remove fluoride from the water) more and more families are abandoning tap water, most likely due to a fear of ingesting heavy metals that exist due to old water pipes. What they don’t realize however is that municipal drinking water is highly regulated, definitely more than bottled water, and if it is fluoridated they are missing out on its preventative effects.
In April of 2011, the City of Toronto Board of Health held a public forum focusing on removing fluoride from the drinking water in Toronto. This was brought about due to increasing pressure from anti-fluoridationists. Drs. Michael Sigal and Paul Andrews presented at this forum and represented the unified stance of all the faculty members in the Graduate Program in Paediatric Dentistry at the University of Toronto in support of the continuation of water fluoridation. We were all very relieved to find out that a motion was passed following this debate to continue water fluoridation in the City of Toronto. We did not want to lose the fight that many of the cities across Canada have already lost, especially considering that Toronto’s water supply feeds the largest population in the country. This change would have been disastrous.
Why bother to fight for water fluoridation?
Simply put, water fluoridation is still the most cost effective way to deliver fluoride to the greatest number of people in a population. The members of the population who benefit the greatest from water fluoridation are definitely children, particularly those of low socio-economic status.1,2 If the main objective of our public health departments is to prevent disease, then water fluoridation cannot be over-looked when we consider that caries is one of the most common diseases afflicting children in the world. In fact, the Centers for Disease Control considers water fluoridation one of the top ten public health achievements of the 20th century.3
We as dentists have a responsibility to advocate for our patients when it comes to laws that directly influence the levels of dental disease in our communities. No one knows the benefits of fluoride more than dentists because we use it everyday in our practices to help prevent dental caries. Therefore it is up to us as dentists, through our associations, to educate our local governments on the benefits and safety of water fluoridation. If water fluoridation helps to prevent dental caries (which we know it does) then we have to be prepared for a significant increase in the rates of dental caries in our communities if it is removed from our water supplies.
We are what we drink! OH
REFERENCES
1. Arora A, Evans RW. Dental caries in children: a comparison of one non-fluoridated and two fluoridated communities in NSW. NSW Public Health Bull. 2010 Nov-Dec;21(11-12):257-62.
2. Kumar JV, Adekugbe O, Melnik TA. Geographic variation in Medicaid claims for dental procedures in New York State: role of fluoridation under contemporary conditions. Public Health Rep. 2010;125(5):647-54.
3. Centers for Disease Control. Ten great public health achievement United States, 1900-1999. http://www.cdc.gov
