The Fluoride Debate

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TABLE OF CONTENTS

INTRODUCTION

HISTORY/
ENVIRONMENT

CENSORSHIP

THE FLUORIDE
DEBATE

BENEFITS
Question 1
Question 2
Question 3
Question 4
Question 5
Question 6
Question 7
Question 8

ALTERNATIVES
Question 9
Question 10
Question 11
Question 12


SAFETY
Question 13
Question 14

OVERDOSE
Question 15
Question 16
Question 17

DISEASES
Question 18
Question 19
Question 20
Question 21
Question 22
Question 23
Question 24
Question 25
Question 26
Question 27
Question 28
Question 29
Question 30
Question 31
Question 32
Question 33

PUBLIC
POLICY

Question 34
Question 35
Question 36
Question 37
Question 38
Question 39
Question 40

COST
EFFECTIVENESS
Question 41
Question 42
Question 43

CONCLUSION

BENEFITS

Question 8.
Do adults benefit from fluoridation?

ADA's Fluoridation Facts Short Answer
Fluoridation plays a protective role against dental decay throughout life, benefiting both children and adults. In fact, inadequate exposure to fluoride places children and adults in the high-risk category for dental decay.

ADA's Fluoridation Facts Long Answer
Fluoride has both a systemic and topical effect and is beneficial to adults in two ways. The first is through the remineralization process in enamel, in which early decay does not enlarge, and can even reverse, because of frequent exposure to small amounts of fluoride. Studies have clearly shown that the availability of topical fluoride in an adult's mouth during the initial formation of decay can not only stop the decay process, but also make the enamel surface more resistant to future acid attacks. Additionally, the presence of systemic fluoride in saliva provides a reservoir of fluoride ions that can be incorporated into the tooth surface to prevent decay.63

Additional discussion on this topic may be found in Question 1.

Another protective benefit for adults is the prevention of root decay. Adults with gumline recession are at risk for root decay because the root surface becomes exposed to decay-causing bacteria in the mouth. Studies have demonstrated that fluoride is incorporated into the structure of the root surface, making it more resistant to decay.19, 63-66 In Ontario, Canada, lifelong residents of the naturally fluoridated (1.6 ppm) community of Stratford had significantly lower root decay experience than those living in the matched, but nonfluoridated, community of Woodstock.65

People in the United States are living longer and retaining more of their natural teeth than ever before. Because older adults experience more problems with gumline recession, the prevalence of root decay increases with age. A large number of exposed roots or a history of past root decay places an individual in the high risk category for decay.12

Data from the 1988-1991 National Health and Nutrition Examination Survey (NHANES III) showed that 22.5% of all adults with natural teeth experienced root decay. This percentage increased markedly with age:

  1. 18- to 24-year-old age group, only 6.9% experienced root decay
  2. 35- to 44-year-old age group, 20.8% experienced root decay
  3. 55- to 64-year-old age group, 38.2% showed evidence of root decay
  4. over-75 age group, nearly 56% had root decay59

In addition to gumline recession, older adults tend to experience decreased salivary flow, or xerostomia, due to the use of medications or medical conditions.67, 68 Inadequate saliva flow places an individual in the high risk category for decay.12 This decrease in salivary flow can increase the likelihood of dental decay because saliva contains many elements necessary for early decay repair — including fluoride.

There are data to indicate that individuals who have consumed fluoridated water continuously from birth receive the maximum protection against dental decay. However, teeth present in the mouth when exposure to water fluoridation begins also benefit from the topical effects of exposure to fluoride. In 1989, a small study in the state of Washington suggested adults exposed to fluoridated water only during childhood had similar decay rates as adults exposed to fluoridated water only after age 14. This study lends credence to the topical and systemic benefits of water fluoridation. The topical effects are reflected in the decay rates of adults exposed to water fluoridation only after age 14.

The study also demonstrates that the pre-eruptive, systemic effects of fluoridation have lifetime benefits as reflected in the decay rates of adults exposed to fluoridation only during childhood. The same study also noted a 31% reduction of dental disease (based on the average number of decayed or filled tooth surfaces) in adults with a continuous lifetime exposure to fluoridated water as compared to adults with no exposure to water fluoridation.64

A Swedish study investigating decay activity among adults in optimal and low fluoride areas revealed that not only was decay experience significantly lower in the optimal fluoride area, but the difference could not be explained by differences in oral bacteria, buffer capacity of saliva or salivary flow. The fluoride concentration in the drinking water was solely responsible for decreased decay rates.69

Water fluoridation contributes much more to overall health than simply reducing tooth decay: it prevents needless infection, pain, suffering and loss of teeth; improves the quality of life; and saves vast sums of money in dental treatment costs.11 Additionally, fluoridation conserves natural tooth structure by preventing the need for initial fillings and subsequent replacement fillings.70

Repeat of Question 8.
Do adults benefit from fluoridation?

Opposition's Response

"Persons suffering from osteosclerosis or other bone diseases and consuming fluoridated water day after day will just be adding to their troubles." (Dr. J. J. Rae, for 20 years associate professor of chemistry and Ph.D. in bio-chemistry and organics, University of Toronto.)

"Little is known about the complex causes of the major chronic diseases which, unlike dental caries, can cause crippling disability or death, and the fear of death, but two generalizations are possible; they are all associated with the disturbances of the metabolism (to which the enzyme-balance is fundamental), and they tend to be accentuated by nervous and emotional stress. Since there is no medical case for increasing the fluoride intake of adults the various professional advisers have not expert status in recommending this, and I cannot see that it is the duty of anyone in the public health service to impose an added burden of fluoride or of anxiety and indignation, upon the metabolism of those whose health they are supposed to protect." (Dr. C. G. Dobbs, (Ph.D., A.R.C.S.) Senior Lecturer (Mycology), University College of North Whales, Bangor, England.)

"My objection to mass fluoridation is its effect on older people." (Dr. M. B. Dymond, Minister of Health, Province of Ontario.)

"We do not consider it to be established beyond reasonable doubt that increasing the fluoride content of public water supplies to one part per million is without risk to adults in the country." (Professor Hugh Sinclair, Lab. Of Human Nutrition, and Professor D. C. Wilson, Institute of Social Medicine, Oxford, England in letter to the British Medical Journal.)

Drs. Howard V. and Margaret C. Smith, Biochemists at the University of Arizona, have made the study of dental fluorosis their life work. Their investigations in naturally fluoridated areas of Arizona have shown that the low incidence of caries in young children in these areas increases sharply after the age of 21. Moreover, the decay of fluorized teeth is exceptionally severe and difficult to repair.

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First Edition
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