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Health Sentinel Column: Fluoride debate a balancing act

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Fluoride tips

Dr. Domenick Zero of the IU School of Dentistry's Oral Health Research Institute, gives these recommendations to parents of young children:

♦Buy toothbrushes based on size that can appropriately fit in the child's mouth.

♦Put just a smear of paste on the brush for children age 4 and younger; use a pea-sized amount for kids ages 5 to 6.

♦Parents should do the brushing of toddlers' and young children's teeth; don't leave it to the kids.

♦Teach children not to swallow the toothpaste. Don't leave paste in reach of unsupervised youngsters.

♦Brush children's teeth once every morning then again right before bedtime.

Fluoride: How much is too much?

Currently, the maximum allowable amount of fluoride per liter of drinking water under U.S. Environmental Protection Agency standards for communities is 4 milligrams per liter. However, the EPA has set a standard of no more than 2 milligrams per liter per day for children whose teeth are still in formation, or until about age 8.

The dental health benefit range established by the U.S. Department of Health and Human Services is currently 0.7 to 1.2 milligrams per liter per day. The new HHS recommendations are a maximum of 0.7 milligrams per liter per day.

The only enforceable standard is the upper limit of 4 milligrams set by the EPA, but the EPA requires residents be notified when average levels exceed 2 milligrams per liter.

The EPA is considering lowering the maximum allowable amounts found in drinking water. Public comment will be taken on the proposed recommendations for 30 days after they are entered into the Federal Register.

According to the City of Fort Wayne's 2010 Water Quality Report, the most recent annual report available and which compiled 2009 water-quality data, the fluoride levels in 2009 ranged from 0.62 to 1.64 milligrams per liter, which equals parts per million (ppm) and is how the city records levels.

Sources:

♦City of Fort Wayne: www.cityoffortwayne.org/utilities/images/stories/docs/AnnualWQR2010pdf.pdf

♦U.S Department of Health and Human Services: www.hhs.gov/news/press/2011pres/01/pre_pub_frn_fluoride.html

♦U.S. Environmental Protection Agency: http://water.epa.gov/drink/contaminants/basicinformation/fluoride.cfm

Scientists seek level at which mineral does more dental good than harm.

Monday, January 17, 2011 - 11:01 am

I was in early elementary school when “Fluoride Treatment Days” took place. We all lined up, waiting for the county nurse and some dentists to put large, metal clamps into our mouths, then cotton rolls around the gum lines.

Next came the dreaded, horrid-tasting fluoride painting of our teeth. Heads back, we sat for 15 or 20 minutes. Seemed like an hour. A few kids gagged. If the clamp came off, the stern-looking nurse would put it back in place. The fluoride taste lingered in our mouths for hours afterward.

That was 50-plus years ago. Research on fluoride had shown it prevented cavities. Thus federal health officials recommended communities add fluoride to tap water, though fluoride treatment was not — and still is not — mandated. But for places such as Cissna Park, Ill., where we drank well water, the fluoride treatments were the next best thing.

Now for the first time in nearly 50 years, the government is recommending lowering the maximum level of fluoride we ingest in a day. Scientists cite concerns over a dental condition called fluorosis, along with the possibility of brittle bones, fractures and skeletal abnormalities. But at least one Indiana expert urges a balance between too little fluoride and too much.

Levels of fluoride in water vary from region to region

When fluoride was first added to community tap water, it was the main way people were exposed to it other than by naturally-occurring fluoride in the soil and bedrock run-off. To meet recommended amounts in drinking water to prevent cavities, yet not cause other health problems, some communities add very little, others more, depending on the soil. Some communities have never approved adding fluoride.

After fluoridated water came fluoridated toothpastes, mouthwashes, dental rinses and fluoride applied by dentists. Some bottled water even contains fluoride. We know fluoride works to prevent cavities. Today's teenager has an average of 2.6 cavities compared to 6.2 in 1970; regular dental check-ups, dental insurance and tooth sealants are contributing factors as well.

It's the amount of daily fluoride exposure that is spurring the changes. Increased ingestion of fluoride is causing fluorosis, which are white streaks or spots, on children's and teen's teeth.

Most often, fluorosis is a cosmetic issue, not a health issue, says Dr. Domenick Zero. He is associate dean for research at the Indiana University School of Dentistry in Indianapolis, director of the school's Oral Health Research Institute and department chair of Preventive and Community Dentistry.

Fluorosis mostly cosmetic

Usually, the streaking is only noticed by dentists, unless the child is exposed to very high levels of naturally-occurring fluoride while teeth are forming, Zero says. In its worst form, fluorosis, which develops only from ingested fluoride, causes pitting and breakdown of the enamel, requiring dental repair and in rare instances, loss of teeth.

One study, cited by the U.S. Department of Health and Human Services, found in 1999-2004, 41 percent of adolescents had fluorosis compared with 23 percent in a period of time 15 years earlier.

On the U.S. Environmental Protection Agency's website is a discussion of findings from research in two districts in China, where naturally-occurring fluoride ingestion averaged 2 milligrams/liter. A high percentage of residents with lifetime exposure not only had dental fluorosis, but also skeletal fluorosis, which caused pain and stiffness in joints and limbs, bent vertebrae and limbs, bowed legs and other symptoms hindering daily activities.

Striking a balance

The key is balance, Zero says, noting he concurs with the recommended fluoride changes.

“My reaction to this is that it is a measure being taken to be on the safe side and minimize exposure to fluoride.” Yet, he points out, “The real danger is that there is potential for overreaction. If you lower the levels of fluoride, some people may not be getting enough to prevent caries (cavities).”

That thought came to my mind when I heard a recent discussion of the issue on a major TV network show featuring advice from doctors. One of the doctors, albeit she wasn't a dentist, suggested parents brush young children's teeth with baking soda instead of toothpaste.

Zero's response to the comment: “That takes us back to the turn of the last century. … Fluoride is the most effective tool we have for eliminating cavities for the greatest good of the people.”

Toothpaste for toddlers

The Centers for Disease Control recommends children under age 2 use non-fluoridated toothpaste. The problem with young children is they swallow the paste, particularly when it has been made with pleasant flavorings.

Mindy Horst says it is precisely that reason she has avoided buying fluoridated toothpaste for her daughter, Mia, who is 2 1/2 .

But the Fort Wayne mother's 5-year-old son, Toby, uses fluoridated paste because he is better at spitting it out rather than swallowing it.

Even then, Horst says, it is tempting for a child to want to eat the toothpaste. The flavor of her son's toothpaste, for example, is Bubble Berry. “It's specifically for 5- to 7-year-olds, and there's a cartoon character on it.”

Most fluoridated toothpaste used by older children and adults has about 1,000 milligrams/liter. Parents should discuss with their dentist what fluoride amounts in toothpaste are best for their children's ages.

Horst, who grew up in Michigan, drank well water until she went to college. She remembers getting fluoride treatments at the dentist's office.

She's glad her kids are growing up drinking fluoridated water, but after reading about the recommendations on lowering the optimal levels, she said, “I'm going to be more aware of how much is in their toothpaste and in our water.”

This column is the personal opinion of the writer and does not necessarily reflect the views or opinion of The News-Sentinel.