Keeping your child's teeth healthy requires more than just
daily brushing. During a routine well-child exam, you may be surprised to
find the doctor examining your child's teeth and asking you about your water
supply. That's because fluoride, a substance that's found naturally in water,
plays an important role in healthy tooth development and cavity prevention.
Tooth decay occurs when bacteria - found in the plaque that dentists try so
hard to get rid of - break down sugars in food. This process produces damaging
acids that dissolve the hard enamel surfaces of teeth. If the damage is not
stopped or treated, the bacteria can penetrate through the enamel to the underlying
tissues of the teeth, causing cavities (also called caries). Cavities weaken
teeth and cause pain, tooth loss, or even widespread infection in the most
severe cases.
Fluoride combats tooth decay in two ways. It strengthens tooth enamel, a hard
and shiny substance that protects the teeth, so that it can better resist
the acid formed by plaque. Fluoride also allows teeth damaged by acid to repair,
or rematerialize, themselves. Fluoride cannot repair cavities, but it can
reverse low levels of tooth decay and thus prevent new cavities from forming.
Though fluoride benefits adults, it is especially critical to the health of
developing teeth in children. And despite all the good news about dental health,
tooth decay remains one of the most common diseases of childhood. According
to 2000 statistics from the U.S. Surgeon General, more than half of children
ages 5 to 9 years have had at least one cavity or filling, and tooth decay
has affected 78% of 17-year-olds.
Your Child's Fluoride Needs
So how much fluoride does your child need? In general, children under the
age of 6 months do not need fluoride. Your child's 6-month checkup offers
a great chance to discuss fluoride needs with a health professional.
If you live in a non-fluoridated area, your child's doctor or dentist may
prescribe fluoride drops, tablets, or vitamins after your baby is 6 months
old. The American Academy of Pediatrics recommends that these fluoride supplements
be given daily to children between the ages of 6 months and 16 years. The
dosage will change as your child grows. Only children living in non-fluoridated
areas or children who drink only non-fluoridated bottled water should receive
supplements.
Water fluoridation
Most water supplies contain trace amounts of fluoride. Water systems are
considered naturally fluoridated when the natural level of fluoride is greater
than 0.7 parts per million (ppm). When a water system adjusts the level of
fluoride to 0.7–1.2 ppm it is referred to as community water fluoridation.
In 1945, Grand Rapids, Michigan, adjusted the fluoride content of their water
supply to 1 ppm and became the first city to implement community water fluoridation.
Today, approximately 67.3 percent of the U.S. population on public water supplies
has access to fluoridated water.
Bottled water and fluoridation
Currently, there is some concern among dental professionals that the growing
use of bottled water may decrease the amount of fluoride exposure people will
receive. Some bottlers such as Dannon have begun adding fluoride to their
water. Most bottlers, however, do not add fluoride, and fluoride concentrations
are not usually labeled on the bottle. As a result, people who have fluoridated
water supplies may receive less than the amounts of fluoride that fluoride
proponents recommend if they choose bottled water over tap water. However,
if consumers are merely choosing bottled water over other packaged drinks,
such as orange juice or soda (when the latter is produced using water which
has not been fluoridated), the effects may be absent, especially because consumers
will still turn to tap water for cooking (i.e. preparing pasta or making bread).
Effectiveness
Frequently, opponents point to a study by the National Institute of Dental
Research showing little difference in tooth decay rates among children in
fluoridated and non-fluoridated communities. In the study's results, the difference
between the children exposed to water fluoridation, and those who were not
exposed, was very small, between 0.12 and 0.30 DMFS (Decayed Missing and Filled
Surfaces).
Some detractors of water fluoridation support concentrated topical methods
to deliver fluoride, as seen in these fluoride trays often used in dentistry.
Opponents also argue that in the instances that fluoride prevents tooth decay,
the effects are merely topical. Therefore, fluoridating water is unnecessary
and ineffective. Instead, they argue, direct applications of fluoride to teeth
as done in dental offices and with fluoridated toothpastes should be the recommended
methods.
Opponents point out that dental decay continues to exist in water fluoridated
communities. They reason that if fluoride is effective, then there would be
no more tooth decay. Finally, opponents argue that the general decline of
tooth decay is the result of factors beside water fluoridation, including
toothpaste with fluoride, improved diets, and overall improved general and
dental health.
The greatest concern with fluoride overexposure is dental fluorosis. Fluorosis
is undesirable because, in severe cases, it discolors teeth, causes surface
changes to the enamel, and makes oral hygiene more difficult. Government agencies,
such as the Center for Disease Control and Prevention, keep records on the
prevalence of fluorosis in the general public.
Has the prevalence of tooth decay decreased since water fluoridation
began?
Yes. Independent studies initiated in 1945 and 1946 followed four communities
and assessed the value of water fluoridation. By 1960, tooth decay rates in
these communities declined, on average, 56 percent more than in demographically
similar communities whose water supplies were not fluoridated. More recent
studies show that water fluoridation will reduce tooth decay in permanent
teeth by approximately 18 to 40 percent. Although this reduction in decay
is not as dramatic as it was in the 1950s and 1960s, it is significant when
compared to tooth decay in non- fluoridated communities.
