Since the 1940s community water fluoridation has implemented to promote dental nationwide oral health (National Cancer Institue [NIH]). Currently, 74% of the United States population relies on fluoridated water provided by public water systems (Malin et al., 2019). Over the years there have been numerous speculations surrounding the repercussions of water fluoridation. Specifically, research into whether fluoridation causes cancer was conducted in 1991, 1999, and 2011 and each time the conclusion was the same: there is no evidence to support that water fluoridation causes cancer (National Cancer Institute [NIH]). Other investigations have suggested that it may have a role in Alzheimer's disease and the neurodegeneration it brings about (Goshorska et al., 2018). Some even believe that water fluoridation is a mind control method employed by the government to pacify the masses, but let us not go down that road. Please?
Despite the mixed reviews, some new research has come about that may finally have the water fluoridation neigh-sayers telling the rest of us, "I told you so." A cross-sectional study performed by Malin et al. just this year claims that children and adolescents are at risk of suffering kidney and liver damage from long term, low-level, fluoride exposure. What they found was that just a 1µmol/L increase in plasma fluoride levels was associated with an average estimated glomerular filtration rate (eGFR) decrease of 10.36 mL/min/1.73 m^2. Since children and adolescents excrete roughly 45% of the ingested fluoride through the kidneys, while adults can excrete about 60%, it makes sense that individuals in these age groups are more susceptible. These researches also tested blood urea nitrogen levels (BUN) and found that these individuals had a lower BUN than expected implying that the liver may also be affected.
What exactly does this mean? First, it is important to note that the study is not claiming that we are causing kidney and liver disease in our children and teens, but it does appear that the addition of fluoride to our water is affecting kidney and liver function, and metabolism. Second, because of the less effective filtration and excretion of fluoride in children and teens, these researchers believe it possible that as more fluoride is ingested, more will bioaccumulate, sequentially causing more glomerular damage. It is important to note that, although most water sources follow suggested fluoride level guidelines, there are still some that contain well above safe levels causing fluoride toxicity characterized by poor bone formation (including teeth), gastrointestinal issues, and kidney/liver damage (Malin et al., 2019).
The question is, do the benefits of fluoridating our water for cavity prevention and oral health continue to outweigh the damage (even if it is small) that we appear to be doing, especially when vulnerable populations seem to be at the most risk? Or are we doing more harm than good, when we could just as easily promote better oral hygiene and cut out forced intervention all together?
Citations and original article:
https://www.sciencedirect.com/science/article/pii/S0160412019309274?via%3Dihub
Ashley J. Malin, Corina Lesseur, Stefanie A. Busgang, Paul Curtin, Robert O. Wright, Alison P. Sanders,
Fluoride exposure and kidney and liver function among adolescents in the United States: NHANES, 2013–2016,
Environment International, Volume 132, 2019, 105012, ISSN 0160-4120, https://doi.org/10.1016/j.envint.2019.105012.
Goschorska, M., Baranowska-Bosiacka, I., Gutowska, I., Metryka, E., Skórka-Majewicz, M., & Chlubek, D. (2018). Potential Role of Fluoride in the Etiopathogenesis of Alzheimer's Disease. International journal of molecular sciences, 19(12), 3965. doi:10.3390/ijms19123965
If fluoride in our drinking water was meant to pacify our society, I don't think it's working.
ReplyDeleteAccording to the American Dental Association (ADA), fluoride is added to drinking water in order to prevent tooth decay and cavities. Tooth decay is apparently one of the most common childhood diseases in the US (https://www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-fluoridation/5-reasons-why-fluoride-in-water-is-good-for-communities). Dental work to fix this is obviously expensive. So Fluoridation of water, in theory, is a very practical idea. The Center for Disease Control and Prevention placed this movement in its top ten greatest health achievements of the 20th century. Partly due to the fact that it is extraordinarily cheaper than the dental bills and dental problems that come with water lacking fluoride.
But too much of anything can be a problem. High levels of fluoride in drinking water can cause fluorosis, along with what was noted in the blog post. This is when bones become hyper-mineralized due to high intake of fluoride (https://www.who.int/water_sanitation_health/diseases-risks/diseases/fluorosis/en/). First, the teeth are affected, but other bones have been known to follow. This disorder is characterized partly by molting of teeth. Ouch. It originally was seen in Colorado Springs when resident's teeth were so molted they turned brown due to such high levels of fluoride (Fejerskov, O. & Kidd, E., 2009). But upon regulations and the use of more sophisticated technology, the levels seem to be in check.
The research on children specifically is intriguing to me. I feel as though the effects of fluoride in water would've manifested in our population earlier than 60 years after this movement started. Maybe we are all living with partially functioning organs and don't know any better.
References:
American Dental Association. (2019). 5 Reasons Why Fluoride in Water is Good for Communities. Retrieved from https://www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-fluoridation/5-reasons-why-fluoride-in-water-is-good-for-communities.
Fejerskov O, Kidd E (16 March 2009). Dental Caries: The Disease and Its Clinical Management. John Wiley & Sons. pp. 299–327. ISBN 978-1-4443-0928-7.
World Health Organization. (2016, August 29). Water-related diseases. Retrieved from https://www.who.int/water_sanitation_health/diseases-risks/diseases/fluorosis/en/.
Nick,
ReplyDeleteWhile the fluoridation of community water sources has been widely lauded as a public health policy success, I agree that it is important to consider the longitudinal effects of water fluoridation when determining appropriate dosages (if any level is found to be safe at all). With respect to Carter's input, I think it is important to realize that when weighing the negative outcomes of fluorosis, one must consider the fiscal savings and positive patient outcomes associated with improved rates of dental cavities. Dental health and hygiene has been implicated to have a relationship with systemic health, such as with cardiac valve issues (Nakano et al., 2006). Therefore, the benefits in preventing dental cavities also extend into aspects of systemic health.
However, realizing the potential negative effects of using fluoride to prevent dental caries, there has been research investigating other methods of prevention and treatment. Traditionally, the use of sealants provide short-term resistance against acidic demineralization; however, their application requires frequent and routine professional application (Buzalaf et al., 2014).
More recent research has begun to investigate the inclusion of nanoparticles of hydroxyapatite into toothpaste in place of fluoride, which has yielded higher rates of remineralization when compared to fluoride toothpastes (Tschoppe et al., 2011). Fluoride's protective effects against dental caries involves the hydroxyapatite crystal structure of teeth with fluorapatite, a mineral that remains insoluble in more acidic conditions (Dawes, 2003). However, by increasing hydroxyapatite concentrations in the mouth, a similar remineralization effect may be produced. Additionally, given the biocompatibility of hydroxyapatite versus compounds such as fluorapatite, treatments such as these reduce the negative outcomes involved with the introduction of fluoride into dental regimens.
References:
Buzalaf, M.A., Magalhaes, A.C., Wiegand, A. (2014). Alternatives to fluoride in the prevention and treatment of dental erosion. Monogr. Oral Sci., doi: 10.1159/000360557
Dawes, C. (2003). What Is the Critical pH and Why Does a Tooth Dissolve in Acid? Journal of the Canadian Dental Association, 69(11), 722-724.
Nakano, K., Inaba, H., Nomura, R., Nemoto, H., Takeda, M., Yoshioka, H., Matsue, H., Takahashi, T., Taniguchi, K., Amano, A., Takashi, O. (2006). Detection of Cariogenic Streptococcus mutans in Extirpated Heart valve and Atheromatous Plaque Specimens. Journal of Clinical Microbiology, 44(9), 3313-3317. doi: 10.1128/JCM.00377-06
Tschoppe, P., Zandim, D.L., Martus, P., Kielbassa, A.M. (2011). Enamel and dentine remineralization by nano-hydroxyapatite toothpastes. Journal of Dentistry, 39(6), 430-437, https://doi.org/10.1016/j.jdent.2011.03.008
Its a great pleasure reading your post.Its full of information I am looking for and I love to post a comment that "The content of your post is awesome" Great work.
ReplyDeleteperiodontist near me