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Tuesday, 1 November 2011

Fluoridation: A huge cavity developing in protecting oral health

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Fluoridation has been touted as one of the great public health interventions of the past century.  The past few years have seen the anti-fluoridationists slowly winning and succeeding in reversing past decisions.   This combined with ambiguously changing “professional” guidelines that went from 1.0 mg/L to 1.2 and now reduced to 0.7, must make members of the public suspicious of what the real story behind fluoride is.  Do we need it or do we not?   I’ve certainly had dental professionals advising that water fluoridation is not the panacea that it once was because of the innumerable alternate ways to receive fluoride combined with better oral hygiene.   This advice usually precedes a discussion as to what intensity of effort should be undertaken in the next community plebiscite to drop fluoridation.
The list of communities that have reversed fluoridation seems to be growing faster than new additions. About 45% of Canadians now benefit from water fluoridation and while that increased from 2002-2009, I would be shocked to learn that it has not decreased given the demise of fluoridation in some large Canadian jursidications recently.  Without changes to public policy this can expect to drop further. Provinces such as Alberta, Manitoba, Ontario, Nova Scotia and NWT provide fluoride to a majority of their residents. BC, Yukon, Nunavut, Newfoundland and Quebec leave over 90% of their populations unprotected.   Few provincial or federal political parties want to own the issue of pushing fluoridation.  
Like vaccine preventable diseases, many middle class parents are forgetting the horrors of poor oral hygiene and at times oral health professionals have become more concerned with the quality smile than the quality of health. The debate has become over the cosmetic problems associated with mild fluorosis (staining secondary to fluoride exposure) rather than the impacts of restorative treatment (which can now nearly mimic normal teeth).  Even the Health Canada information on fluoride is more about mitigating concerns than promoting the benefits Health Canada and you Fluoride  .  
Oral health is getting better Chief Dental Health Officer statistical report but is far from being acceptable.  Most children still have at least one experience with caries in their lives, with an average of 2.5 restorations, down from over 10 a few decades back.  The situation in Inuit communities is much bleaker Inuit oral health survey  with decay scores of 7 and numerous other poorer measures.   Other First Nations are likely similar and not yet as well documented.  Few First Nations communities have ever benefited from fluoridation. 
There is evidence that there is a correlation between poor oral health and some chronic diseases and poor school performance.  While the causal link may need to be better proven, chronic inflammatory processes may well contribute to exacerbating atherosclerosis;  pain and under nutrition to poorer school performance.
Aging infrastructure that needs costly replacing provides incentives for communities to reverse public decisions on fluoridation. Dental public health programs have been undermined across the country and are shifting to high needs populations for restorative care and abandoning the efforts at universal protection.  The lack of leadership may be the slow death bell for water fluoridation – or perhaps some enlightened Canadians could look to California that is a bastion for public health policy.  State law requires communities of greater than 10,000 to fluoridate. Now that seems to make a lot more sense that the perverse approach to requiring plebiscites for adopting fluoridation, and in the Calgary situation merely a Council vote to stop.  Clearly there is something wrong with this singular approach to protecting the public’s health.

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