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Fluorides and the changing prevalence of dental caries

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tirath's picture
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Community water fluoridation and individual use of fluorides have brought about a marked reduction in the prevalence of dental caries in the United States during the past 35 years. There is evidence that the prevalence of caries is declining in communities with unfluoridated water as well as in those with fluoridated water. This phenomenon may be related to an increase of fluoride in the food chain, especially from the use of fluoridated water in food processing, increased use of infant formulas with measurable fluoride content, and even unintentional ingestion of fluoride dentifrices. This trend should encourage reevaluation of research priorities and previously accepted standards for optimal fluoride use.

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Drsumitra's picture
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Fluorides and the changing prevalence of dental caries

 Researchers have determined the tactics bacteria use to battle the impact of fluoride, which the bacteria come into contact with from toothpaste and mouthwash.

A Yale University research group explains it findings in the Dec. 22 issue of the online publication Science Express.

The researchers determined there are RNA messages named riboswitches that are capable of noticing buildup of fluoride, enabling the bacteria to utilize defense mechanisms. Some of the bacteria are associated with tooth decay.

The ability of fluoride to attach to teeth and protect the enamel is one of the reasons it has become so prevalent in toothpaste and mouthwash. It fights against acids that the bacteria generate.

These riboswtiches that have been detected, however, have a way to fight the impact Bacteria fluoride generally has on bacteria.

Based on the negatively charged fluoride and many RNA sensor molecules, the two entities should not be capable of binding, based on most logic. But that wasn’t the case in this study.

It was also determined that these RNAs are ancient. This indicates many organisms have had to experience toxic levels of fluoride. Since humans don’t have fluoride riboswitches and the protein associated with the bacteria, it’s possible the fluoride defensive systems could be a target area of drugs.

Despite this information, it’s still unclear as to the mechanism humans use to beat high fluoride levels. Also, the debate over how fluoride truly impacts people will continue despite the information provided by this study.

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Fluorides and the changing prevalence of dental caries

The issue of water fluoridation has flared up again in communities across the U.S. In October, an article in the New York Times contended that budget constraints and skepticism over fluoride's effectiveness were responsible for some 200 communities abandoning the practice. And MSNBC reported that tea party activists had hijacked a fluoridation debate in Pinellas County, FL, resulting in the end of fluoridated water for 700,000 people there.
More news from the fluoride front poured in on November 15, when the Santa Clara Valley Water District in California voted unanimously to fluoridate water to segments of San Jose, which will give access to more than 280,000 residents. The move was applauded by the Pew Children's Dental Campaign, which had teamed with two other organizations, Voices for America's Children and the American Academy of Pediatrics, to sound the alarm about "misinformation" being spread by antifluoridation activists through its new Campaign for Dental Health, also launched on November 15.

South of San Jose, the city of Watsonville's efforts to fluoridate its water have been conflicted for nearly a decade. In 2002, residents voted by a small margin to eliminate fluoridation. But a subsequent court battle, which Watsonville lost, led to a city council vote last year to accept $1.6 million in funding from the California Dental Association (CDA) to build a fluoridation system. Per state law, a California city with a population greater than 10,000 must fluoridate its water if outside funding is provided.

“The voters didn't feel fluoridation was necessary.”
— Steve Palmisano, city water division
manager, Watsonville, CA
"The decision on whether or not to fluoridate was purely political, based on the efforts of the city council," Steve Palmisano, the city's water division manager told DrBicuspid.com. "Although it was 10 years ago, I think the primary objection was to putting additional substances in the water with potentially harmful side effects. The voters didn't feel it was necessary."

They may ultimately get their wish. Watsonville's fluoridation project stalled last month when all five construction bids arrived between $1.2 and $1.9 million above the CDA's grant. The CDA is unlikely to get help from the city as it ponders its next move. Palmisano asserted that Watsonville won't build the fluoridation devices unless they are paid for with outside funding, and that the city is unable to chip in anyway.

"The decision really is in the hands of the CDA," he said. "I had a conversation with them, asked for an indication if it will go through, and they didn't give me any at all."

3 treatment plants, $10 million

Despite the November 15 vote endorsing fluoridation for the Santa Clara Valley Water District, Donald Gage, director of District 1 and 2011 chair, shared a similar view.

"We have three things in our charter: One, provide clean, safe drinking water. Two, flood control. And three, environmental issues," Gage told DrBicuspid.com. "[Fluoridation] is not something we're supposed to do, and we don't have the money anyway."

Because it is a wholesaler, the Santa Clara Valley Water District is not beholden to the state's fluoridation law. But the district intends to move forward with water fluoridation anyway -- if the cost issues can be adequately addressed.

The equipment the Santa Clara Valley Water District needs to provide fluoridation at its three treatment plants will cost $10 million, Gage said. The district's looming priorities, per its charter, start with what Gage estimates to be $500 million needed to seismically retrofit aging area dams. Replacing antiquated levies around the region's delta may cost even more.

"What we're doing is setting up a general policy that will enable the people who want water fluoridation to move forward with it," Gage said. "There's some wording in there that needs to be changed because it doesn't allow public/private partnership." The details, he explained, will be addressed later.

Now the Health Trust, a Silicon Valley nonprofit promoting wellness, and the California Department of Public Health are working to identify potential funding sources for the equipment installation. Gage believes that the communities that will receive fluoridated water, such as San Jose and Sunnyvale, should foot the bill for operations and maintenance once the infrastructure is in place, at a cost of about $1 per person annually. That is where his opinion about fluoridation ends.

"If the majority wants it, because we're a democratic society, I'm willing to do it," he said. "But other than that, because I'm not scientist, I have to look to the federal and state government to tell me whether it's safe or not."

Science and budget concerns

For one Florida county commissioner, contradictions between federal agencies regarding fluoridation led to his determination that it should be ended. Norm Roche, who has an extensive background in Pinellas County Water Department policy research, became a national lightening rod for his stance on fluoridation when he led a successful effort to cease fluoridating the water supply for roughly 700,000 Floridians this year. But he believes his position has been mischaracterized.

Roche told DrBicuspid.com that he has expressed concerns about fluoridation since 2003, when the council first voted in favor of it.

"My issue back then, as it is today, is with the actual chemical we use to fluoridate the water, fluorosilicic acid," he explained. "On the one hand, the U.S. Centers for Disease Control and Prevention talks of fluoridation as a great concept. But the U.S. Food and Drug Administration will not approve fluorosilicic acid for human consumption. So there are competing federal agencies there on the issue."

He is also concerned by a lack of consensus among physicians, dentists, and chemists about which particular type of chemical should be used and whether ingesting fluoridated water was better than a topical delivery via dentifrice.

"Expecting seven politicians to watch experts, doctors, accuse each other of faulty information and then look at us saying, 'You make the call ...' -- I don't find that to be our role," he explained.

There were other complications with fluoridation as well. Pinellas switched to a regional water source about 10 years ago, and now receives a blended mix of desalinized water, ground water, and surface water from a local river.

"All of them have various degrees of naturally occurring fluoride, which made our plant operators almost daily have to tweak the fluorosilicic acid drip," he explained. "It became a complex issue -- and guesswork."

While the cost of fluoridation was not a major consideration, Roche acknowledged that it played a role in the issue. "It was born, if you will, of the budget discussion," he said. "But the fiscal impact was the least of my concerns."

A philosophic disagreement

Scott Tomar, DDS, DrPH, a professor at the department of community dentistry and behavioral science at the University of Florida College of Dentistry, is worried that other communities will take a similar tack while governments look to trim budgets.

“It came down more to a philosophic disagreement than a financial one.”
— Scott Tomar, DDS, DrPH, University
of Florida College of Dentistry
"I think it certainly has emboldened opponents to fluoridation to seize on it," he told DrBicuspid.com. "What I'm seeing more of lately, and I think what happened in Pinellas County, it came down more to a philosophic disagreement than a financial one."

That is the sort of impression that has dogged the Pinellas County city commission's decision. After the narrow 4-3 vote, national attention ensued -- due primarily to the Associated Press describing the decision as a tea party victory for smaller government, according to Roche.

"I interviewed with the NY Times, "NBC Nightly News," Rachel Maddow, "The Daily Show" even, all based on the misinterpretation of the decision," he recalled. "And they all went, 'This isn't really the story we got on the AP wire.' "

The perception of tea party politicians blocking fluoridation has been aided by the way other districts have handled fluoridation. Dr. Tomar referenced a recent example in High Springs, FL, where fluoridation landed on the city council's agenda.

"In my testimony before the city council, I raised the point that of $8,000 that they might save, all they're really going to do is transfer it onto the backs of their citizens," he recalled. "But they said, it was never about the money, it was more a discussion of whether city or county government should be providing preventive services."

Dr. Tomar cited other examples in which opposition to fluoridation centered on whether it is an essential service. While most are swayed by the notion that the savings end up coming out of the pockets of the community needing greater dental work, he said the role of government is an argument that's been coming up a lot.

"The science is on our side, fully supported by every legitimate health and medical organization," he said. "But if there's a political opposition to it that has nothing to do with the science, there isn't much you can do to change that."

While Roche has asserted that he's unconcerned with the political aspect of the issue, he sees inefficiency in the fluoridation process.

"If you want to reach 10,000 underprivileged people who aren't getting adequate access to dental care, do you publicly fluoridate the water for 1 million just to get to them?" he asked. "Or do you focus your resources in order to get them the help that they need?"

Trust also appears to be a factor.

"One of the other issues arising here is, even though cities and counties have been fluoridating for quite a long time, Florida still gets an F for dental care for the indigent and underprivileged," Roche said, also noting that only 25% of dentists in the state will see Medicaid patients. "Is their position to keep fluoride in the water so that they won't have to see them? I think that's a valid part of the discussion."

 

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drmithila's picture
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Fluorides and the changing prevalence of dental caries

Parents should use toothpastes that contain fluoride with a minimum concentration of 1,000 parts per million to prevent tooth decay in their children, says a new report. Preventing tooth decay can help reduce the need for extensive and costly dental treatments, including extractions.
But the authors, in a second related study, suggest that parents concerned about the risk of fluorosis -- the discolouration or mottling of the teeth caused by excessive fluoride ingestion -- should consult their dentist to discuss the benefits and risks.
Researchers for the Cochrane Oral Health Group, based at the School of Dentistry, The University of Manchester, have previously shown that fluoride toothpastes reduce dental decay by 24% on average compared to non-fluoride products.
The group's latest research, which involved 79 trials on 73,000 children worldwide, examined the effect of different children's toothpastes and found that those with fluoride concentrations less than 1,000 parts per million were only as effective as non-fluoride toothpastes at preventing tooth decay. Children's toothpastes range from 100ppm to 1,400ppm fluoride concentration.
The report suggests that brushing a child's teeth with a toothpaste containing fluoride before the age of 12 months may be associated with an increased risk of developing mild fluorosis. Swallowing large amounts of toothpaste may still cause fluorosis in children up to the age of six years when the permanent teeth are still developing, but using a small amount, carefully, will reduce these risks. After the age of six years, the teeth are fully developed and toothpaste can be used without fear of fluorosis.
Dr Anne-Marie Glenny, an author on the review, said: "It is very confusing for parents to know how to strike the right balance, which isn't helped by the fact that different companies use different concentrations of fluoride in their toothpastes aimed at children.
"From a public health point of view, the risk of tooth decay and its consequences such as pain and extractions is greater than the small risk of fluorosis. Children would have to swallow a lot of toothpaste over a long period of time to get the severe brown mottling on the teeth, as opposed to the more typical mild white patches.
"For children that are considered to be at a high risk of tooth decay by their dentist, the benefit to health of preventing decay is likely to outweigh the risk of fluorosis. In such cases, careful brushing of their children's teeth by parents with a small amount of toothpaste containing higher levels of fluoride would be beneficial. If in any doubt, we would advise parents to speak to their family dentist."

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Fluorides and the changing prevalence of dental caries

Children drinking water with added fluoride helps dental health in adulthood decades later, a new study finds
In an article appearing in the October issue of the American Journal of Public Health, Matthew Neidell reports a strong relationship between fluoride levels in a resident's county at the time of their birth with tooth loss as an adult.
"Your fluoridation exposure at birth is affecting your tooth loss in your 40s and 50s, regardless of what your fluoridation exposure was like when you were 20 and 30 years old," said Neidell, a health policy professor at the Mailman School of Public Health at Columbia University.
He combined data from a recent Centers for Disease Control and Prevention community health study and a water census to see the impact of drinking fluoridated water in the 1950s and 1960s on tooth loss in the 1990s.
"We know that the benefits of fluoridation are greatest from birth," said Howard Pollick, a professor of clinical dentistry at the University of California, San Francisco. "This recent study adds credence to that."
For children whose adult teeth haven't shown yet, fluoride still improves tooth enamel, the highly mineralized tissue on teeth's surface. Fluoride also helps teeth damaged from the decay process and breaks down bacteria on teeth.
The researchers write that respondents who did not live in the same county their entire lives received differing amounts of fluoride in their water, which complicated study findings. The study, which focused on tooth loss as an indication of overall oral health, could not adjust for factors such as use of toothpaste, which also provides a dose of fluoride.
Pollick said that roughly 75 percent of people served by public water systems have fluoride added. The process uses small amounts of the naturally occurring mineral to increase concentrations to no more than one part per million typically.
The American Dental Association, which has supported fluoridation of community water since 1950, says scientists continue to show adding the mineral to water is safe and aids tooth health. One 2007 study of Kaiser Permanente HMO members found that adults benefitted from community fluoridation more than children.
Pollick pointed to a study of Medicaid dental patients in Louisiana, which showed that for every $1 invested in water fluoridation, the state saw $38 in reduced dental costs.
To prevent tooth decay, Pollick recommends also brushing twice a day with fluoride toothpaste and reducing sugar levels in diet.

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Fluorides and the changing prevalence of dental caries

 New light/research on Fluoride action on teeth

Research from a German university – All bacteria species exhibit lower adhesion forces after fluoride treatment of the surfaces. These findings suggest that the decrease of adhesion properties is a further key factor for the cariostatic effect of fluoride besides the decrease of demineralization. The research is published in the journal Langmuir can be found 

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Fluorides and the changing prevalence of dental caries

Voters in Portland, OR, definitively rejected water fluoridation May 21 for the fourth time in the city's history since 1956 with a 60%-40% split, the Oregonian reported.

Last September the city council unanimously approved a plan to add fluoride by March 2014. But fluoridation opponents subsequently gathered more than 30,000 signatures to force a referendum, and the city council decided it was in the public interest to schedule the vote for May 2013.

There was financial support -- more than $1 million for a city campaign -- and political support for the fluoridation plan, according to the Oregonian.

Opponents of public fluoridation contend it is unsafe and violates an individual's right to consent to medication. They called for an independent scientific review of the latest research so voters can make an informed decision.

Portland's drinking water already contains naturally occurring fluoride, though not at levels considered to be effective at fighting caries. Portland voters twice rejected fluoridation before approving it in 1978, but that plan was overturned before any fluoride was added to the water.

 

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Fluorides and the changing prevalence of dental caries

Two Northern California cities -- Davis and Woodland -- are considering adding fluoride to their drinking water.

Adding fluoride to the water could improve dental health for 130,000 people, particularly low-income residents who can't afford regular dental care, according to a Sacramento Bee story.

But opponents say fluoridation amounts to medication of residents that harms people and the environment. While county health and education officials have endorsed fluoridation, activists are organizing an opposition effort.

A nonbinding resolution to fluoridate the cities' water supply was recently approved by county supervisors 4-1, according to the story. However, fluoridation has been rejected by both cities' voters in the past.

 

 

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Fluorides and the changing prevalence of dental caries

U.S. officials recently lowered the recommended dosage of fluoride in water from 1.2 to 0.7 parts per million -- a limit that previously had been several times higher.

But detecting fluoride at such miniscule levels can be tricky, according to Texas A&M University chemist François Gabbaï, PhD.

So he and his research team have focused on building a solution -- organometallic molecules that emit fluorescence when they are mixed with water containing fluoride. The new tool could be used to monitor water supplies and ensure safety standards.

"The sensors have to physically make contact with fluoride, but we had a fundamental challenge: Water serves as a very efficient buffer and keeps the sensor away from the fluoride anion," said Gabbaï, a professor in the department of chemistry. "So we make organometallic compounds that have a high affinity for small anions. These compounds are Lewis acids -- molecules that are lacking in electrons -- that capture fluoride and brighten when they find it."

Gabbaï recently earned a $440,000 National Science Foundation grant to further develop the technology.

 

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