Dental Health is Community Health

We need to return to adding fluoride to our water supply.

The Centers for Disease Control and Prevention (CDC) states that fluoridation of community water supplies is one of the ten great public health achievements of the 20th century in the United States. It ranks up there with vaccinations and control of infectious diseases. According to the CDC, fluoridation of drinking water, which began in 1945 and now reaches three out of four Americans, is both safe and inexpensive. The benefit? Reductions in tooth decay (40%-70% in children) and of tooth loss in adults (40%-60%).

Fluoridation of the water supply is race-blind and socioeconomic status-blind. It benefits children and adults regardless of access to dental care. According to dental association reports, on an individual basis, the lifetime cost of fluoridation is less than the cost of one dental filling. For communities, every $1 invested in water fluoridation saves $38 in dental treatment costs. This is a straightforward example of the benefit of public health.

The Texas Department of State Health Services runs the Texas Fluoridation Program (TFP) specifically to improve the health of Texans by preventing tooth decay through community water fluoridation. TFP assists public water systems in the engineering design, installation, and maintenance of water fluoridation systems; monitors the adjusted fluoride level in the drinking water; and maintains the US Centers for Disease Control and Prevention (CDC) fluoridation database for the State of Texas. The Texas DSHS notes that community water fluoridation is recommended by nearly all public health, medical, and dental organizations. The US Department of Health and Human Services’ Community Preventive Services Task Force completed its most recent review of community water fluoridation in April 2013; it recommended water fluoridation based on strong evidence of effectiveness in reducing tooth decay across population groups.

This is also an equity issue. A dental public health publication concluded that water fluoridation is the most effective and practical method for reducing the gap in decay rates between low-income and upper-income Americans. The Hispanic Dental Association has called fluoridation a valuable tool in the reduction of oral health disparities. Another public health paper noted that school performance is indirectly affected by fluoridation because children with poor dental health are nearly three times more likely to miss school and are four times more likely to earn lower grades.

Most water has some fluoride, but usually not enough to prevent cavities. The City of Lufkin 2017 Annual Water Quality Report – the most recent available online – states the fluoride level at the time was 0.722 ppm. The City of Lufkin website, on their FAQ page, continues to state that they add fluoride “at a constant concentration of 1 part per million gallons” and that it is added “as a deterrent to tooth decay.” But according to the CDC, the City of Lufkin’s water system, which supplies a population of more than 42,000 (not just Lufkin, mind you!), now has a fluoride concentration of 0.3, below what is recommended.

I confirmed with our City Manager, Keith Wright, that the City of Lufkin stopped fluoridating water last year. The rationale was that people get fluoride in many ways now, and it seemed unnecessary. In addition, there was concern about conflicting reports of health effects.

Chronic fluoride toxicity is usually caused by excessive fluoride concentrations in drinking water or the use of fluoride supplements. With controlled, measured fluoridation, there is minimal risk with significant public health benefit. A New England Journal of Medicine Journal Watch commentary noted that there may even be an added benefit for older women by increasing bone mineral density with less risk of hip fracture. As for fluoride from other sources, I love the way the Texas Oral Health Coalition, Inc. puts it: “Community water fluoridation and brushing with fluoride toothpaste complement each other, like seat belts and air bags in automobiles. Both work individually, but together they provide even better protection.”

The US Public Health Service’s recommendation for the optimal level of fluoride in community water systems is a ratio of fluoride to water calibrated at 0.7 parts per million. They reached this number after years of scientifically rigorous analysis of the amount of fluoride people receive from all sources, not just fluoridation of the water supply.

What about cost? The Texas Department of State Health Services Fluoridation Program estimates the cost of fluoride additive at $4011/year to the city, based on Lufkin’s average production rate and current average fluorosilicic acid price at $2.00/gallon. I don’t know exactly how accurate those numbers are, but it is obvious we are not talking a lot of money here.

Bottom line? Lufkin needs to return to fluoridating our water supply. And the Texas legislature should consider requiring municipalities to maintain recommended fluoride levels in municipal water supplies. After all, dental health is part of public and community health.