Building Effective Statewide Teams for Fluoridation Itasca, IL March 20-21, 2018 Johnny Johnson, Jr., DMD, MS
Community Water Fluoridation: Where it started How it works Building a village to support it
Fluoride & Fluoridation: 400 mile view Grassroots view
Fluoride is Naturally Occurring 13 th most abundant mineral in the earth s crust Surface water (rivers) -- typically low concentrations, 0.2 mg/l (ppm) or less Groundwater (wells) --higher concentrations, 0.1 mg/l to over 5.0 mg/l Ocean water is typically 0.8 to 1.4 mg/l
Courtesy CDC Water Fluoridation Course Materials, 2015
How Did We Discover the Scientific Benefits of /.FDZ```Q Fluoride on Reducing Decay?
History of Fluoride s Benefits Frederick S. McKay 1901 established practice in Colorado Springs, CO Colorado Brown Stain Only life-long residents (or those who had moved there as infants) had stain 1908 began to investigate extent of condition in surrounding areas Key Observation: very few cavities in this population https://www.nidcr.nih.gov/health-info/fluoride/the-story-of-fluoridation
1930 - H. V. Churchill used a newly available method of spectrographic analysis that identified high concentrations of fluoride (13.7ppm) in the water of a community in Arkansas with high rates of mottled enamel 1931 McKay contacted Churchill and sent him water samples. Fluoride was discovered in each sample that McKay sent for analysis (2.0ppm to 12.0 ppm) It was now known what substance in the water was causing the staining of teeth: FLUORIDE
Mother Nature is Replicated: Community Water Fluoridation Begins A 21 city study is undertaken to replicate what Mother Nature has taught us Grand Rapids, Michigan was the first city to adjust fluoride concentration in public drinking water (1945) Cavity rates dropped dramatically
At the time CWF was initiated Almost everyone had tooth decay No one knew how to prevent it Not uncommon for 13-year-olds to have lost one or more permanent teeth to decay About half of older Americans (age 65+) had lost all their natural teeth Recruits into WWII rejected because of poor oral health (6 opposing teeth -10% rejection rate; 40% needed immediate treatment for relief of pain)
How Does Fluoride Work?
How fluoride works Topical Effect From the outside of the tooth Saliva, fluoridated toothpaste and other topical products Systemic Effect From the inside and outside of the tooth Saliva bathes the teeth enamel 24/7/365 Adults also benefit from fluoride, rather than only children (as was once assumed) http://www.cdc.gov/fluoridation/basics/index.htm
How Fluoride Works Topically Fluoridation Basics Fluoride inhibits demineralization Fluoride enhances remineralization of surface enamel Dental plaque is fluoride reservoir releasing small amounts of fluoride when ph is lowered as we eat Fluoride is taken up more readily by demineralized enamel than by sound enamel Fluoride in saliva continuously bathing the tooth in fluoride Koulorides. J Dent Res 1990;69(Spec Issue):558.
Are There Alternatives to Water Fluoridation-NO!! 1. Community Water Fluoridation: The Gold Standard 0.7mg/L (ppm): Reduces cavities by 25% Adults and children 2. Closest thing to a Magic Bullet we have 3. Fluoride toothpaste is not a replacement: CWF + TP 4. Fluoride Supplements: Compliance Terrible! 5. No alternative works as well or is as cost effective as CWF http://www.cdc.gov/fluoridation/basics/index.htm
HEALTH BENEFITS OF WATER FLUORIDATION? CAVITIES ARE REDUCED FOR ALL P.S.-Ya still gotta brush, floss, eat well, get dental checkups, and sealants
Is Water Fluoridation Still Necessary? YES! Effect of Starting Community Water Fluoridation: 25% cavity reductions Effect from Stopping CWF: Huge increases in cavities Calgary, Alberta, Canada-stopped 2011 Cavity rates have skyrocketed 146%
Why do cavities matter? The most common chronic disease for children and teens. It s at least 2-3 times more common than asthma and obesity, 20 times than diabetes Severe pain (toothaches) Difficulty in chewing Poor weight gain Difficulty concentrating Predictor of cavities later in life Costly to treat Deaths
CAVITIES: Unevenly Distributed Low income kids are more than twice as likely to experience tooth decay The disadvantaged bear a disproportionate burden of cavities
Operating Room Full Mouth Restorations reduced by 2/3 to 3/4ths by CWF U.S. and International studies confirm benefits for children CWF decision-makers & Water Operators prevent more cavities by fluoridating the water than all of us can do (Sources:. An alternative marker for the effectiveness of water fluoridation: hospital extraction rates for dental decay, a two-region study, Elmer et al, British Dental Journal 2014; 216: E10; J. Dental services, costs, and factors associated with hospitalization for Medicaid eligible children, Louisiana 1996-97. Griffin SO, et al, Public Health Dent. 2000 Winter;60(1):21-7; Hospitalizations for dental infections - Optimally versus non-optimally fluoridated areas in Israel. Amir Klivitsky, MD; et al, http://jada.ada.org/article/s0002-8177(14)00115-9/)
Operating Room Full Mouth Restorations reduced by 2/3 to 3/4ths by CWF
A (big) ounce of prevention The CDC has called fluoridation one of 10 great public health achievements of the 20th century. Fluoridation reduces tooth decay by 25% over a lifetime protection beyond what is offered by fluoride toothpaste and other preventive methods. Over 211 million U.S. residents, 3 out of 4 people on community water systems, have access to optimally fluoridated water. (Sources: Centers for Disease Control and Prevention, Ten Great Public Health Achievements in the 20th Century, web content updated on April 26, 2013; CDC s 2014 Fluoridation Statistics; CDC, Water Fluoridation Basics, web content updated on June 17, 2016.)
Variations in tooth enamel (fluorosis) Normal Very Mild Moderate Improper use of fluoride products Questionable Mild Severe Not caused by CWF (Source: Information from the Centers for Disease Control and Prevention s website, accessed in October 2017 at http://www.cdc.gov/fluoridation/faqs/dental_fluorosis/index.htm)
Fluoride & Fluoridation: The Village 400 mile view Grassroots view
The Two Villages Immediate Challenge: Timeline-extremely short Key claims being made Department of Health Local, state, and national group support-healthcare, coalitions Key influencers in community Faith-based community Building support for initiation Timeline-months to years Key claims being made Department of Health Local, state, and national group support-healthcare, coalitions Key influencers in community Faith-based community
The Two Villages Immediate Challenge: Timeline-extremely short Key claims being made Department of Health Local, state, and national group support-healthcare, coalitions Key influencers in community Faith-based community Immediate Challenge: Who will lead? Who will follow? Who s in the sandbox? It takes a Village
Collaborative project between CDC and KC Industries to Fluoridate the remaining 25% of U.S. Sodium Fluorosilicate tablets-standard 60 approved
Thank You!! Johnny Johnson, Jr., D.M.D., M.S. President, American Fluoridation Society www.americanfluoridationsociety.org @AFS_FLUORIDE https://www.facebook.com/americanfluoridationsociety