Community Water Fluoridation An Essential Component for Oral Health April 3, 2018
Who Are We? Patricia Hildebrand, MS, RD, LD Sara Carmichael-Stanley, MPH CWF Advisory Group 2
Outline History of Community Water Fluoridation (CWF) Grand Rapids, MI Study What is Fluoride? Why is CWF Important How IDPH is Involved Current Iowa Data Goal for Iowans for Oral Health (Coalition) How YOU Can Help 3
The History of Community Water Fluoridation (CWF) 4
The Grand Rapids Michigan Fluoride Study 5
What is Fluoride? Fluoride is a natural occurring ion of the periodic element, fluorine. Fluoride is a mineral that occurs naturally and is released from rocks into the soil, water, and air. Almost all water contains some fluoride, but usually not enough to prevent tooth decay. 6
How Does Fluoride Prevent Cavities? Fluoride works by stopping or even reversing the tooth decay process - it keeps tooth enamel strong and solid. Tooth decay is caused by certain bacteria in the mouth. When a person eats sugar and other refined carbohydrates, these bacteria produce acid that removes minerals from the surface of the tooth. Fluoride helps to remineralize tooth surfaces and prevents cavities from forming. 7
Systemic and Topical Fluoride Systemic fluorides are those that are ingested and become incorporated into forming tooth structures. Systemic fluorides also provide topical protection because fluoride is present in saliva, which continually bathes the teeth. Topical fluorides strengthen teeth already present in the mouth, making them more decay resistant. 8
Why Should We Worry About Cavities? Children who do not drink fluoridated water have a 32% higher rate of decayed or missing teeth 164 million hours of work are missed each year because of dental issues. Today, more than 100 million Americans lack dental insurance. 9
Dental pain and Education Children with poor oral health were nearly 3 times more likely to miss school due to dental pain, according to a North Carolina study. In a Los Angeles Angeles study, dental problems were responsible for about 1/3 of elementary school absences, among children from economically vulnerable families. California teens reporting recent dental pain were almost 4 times more likely to have a lower grade-point average than their healthier peers. 10
Why is CWF Important? Effective: Community water fluoridation has contributed to the largest decline in cavities in the United States. Drinking fluoridated water keeps teeth strong and reduces cavities by about 25% in children and adults. Safe: Scientists in the United States and other countries have studied the safety and benefits of fluoridated water for over 70 years, and found no convincing evidence to link water fluoridation and any potential unwanted health effect other than dental fluorosis. Affordable: Community water fluoridation is the most cost effective preventive strategy to reduce dental decay for adults and children. Every $1 invested in community water fluoridation yields a savings of $38 in dental care. 11
Who Supports CWF? American Academy of Pediatrics American Dental Association Centers for Disease Control and Prevention Academy of Nutrition and Dietetics American Water Works Association National Cancer Institute World Health Organization American Academy of Family Physicians American Medical Association American Council on Science and Health American Hospital Association American School Health Association National Governors Association and many others 12
CWF in Iowa CWF: Adjustment (up or down) of natural fluoride levels in ground/surface water Iowa s natural fluoride levels: 0.1-4.0 mg/l First plant started fluoridating in 1951 (Waukon Water and Dubuque Water) Fluoride Content in Food Food/Drink Fluoride Amount (mg/l) Soda 0.72 Raisins, seedless 0.39 Black Tea (brewed) 0.30 Crab 0.25 Red Wine, Toothpaste 0.15 Apple 0.004 13
Who s in Charge of CWF in Iowa? DNR IDPH Regulatory agency that gives permits for water fluoridation Strictly interested in fluoride levels over 2 and 4 mg/l Monitors and Educates Bureau of Oral and Health Delivery Systems 14
How IDPH is Currently Involved Health Resources and Services Administration (HRSA) Grant (through August 2018) Water Fluoridation Coordinator State Fluoridation Plan (2016-2021) Water fluoridation data census, report, data collection protocol Toolkit of resources and educational video 15
Definitions of Community Water Systems Adjusted: Adds F to optimal level of 0.70 mg/l Natural: Natural F level above 0.60. No F added. Non-Adjusted: Natural F level below 0.59. No F added. Consecutive: Purchases water from another system. May or may not have enough F. No F added. Multi-Source: Receives water from multiple sources. No F added. Defluoridated: Very high natural F level (above the set EPA limit). Must remove F. 16
Community Water Systems in Iowa Identified as Fluoridated and Non-Fluoridated Number of Systems Population Served by System All Water Systems 1,091 2,818,710 Fluoridated Adjusted 151 1,608,909 Natural 210 380,004 2017 Data Defluoridated 1 1,692 Consecutive 197 422,674 Multi-Source 10 129,185 Total 569 2,542,464 Non-Fluoridated Non-Adjusted 486 259,746 Consecutive 36 16,500 Total 522 276,246 17
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My Water s Fluoride Public s access for their fluoride level 20
What is the Goal of Iowans for Oral Health (Coalition)? 21
How YOU Can Help 22
Where can I find information based on scientific resources? Campaign for Dental Health (American Academy of Pediatrics) https://ilikemyteeth.org/ Centers for Disease Control and Prevention https://www.cdc.gov/fluoridation/index.html Iowa Department of Public Health http://idph.iowa.gov/ohds/oral-health-center/fluoride Iowans for Oral Health (Iowa Public Health Association) https://www.iowapha.org/cwf 23
Contact Information Patricia J. Hildebrand MS, RD, LD Coordinator for Iowans for Oral Health Coalition Iowa Public Health Association www.iowansfororalhealth.com 5815 Kingman Ave, Des Moines Iowa 50311 515-865-4095 patriciajo46@gmail.com Sara Carmichael-Stanley, MPH Water Fluoridation Coordinator Bureau Oral and Health Delivery Systems Iowa Department of Public Health 321 E. 12th Street, Des Moines, IA 50319 515-725-1112 sara.carmichaelstanley@idph.iowa.gov 24