Dental Articles

Dr. Arthur Kezian

Dr. Narine Tashjian

Keeping your child's teeth healthy requires more than just daily brushing. During a routine well-child exam, you may be surprised to find the doctor examining your child's teeth and asking you about your water supply. That's because fluoride, a substance that's found naturally in water, plays an important role in healthy tooth development and cavity prevention.

Tooth decay occurs when bacteria - found in the plaque that dentists try so hard to get rid of - break down sugars in food. This process produces damaging acids that dissolve the hard enamel surfaces of teeth. If the damage is not stopped or treated, the bacteria can penetrate through the enamel to the underlying tissues of the teeth, causing cavities (also called caries). Cavities weaken teeth and cause pain, tooth loss, or even widespread infection in the most severe cases.
Fluoride combats tooth decay in two ways. It strengthens tooth enamel, a hard and shiny substance that protects the teeth, so that it can better resist the acid formed by plaque. Fluoride also allows teeth damaged by acid to repair, or rematerialize, themselves. Fluoride cannot repair cavities, but it can reverse low levels of tooth decay and thus prevent new cavities from forming.
Though fluoride benefits adults, it is especially critical to the health of developing teeth in children. And despite all the good news about dental health, tooth decay remains one of the most common diseases of childhood. According to 2000 statistics from the U.S. Surgeon General, more than half of children ages 5 to 9 years have had at least one cavity or filling, and tooth decay has affected 78% of 17-year-olds.

Your Child's Fluoride Needs

So how much fluoride does your child need? In general, children under the age of 6 months do not need fluoride. Your child's 6-month checkup offers a great chance to discuss fluoride needs with a health professional.
If you live in a non-fluoridated area, your child's doctor or dentist may prescribe fluoride drops, tablets, or vitamins after your baby is 6 months old. The American Academy of Pediatrics recommends that these fluoride supplements be given daily to children between the ages of 6 months and 16 years. The dosage will change as your child grows. Only children living in non-fluoridated areas or children who drink only non-fluoridated bottled water should receive supplements.

Water fluoridation

Most water supplies contain trace amounts of fluoride. Water systems are considered naturally fluoridated when the natural level of fluoride is greater than 0.7 parts per million (ppm). When a water system adjusts the level of fluoride to 0.7–1.2 ppm it is referred to as community water fluoridation. In 1945, Grand Rapids, Michigan, adjusted the fluoride content of their water supply to 1 ppm and became the first city to implement community water fluoridation. Today, approximately 67.3 percent of the U.S. population on public water supplies has access to fluoridated water.

Bottled water and fluoridation

Currently, there is some concern among dental professionals that the growing use of bottled water may decrease the amount of fluoride exposure people will receive. Some bottlers such as Dannon have begun adding fluoride to their water. Most bottlers, however, do not add fluoride, and fluoride concentrations are not usually labeled on the bottle. As a result, people who have fluoridated water supplies may receive less than the amounts of fluoride that fluoride proponents recommend if they choose bottled water over tap water. However, if consumers are merely choosing bottled water over other packaged drinks, such as orange juice or soda (when the latter is produced using water which has not been fluoridated), the effects may be absent, especially because consumers will still turn to tap water for cooking (i.e. preparing pasta or making bread).

Effectiveness

Frequently, opponents point to a study by the National Institute of Dental Research showing little difference in tooth decay rates among children in fluoridated and non-fluoridated communities. In the study's results, the difference between the children exposed to water fluoridation, and those who were not exposed, was very small, between 0.12 and 0.30 DMFS (Decayed Missing and Filled Surfaces).

Some detractors of water fluoridation support concentrated topical methods to deliver fluoride, as seen in these fluoride trays often used in dentistry.
Opponents also argue that in the instances that fluoride prevents tooth decay, the effects are merely topical. Therefore, fluoridating water is unnecessary and ineffective. Instead, they argue, direct applications of fluoride to teeth as done in dental offices and with fluoridated toothpastes should be the recommended methods.
Opponents point out that dental decay continues to exist in water fluoridated communities. They reason that if fluoride is effective, then there would be no more tooth decay. Finally, opponents argue that the general decline of tooth decay is the result of factors beside water fluoridation, including toothpaste with fluoride, improved diets, and overall improved general and dental health.
The greatest concern with fluoride overexposure is dental fluorosis. Fluorosis is undesirable because, in severe cases, it discolors teeth, causes surface changes to the enamel, and makes oral hygiene more difficult. Government agencies, such as the Center for Disease Control and Prevention, keep records on the prevalence of fluorosis in the general public.

Has the prevalence of tooth decay decreased since water fluoridation began?

Yes. Independent studies initiated in 1945 and 1946 followed four communities and assessed the value of water fluoridation. By 1960, tooth decay rates in these communities declined, on average, 56 percent more than in demographically similar communities whose water supplies were not fluoridated. More recent studies show that water fluoridation will reduce tooth decay in permanent teeth by approximately 18 to 40 percent. Although this reduction in decay is not as dramatic as it was in the 1950s and 1960s, it is significant when compared to tooth decay in non- fluoridated communities.

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