Each time the debate surrounding community water fluoridation surfaces, faculty and alumni of Texas A&M University Baylor College of Dentistry take measures to ensure the oral health of the Dallas community. On Jan. 28, Dallas City Council members voted once again to retain the city’s water fluoridation program. The dental school dean, Dr. Lawrence Wolinsky, offered his input during the council meeting, and in this Jan. 26 essay, he shares more on this important public health issue.

Dr. Lawrence Wolinsky, dental school dean

Dr. Lawrence Wolinsky, dean, Texas A&M University Baylor College of Dentistry

In April 2014, a dialogue commenced regarding Dallas’ community water fluoridation program, a time-tested public health measure practiced in this city for half a century.

As anti-fluoridation groups entered the scene, some members of the Dallas City Council entertained the notion — even if just for a moment — of bringing this public service to a stop. Faculty and alumni of Texas A&M University Baylor College of Dentistry added input to the conversation then, and as representatives of Dallas’ dental school, we are doing so again. As the city council prepares to vote Jan. 28 on whether to enter into a $1 million partnership with a new water fluoridation vendor, the topic has once again permeated local media. It would be a disservice not only to our patients but also to our children and the generations that come after us, if we did not weigh in on this debate.

There’s something to be said for the fact that the American Academy of Pediatric Dentistry recommends fluoride supplements for children as young as six months who live in an area with suboptimal fluoride content in their drinking water. Thanks to evidence-based science, we know that early in life when teeth are forming, having adequate levels of fluoride available for incorporation into new teeth makes them much more resistant to tooth decay. This is also true when the teeth first erupt because they are porous and easily absorb fluoride. Taking advantage of this developmental period in children’s lives increases the ability of their teeth to mineralize, for enamel to harden and, in turn, increase resistance to tooth decay. Because of community water fluoridation, having access to this cavity-fighting substance is as simple as taking a sip of water.

For those opposed to community water fluoridation, a concern that repeatedly comes to the fore is the question of fluoride’s toxicity. Like any naturally occurring substance, when consumed to the excess, the harm can outweigh benefits. Take for instance, something found in 70 percent of kitchens throughout the world: iodide, a reduced form of iodine, which is added to table salt. Iodide is essential to thyroid function, immune response and even skeletal and nervous system development, but when consumed in amounts exceeding the daily recommended levels, health issues surface such as goiter, hypothyroidism and, in acute poisoning cases, burning of the mouth, throat and stomach.

Does that mean we provide a diet for ourselves and our children completely devoid of iodide? No. To take the analogy one step further, complaints that there is too much iodide in salt and questions of why it is even added to the seasoning are not commonplace. Moderation is key, and the same is true of fluoride.

It is known that fluoride has the potential to cause pitting of the teeth, bone tenderness and a heightened risk of fracture, but only in amounts exceeding 4.0 parts per million, according to the U.S. Environmental Protection Agency. What’s interesting to note is that fluoride is naturally present in water throughout the country. According to numbers from the Centers for Disease Control and Prevention circa 1969, when U.S. cities were just beginning to implement community water fluoridation, naturally-occurring levels throughout the state ranged from as low as .7 parts per million in Weslaco, Texas, to as high as 6.3 parts per million in Bardwell. Levels could change depending on the region and time of year, and community water fluoridation in Dallas simply regulates that amount, striving to maintain an optimal level of .7 parts per million in accordance with U.S. Department of Health and Human Services recommendations.

Millions are exposed to this concentration of fluoride with no negative consequences, and volumes of scientific research indicate the benefits far outweigh the potential consequences. Plus, no one can argue that fluoridation doesn’t work. Getting rid of community water fluoridation would hit the most vulnerable population — those without access to dental care — the hardest. Ranked right up there with the polio vaccine as one of the most effective preventive measures of our time, community water fluoridation is here for the public good. Let’s keep it that way.

Dr. Lawrence Wolinsky is dean of Texas A&M University Baylor College of Dentistry. He may be reached at dental-dean@dentistry.tamhsc.edu

— Jennifer Fuentes

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