Mouth Matters

0 6 | Mouth Matters By David Schmeichel - For the Free Press Officially, statistics show that fluoridation - the process of adding fluoride to public water supplies - has been proven to reduce tooth decay in children by 18 to 40%. But in the opinion of longtime dentist Dr. Bill Kettner, anecdotal evidence skews to the higher end of the range, with each passing generation showing proof of increased resistance to the factors that cause cavities. "It's not just that people are eating smarter, because they're not - and it's not because kids are better brushers, because they're not," Kettner says. "But it is rare in this day and age to see kids with extreme problems of caries or cavities. And that's mostly due to the preventive nature of fluoride, without question. That's the only thing that's changed between my generation and this one." Kettner was born in the mid-1940s, the same time a series of landmark fluoridation studies got underway in various parts of the U.S., and in the Brantford-Sarnia-Stratford region of Ontario. The studies' findings proved that adding fluoride to drinking water - at the recommended level of 0.7 milligrams per litre - was a safe and effective way of reducing the incidence of dental decay. There's since been more than 50 years of additional research worldwide to support those initial findings, and fluoridation has the full endorsement of more than 100 government agencies and international health organizations, including Health Canada, the World Health Organization, the U.S. Centers for Disease Control and Prevention, and both the Canadian and American Dental Associations. In Manitoba, nearly 95% of populations supplied by a public source draw fluoridated water from their taps, a process that works both topically and systemically to increase the resistance of tooth enamel to decay. Dental decay is still the number one chronic disease among children and teens in North America, and fluoridation is the most important measure used to effectively and inexpensively combat the disease. In addition to the impact on public health, fluoridation also pays off economically - it's estimated that with every dollar spent on the process, an additional $38 is saved in dental treatment costs. Kettner points out that fluoride alone can't provide fail- safe protection against the damage caused by unhealthy eating habits. And regular dental checkups are important for maintaining oral health. But fluoridation is beneficial, especially to young children and seniors. When kids are young and their teeth are still being formed, fluoride actually alters the makeup of the enamel slightly, making it more resistant to acid while also reducing plaque's ability to adhere to the surface. "It continues to have a mild preventive effect over the period of time you have teeth," Kettner says. "The greatest amount is in the earlier years, but there's a continued positive effect over time." Senior citizens, meanwhile, often suffer from dry mouth conditions and are thus deprived of the topical effect of low levels of fluoride present in saliva. "Saliva helps to bathe and battle any acids that are forming in your mouth when plaque converts carbohydrates or sugars. In the elderly, there's less of the ability for that bathing of the teeth to take place," Kettner says. "So we'll actually prescribe an additive fluoride for elderly people to take on a monthly basis." Fluoridation is also of particular importance to those in lower-income communities, where access to other preventive measures may be limited. Allegations that fluoride could be harmful are unfounded, Kettner says. The recommendation of 0.7 milligrams per litre has a built-in margin of safety that takes into account other sources of fluoride, and of the thousands of credible scientific studies on fluoridation over the years, not one has shown there are health risks associated with the consumption of optimally fluoridated water. And because fluoride has a cumulative effect, dentists are comfortable prescribing it in more concentrated doses, via topical treatments administered directly after a cleaning at the dentist. That's the rinse-but-don't-swallow solution that typically comes in a variety of flavours. "The additive effect is really greatest at the moment the teeth are completely clean, because you've got no plaque there," Kettner says. "So for a period of time, if you can provide a heavier hit of fluoride to the teeth, that's a good thing. With people who have really healthy mouths, it's not that important, but there's also no harm to it, because it's not ingested." the faCts abOUt flUOride

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