Health experts, KU researcher weigh in on new lower fluoride recommendation by HHS
- on January 26, 2011
Dental hygienist Holly Blick applied fluoride varnish to eight children’s teeth during a free treatment clinic this week at the Lawrence-Douglas County Health Department.
The varnish is a sticky coating of fluoride that is applied to teeth to help prevent decay.
“It offers a more concentrated delivery of fluoride to the tooth’s surface,” said Dr. Cheryl Biesterfeld, a Lawrence dentist with Douglas County Dental Clinic, which co-sponsored the clinic. The clinic serves uninsured, low-income residents.
Biesterfeld said tooth decay is “incredibly common” among her patients. She thinks it’s because their diets are high in sugar and acid. If left untreated, they can lose their teeth.
The fluoride treatment clinic follows a recommendation earlier this month by the U.S. Department of Health and Human Services to lower the level of fluoride in drinking water. Its proposed recommendation to the Environmental Protection Agency is 0.7 milligrams of fluoride per liter of water — a level the city of Lawrence has maintained for decades. The current recommendation is 0.7 to 1.2 milligrams per liter.
The HHS proposal is meant to reduce the possibility of children, ages 8 and younger, receiving too much fluoride during tooth development — known as fluorosis.
According to HHS, dental fluorosis in the United States appears mostly in the mild form, which is barely visible white spots or streaks. Severe forms — staining or pitting of the tooth surface — is rare.
The U.S. Centers for Disease Control and Prevention found a 9 percent higher prevalence of dental fluorosis in children than was found in a similar survey 20 years ago.
Another recent government study found that 41 percent of children, ages 12 to 15, have tooth streaking or spottiness because of too much fluoride.
Biesterfeld said she rarely sees patients with fluorosis, but admitted she has a mild case of it that has not caused problems.
A total of 63 — or 7 percent — of 895 water systems in Kansas are fluoridating the water, according to the state’s health and environment department.
Katie Ingels, department spokeswoman, said the agency encourages the new HHS recommendation. It does quarterly checks on the fluoridating systems.
She said the EPA requires a water system exceeding 2 milligrams per liter to inform it customers, but the system is not in violation of the law until its yearly average exceeds 4 mg/L.
Ingels noted that it’s not difficult for cities to adjust fluoride levels and can be done almost immediately.
KDHE does not have data on the incidence of fluorosis in Kansas, but it has plenty on tooth decay. A 2004 survey of third-graders found one in four had untreated dental decay. KDHE is planning a new survey next fall.
Last year, the agency did a survey of children in Douglas County, which has mostly flouridated water, and Sedgwick County, which mostly doesn’t. The percentage of children who had been treated for decay was 33 percent in Douglas compared to 43 percent in Sedgwick. The percentage of children with untreated decay was 18 percent in both places.
Albert Burgstahler, retired professor emeritus of chemistry at Kansas University, believes fluoridations does more harm than good.
Burgstahler, 82, of Lawrence, co-wrote “Fluoridation: The Great Dilemma,” serves as editor of the quarterly journal “Fluoride” and was a founding member of the anti-fluoridation Fluoride Action Network.
He said he became involved with the issue in 1965 when he had developed a low thyroid condition that caused him excessive thirst, bloating and headaches. While he was working on research, he came across information about how too much fluoride in drinking water — 4 to 5 mg/L — might cause his condition. He switched to distilled water.
“I was absolutely amazed,” he said of the results. The symptoms vanished. Since then, he has been a staunch opponent of fluoridation. He has been fighting it at the national and local level.
“The public health service still maintains that fluoridation has a real important role to help reduce tooth decay, and that is where the real nub comes in. Not only does it cause harm such as what I describe in my own case, but other problems,” he said.
Burgstahler said research has linked fluoride to Down syndrome, neurological problems and arthritis, among other things.
He said his five children and wife also switched to drinking nonflouridated water, and as a result his wife’s back pain went away and his daughter’s hearing loss was reversed. He said his children did not have cavities.
“These are facts, and no amount of calling them unsubstantiated anecdotal reports can alter their reality and association with the Lawrence city fluoridated water,” he said.
According to KDHE and CDC, peer-reviewed evidence does not support an association between water fluoridation and any adverse health effect or systemic disorder.
But, the EPA released two new reviews of research. One of the studies found that prolonged, high intake of fluoride can increase the risk of brittle bones, fractures and crippling bone abnormalities.
Biesterfeld, who has been a dentist for nine years, said the amount of fluoride needed varies by patient.
If someone is at risk for decay, she recommends additional fluoride treatment, such as a prescription toothpaste or the fluoride varnish.
If a patient is not at risk, she doesn’t recommend anything beyond what’s already in drinking water, toothpaste, soft drinks, juices, and other products — well, maybe a rinse after brushing.
“It’s nice to do a fluoride application after cleaning for everyone just because we remove probably a few microns of the fluoride-rich outer layer of enamel with polishing, so it is nice to replenish that.”
The Kansas Department of Environment and Health has a screening program that includes oral health. Last school year, it looked at children in Sedgwick County, which mostly has unfluoridated water, and Douglas County, which has mostly fluoridated water.
It surveyed 1,200 children in Douglas County and 20,842 in Sedgwick. The results:
• Children who already had restorative treatment due to decay — Douglas, 33 percent; Sedgwick, 43 percent.
• Children with untreated decay — Douglas, 18.8 percent; Sedgwick, 18.5.
• Children with urgent care needs — Douglas, 1.8 percent; Sedgwick, 3.4 percent.