This year Portland, Oregon made national headlines when the majority of voters rejected a measure to add fluoride to the city’s public water system. The debate was heated, and as a whole, the final decision was criticized by many as ill-informed and not in the best interests of our children. As a dentist, it may surprise you to know that I do not believe Portland was wrong in their decision, but my reasons have little to do with the fluoride itself.
Certainly, I am fully aware of the dental benefits that topical fluoride can provide to children and adults under the right circumstances. The scientific evidence is clear that fluoride does contribute to stronger enamel development and thus helps prevent cavities. In our modern society, however, tooth decay simply does not happen because we lack fluoride. It happens because of what we eat and how we take care of our teeth. Fluoride can be a helpful aid in the battle against decay, but it is not the cause or the ultimate solution to the problem.
Tooth decay is caused by pathogenic bacteria that live in our mouths. Everyone has this bacteria and there is no way to remove it completely without also removing beneficial forms of bacteria that live in the mouth as well. Preventing the development of tooth decay is all about controlling the numbers of these pathogenic bacteria through diet and home care (brushing and flossing).
The bacteria responsible for tooth decay thrive on sugar, refined flour, and acid. Diets high in sugar, high-fructose corn syrup, white flour, and acid are the quickest way to multiply the number of pathogenic bacterial colonies in the mouth. Sugar-sweetened beverages are especially attractive to these bacteria because they often contain high amounts of both sugar and acid.
The most common chronic condition in Oregon children is tooth decay. In 2011, the Oregon Public Health Division reported that in Oregon, more than 177 million gallons of sugar sweetened beverages are consumed each year (read report here). That amounts to approximately one gallon per week for every man, woman, and child in the state. The same report quoted a survey of Oregon mothers indicating that about half of the 2 year olds in Oregon drink sugar-sweetened beverages at least once per week.
What troubles me most about these statistics is that they do not include all the other food sources of sugar and acid in a child’s diet that also contribute to tooth decay (and childhood obesity). Fruit juice, for example, may not be sweetened with sugar but can still have the same effects on the teeth and the body. Fructose is a naturally occurring form of sugar found in all fruit and bacteria feed on it just as easily – especially when all the fiber of the fruit itself is removed during the juicing process. And certainly, when a child is drinking a sugary beverage, the likelihood that he or she is also eating a meal or treat that is high in sugar, acid and/or refined white flour is fairly high.
In the battle against tooth decay, every little bit counts, and when tooth decay in children reaches epidemic proportions, water fluoridation as a stop-gap is an option we all need to consider. But consider this as well: If a child’s diet is filled with sugars, highly-refined flours, and acid, fluoridated water is simply not enough. And if that same child also does not brush and floss his or her teeth – or they do not know how to do it correctly – then nothing (including fluoridated water) will be able to prevent tooth decay from developing.
Information is perhaps the most powerful tool there is in preventive medicine. In my continuing effort to provide relevant information on how to care for your teeth and prevent decay no matter where you live or what kind of water you drink, I have created several informational resources that I hope you will take the time to review for your own health and the health of your children.
As always, I encourage you to read and learn as much as you can from as many reputable sources as possible in order to make the best decisions possible for yourself and your family.