Fluoridation: Part Two

Fluoridation: Part Two

By Mina Levi, DDS, 04/17/2014

In our last article, we talked about water fluoridation and answered questions like, “what is fluoride?” and “how does fluoride help with tooth decay?” In part two of our three part series, we will continue our discussion on fluoridation but will delve deeper into the topic and explore national levels of fluoridation and CDC recommendations.

Fluoridation San Francisco

National Levels

As of 2012, the total US population was about 313,914,040 people. About 232,534,910 people in the US are on community water systems (CWS), and 210,655,401 people in the US population are on fluoridated drinking water systems. This means that about 74% of people that are on community water systems are receiving fluoridated water. The District of Columbia region has the highest percentage of population receiving fluoridated water at 100% in comparison to all other states/regions. The next highest state percentage is Kentucky at 99.9%. The lowest state percentage is Hawaii; only 139,598 people out of 1,290,549 are receiving fluoridated water, about 10.8%. California is at about 63.7%.

CDC Recommendations and Comments

The CDC, the Centers for Disease Control and Prevention, has released findings and conclusions from studies on fluoridation.  The following are their official comments on the efficacy and risks of fluoride as well as their recommendations for fluoride use and water fluoridation:

Fluoride efficacy in preventing and controlling dental caries

· Fluoride effects enamel and inhibits dental caries only when incorporated into developing dental enamel
· Topical fluoride on the enamel surface remineralizes the enamel when the pH drops in the mouth in response to acid production
· As fluoride concentrates in the dental plaque that accumulates in the mouth, it inhibits the process by which cariogenic (caries-causing) bacteria metabolize and produce acid.
· Fluoride works primarily after teeth have erupted, especially when small amounts are maintained constantly in the mouth.
· Both adults and children benefit from fluoride

Risk for enamel fluorosis

· Concerns regarding the risk for enamel fluorosis are limited to children less than eight years of age
· Most fluorosis today is of the mildest form, which effects neither cosmetic appearance nor dental function
· A low prevalence of the milder forms of fluorosis has been accepted as a reasonable consequence balanced against substantial protection from dental caries
· In the severe form, enamel might break away which results in excessive wearing of the teeth
· Even in the severe form, fluorosis is considered a cosmetic effect and not a functional effect
· Cases of moderate to severe forms occur even among children living in areas with low fluoride concentrations

Guidelines for fluoride use

· It is recommended for fluoride use to include an optimally adjusted concentration of fluoride in community drinking water to maximize caries prevention and limit enamel fluorosis
· The approved concentration ranges from 0.7 ppm to 1.2 ppm depending on the average daily air temperature of the area
· The EPA, which is responsible for the safety and quality of drinking water in the United States, sets a maximum allowable limit for fluoride in drinking water at 4 ppm and a secondary limit at 2 ppm

Fluoridated drinking water and its effects

· Initial studies of community drinking water fluoridation demonstrated that reductions in childhood dental caries attributed to fluoridation were 50-60%
· More recent estimates are lower (18-40%) which is likely caused by the increasing use of fluoride from other sources like fluoridated toothpaste
· Studies of benefits of fluoridation for adults is more complicated because their fluoride histories are potentially more varied and their tooth loss or restorations might be caused by problems other than caries
· Nevertheless, adults are reported to receive caries-preventive benefits from community drinking water fluoridation, particularly advantageous for those above fifty years of age
· Prevalence of root caries among adults is inversely related to fluoride concentration in community drinking water (lower fluoride levels correspond with higher root caries levels)
· Caries reduction is considerably higher among persons in low socioeconomic status (SES) than among those in high SES.
· Enamel fluorosis occurs among some people in all communities, even those with a low natural concentration of fluoride
· In the most recent study, in communities with water containing 0.7-1.2ppm fluoride had a prevalence of 1.3% for the moderate form of fluorosis and 0% for the severe form

Conclusions

· When used appropriately, fluoride is a safe and effective agent that can be used to prevent and control dental caries
· Fluoride has contributed profoundly to the improved dental health of persons in the US
· To ensure additional gains in oral health, water fluoridation should be extended to additional communities, and fluoridated toothpaste should be used widely
· Adoption of these recommendations could lead to considerable savings in public and private resources without compromising the benefit of fluoride

For more information about the reported comments and recommendations of the CDC, you can visit the CDC website at www.cdc.gov. Next week in the last article of the three-part series, we will take a look at water fluoridation from a local standpoint, visiting the bay area’s levels of fluoridation and community responses. If you have any specific questions or would like us to discuss another water fluoridation issue, please give us a call at (415) 513-5066 or visit us on the web at www.minalevidds.com.

Topics: CDC, national levels, national levels of water fluoridation, water fluoridation, fluoride, fluoridation, tooth enamel, dental cavities, dental decay, tooth decay, public water fluoridation, cavities, dental caries,oral bacteria, fluoridated toothpaste, fluoride toothpaste, controversy, dentist San Francisco

Fluoridation: Part One

Fluoridation: Part One

By Mina Levi, DDS, 04/10/2014

For a long while, fluoridation has been a heated debate topic in many United States communities. Some people strongly oppose fluoridation and some people are okay with it or have no opinion on it at all. Many people, however, do not have a lot of information about fluoridation and are unable to make an educated decision for their families and themselves. In this three-part article series, we will discuss fluoridation in depth, answering many questions and hopefully providing people with better knowledge and understanding.

What is fluoride?

Fluoride is an anion (derivative) of the chemical element fluorine. Fluoride is found naturally in low concentrations in drinking water and foods, as well as seawater. Fluoride is a basic substance with a negative charge, as opposed to an acidic substance, which means it can easily combine with a proton.  Fluoride salts and hydrofluoric acid are the main fluorides of industrial value. The main uses of fluoride are in the production of cryolite used in aluminum smelting. Hydrofluoric acid has a variety of applications, which includes its ability to dissolve glass.

The most widely known application for fluoride in the majority of the population, though, is for cavity prevention. Fluoride-containing compounds are used in topical fluoride therapy for preventing tooth decay and are used in many oral hygiene products. The fluoridation of water is known to prevent tooth decay in the surrounding populations and is considered by the Centers for Disease Control and Prevention as “one of the ten great public health achievements of the 20^th century”.

How does fluoride work to help tooth decay?

Tooth enamel is made up of a compound that has calcium and phosphate, and is susceptible to attack by acidic substances. The bacteria that live in the mouth thrive on sugars that we eat and produce acids. When we brush our teeth, we are getting rid of some of the bacteria, but we aren’t able to undo any acid damage that has already been done to the enamel. Saliva neutralizes some acids and re-mineralizes the enamel. However, when more minerals are lost from the tooth enamel than are able to be replaced by saliva, cavities form. Fluoride works by interacting with tooth enamel to form a stronger compound that is less vulnerable to acid. Fluoride also re-mineralizes damaged enamel and can inhibit the growth of bacteria or limit their capacity to produce acid. When you brush your teeth and rinse with mouthwash, even when the toothpaste is gone from your mouth there is enough fluoride left over to protect your teeth for a while (if you are using fluoridated toothpaste or rinse).

Water fluoridation

Water fluoridation is the controlled addition of fluoride to public water supplies in an effort to reduce tooth decay in the surrounding populations that consume and use this water. Dental cavities are a major public health concern in many industrialized countries. Fluoridation is accomplished by adding sodium fluoride, fluorosilcic acid or sodium fluorosilicate to water. Adding fluoride does not alter the appearance, taste, or smell of the water.

Water fluoridation controversy

The public water fluoridation controversy involves many concerns, including ethical and safety matters. Many oppose water fluoridation with the argument that fluoridation may cause health problems, is not effective enough to justify the cost of water fluoridation, and that a dosage cannot be controlled precisely enough. The following are a number of reasons people have for being for and against water fluoridation:

Reasons against:

· It may be a form of “mass medication”

· Consent by all water consumers cannot be achieved

· Water suppliers cannot control the exact levels of fluoride that individuals consume

· Large amounts of fluoride can cause poisoning

· Water fluoridation may be unsustainable for the environment

Reasons for:

· Fluoride is proven to reduce and protect against dental cavities

· American Dental Association stated that water fluoridation is one of the safest and most beneficial cost-effective public health measure for preventing and controlling tooth decay

· The amount of fluoride allowed in public water fluoridation is much smaller than the amount necessary to poison

· Water fluoridation has effectively shown a reduced number of dental cavities and filled primary teeth in the surrounding populations

· No adverse environmental  have been found through investigative studies

After learning a bit about fluoride and the water fluoridation process, you may have developed an opinion on your own about whether or not you agree that water fluoridation is the best choice for yourself. In our next article, we will discuss national levels of water fluoridation and CDC recommendations for fluoridation. If you have any specific questions or would like us to discuss another water fluoridation issue, please give us a call at (415) 513-5066 or visit us on the web at www.minalevidds.com.

Topics: water fluoridation, fluoride, fluoridation, tooth enamel, dental cavities, dental decay, tooth decay, public water fluoridation, cavities, dental caries,oral bacteria, fluoridated toothpaste, fluoride toothpaste, controversy, dentist San Francisco

Understanding TMD and What to do about it

Understanding TMD and What to do about it

By Mina Levi, DDS, 04/03/2014

About five to twelve percent of the world population suffers from temporomandibular joint dysfunction or temporomandibular disorder (TMD). This describes a variety of conditions affecting the joints, muscles, and nerves in the jaw. In this article, we discuss what TMD is, what causes it and what to do about it if you have it.

What are the temporomandibular joints?

The temporomandibular joints are located on either side of your face right in front of your ears, and connect your lower jaw to your skull. These joints and their accompanying muscles allow you to open and close your mouth, as well as allow you to move your lower jaw from side to side. These joints are easily felt by placing your hands in front of your ears and opening and closing your mouth.

What is TMD?

TMD occurs when the temporomandibular joints are damaged in some way, or when the muscles accompanying the joint are not working properly, which causes an imbalance in jaw movement. Painful chronic muscle pain and spasms are associated with this disorder.

What causes TMD?

A lot of the time, the cause underlying TMD is unclear. TMD may be caused by trauma like an injury or dislocation, or an improper bite, which affects the chewing muscles. Stress behaviors like clenching and grinding teeth may make the condition worse. TMD appears to be more common in women than men.

Signs and Symptoms of TMD

Those who suffer from TMD may experience the following symptoms:

·         Jaw pain/soreness that is more prevalent in the morning or in the evening

·         Jaw pain that is aggravated by chewing, biting or yawning

·         Clicking noises when opening and/or closing the mouth

·         Difficulty opening and closing the mouth

·         Locking or stiff jaw

·         Tooth sensitivity not associated with other dental problems such as decay or restorative work

·         Headaches or neck pain

·         Earaches

The dentist can perform an examination of the joints and muscles of your jaw if you feel that you may be suffering from any of these symptoms or think that you may have TMD.

How is TMD treated?

Some TMD cases can be handled with these lifestyle modifications:

·         Avoiding chewing gum and biting of the nails

·         Eating softer foods

·         Stress relief techniques

·         Taking non-aspirin pain relievers to manage pain

In more severe TMD cases, the dentist will most likely recommend physical therapy, appliance therapy, or medication.

Is TMD permanent?

TMD is a cyclical condition that can recur during times of stress. If you have this disorder, make sure to see the San Francisco dentist for regular checkups so that your symptoms can be monitored and your special care can be managed. For more information about TMD or the signs and symptoms of TMD, visit Dr. Mina Levi DDS on the web at www.minalevidds.com or give us a call at (415) 513-5066.

Topics: TMD, TMJ, TMD disorder, clenching and grinding, night guards, appliance therapy, physical therapy, dental restorations, tooth sensitivity, headaches,earaches, jaw pain, San Francisco dentist, dental problems, dental decay, dental cavities, temporomandibular joints, mandibular joints, jaw problems, jaw clicking, jaw popping