The future of fluoride: an update one year after the National Toxicology Program study

Article Abstract:

A report is presented concerning the benefits and risks of water fluoridation, based on findings by an Ad Hoc Subcommittee of the US Public Health Service. An earlier report by the National Toxicology Program (NTP) detailed results from animal research on the health effects of sodium fluoride. The only significant adverse effect was an elevation in the number of cases of osteosarcoma (a rare form of bone cancer) in male rats that received high and medium-high doses of fluoride. However, similar rates had been found for control rats in previous NTP studies, and the findings were not replicated in experiments using female rats or mice of either sex. The NTP concluded that the evidence for carcinogenic activity of fluoride in male rats was equivocal, and that extrapolation of the results to humans would require additional research. Fluoride is added to drinking water primarily to prevent cavities. It is used in low doses and costs, on average, 51 cents per person annually. Excess fluoride can cause an increase in bone mass and a decrease in bone strength; there is some evidence that this may lead to an increase in risk of fracture. Dental fluorosis (chronic fluoride poisoning) is a condition characterized by discolor of the teeth. In recent years, the rate of fluorosis has increased more in areas with fluoridated water than in areas with non-fluoridated water, which is a matter of concern. Fluoride has become more available as an indirect consequence of community fluoridation programs (in food and beverages); from swallowed toothpaste or mouthwash (particularly by children); and from inappropriate administration of supplements. A graph is presented of the minimum and maximum amounts of fluoride ingested by adults and children in areas with high and low fluoride levels in the drinking water. The recommended fluoridation level for public water supplies is one part per million, a value that was determined in 1942 before the development of fluoridated tooth products. It is possible that people now consume more than the recommended one milligram per day that is considered necessary to reduce cavities without risk. This issue deserves the careful attention of the dental community. (Consumer Summary produced by Reliance Medical Information, Inc.)

Investigations, Fluorosis, United States. National Toxicology Program

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Adult root caries survey of two similar communities with contrasting natural water fluoride levels

Article Abstract:

Caries of the tooth root are becoming more common due to the increased longevity of the United States population and the overall better health of teeth, which results in more teeth remaining in the mouth until older ages when this condition is most prevalent. Root caries develop when root surfaces are exposed as a consequence of receding gums; these caries may result from diets rich in sugar, from microorganisms, or from changes in saliva brought on by medications typically consumed by the elderly. More information is needed on the incidence of this condition and its relationship to age, gender, and tooth health under differing conditions of water fluoridation. To this end, the problem of root caries was investigated in 967 adults who had been lifelong residents of one of two towns in Canada with different fluoride levels in the water (Woodstock, 0.2 ppm; Stratford, 1.6 ppm). A team of dental examiners trained to evaluate root caries collected clinical information for each tooth surface including plaque index, gingival index, gingival recession, root lesions or restorations, location of root lesions, and fillings. Criteria for root surface caries were consistent with those recommended by the World Health Organization. More residents of Woodstock had root caries (35.9 percent) than residents of Stratford (20.3 percent). This trend held for all age groups examined and, when adjusted for differences due to age and sex, Woodstock residents had a 62 percent higher root caries incidence. The number of root caries was related to age. Among people with this condition, the number of teeth affected was 21 percent higher in Woodstock, even though people there had, on average, 1.2 fewer teeth. In fact, this may have led to an underestimation of the extent of root caries since fewer teeth were present in the Woodstock group to be affected. Details regarding the distribution of root caries lesions are provided. Accurate diagnosis of this condition is difficult and suggestions for revising the Root Caries Index are presented. These results demonstrate that fluoride in public water reduces caries in both tooth crowns and roots. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surveys, Teeth, Tooth roots, Dental caries research

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Dealing with risks in the dental office

Article Abstract:

Public attention has recently focused on the purported health risks associated with visiting the dentist, including the possibility of contracting AIDS, the dangers of filling material containing mercury (amalgams) and of fluoride, and the risks posed by denture adhesives and alloys containing nickel. Dentists cannot perform exhaustive analyses of all products, but they can become knowledgeable in a general sense about the most commonly used items. Questions concerning risk are really questions about the probability of harm. A short table is presented that shows the risk of death from such causes as riding in a motor vehicle (24/100,000) and eating four tablespoons of peanut butter per day (which contains a carcinogen, aflatoxin; 8/1,000,000). But most dental procedures are not considered life-threatening, but some may be hazardous. Toxic substances are not automatically hazardous. For a health hazard from a toxic substance to exist, exposure to the substance must occur; it must enter the body; and it must be present in a sufficient dose to cause ill effects. Thus, we can swim in sea water even though it contains iodine, a potential toxic, because the concentrations are not hazardous. Many deadly substances cannot be identified by a 'bad' color or odor; carbon monoxide is odorless and the toxin that causes botulism is tasteless. People may perceive less risk associated with actions or treatments they consider beneficial. Also, those who believe they control their own lives are more likely to take greater risks. For dentists to communicate risks accurately to their patients, they need good information about the consequences of the procedures they propose to carry out. Rational choices between the potential benefits and costs of procedures should be made. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Safety and security measures, Dentists, Communicable diseases, Dental materials

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