Keep fluoride on tap in Jonesborough

The date is fast approaching when Jonesborough water customers may be paying for and receiving fluoride-deficient water after 30 years of benefiting from a public water supply with optimal fluoride content. Most of us born after the 1950s grew up on optimally fluoridated drinking water and the result has been the lowest incidence of dental caries (cavities) in history.Unfortunately, when a public health intervention works so well for so long, we can begin to take it for granted because we forget how it was before the intervention. We forget, for instance, that a leading reason many prospective soldiers were rejected from military service during World Wars I and II was too many missing teeth and poor dental health. When we take something for granted, it is easier for someone take it away from us.Fluoride is naturally present in all water sources, but the amount varies from place to place. During the first half of the last century, dentists noticed that children who lived in areas with higher levels of naturally occurring fluoride in their water had fewer cavities than children living in areas with lower levels of fluoride. This discovery eventually led to the recommendation by public health officials to adjust the natural fluoride content of drinking water in areas deficient in fluoride to optimal levels for the prevention of cavities, sometimes called community water fluoridation.Community water fluoridation is endorsed as safe and effective by the American Dental Association, American Medical Association, Centers for Disease Control and Prevention, and the World Health Organization, among many others, all dedicated to improving public health. Over time, the success of community water fluoridation in preventing cavities and tooth loss led to the development of fluoride-containing toothpaste and other products.Public health recommendations for optimal water fluoride levels (0.7 ppm) balance the benefits of cavity prevention with the small chance of dental fluorosis (visually detectable changes in tooth enamel) if children ingest too much fluoride while their teeth are developing. Cosmetically noticeable forms of this condition occur typically among children less than age 6 who ingest more than the recommended amount of fluoride from sources other than drinking water; for example, by habitually swallowing large amounts of toothpaste.So how does fluoride work to protect our teeth? Evidence supports the protective role of ingested fluoride taken up by teeth as they are forming in young children. The greatest benefit, however, appears to be from frequent exposures to appropriate amounts of fluoride throughout the day by drinking fluoridated water and brushing with fluoride toothpaste. Also, when we drink water with fluoride, that fluoride is taken up by our salivary glands, which bathe our teeth in fluoride throughout the day through our saliva.Fluoride acts in several ways to protect our teeth. Fluoride works to make the surface of the tooth resistant to the acid-forming bacteria that cause cavities. Fluoride also inhibits the ability of those bacteria to make the acid that damages teeth. This protects people of all age groups, not just children. Older adults can be particularly susceptible because receding gums leave the roots of teeth, which have no protective enamel, exposed to the bacteria and acid that cause cavities.Some children who are at higher risk of cavities may benefit from additional sources of fluoride, such as fluoride varnish or oral fluoride supplements. The American Dental Association recommends children age 6 months to 17 at increased risk for developing cavities who live in communities with suboptimal water fluoride be prescribed oral fluoride supplements by their primary care provider or dentist. For optimal dental health, the Tennessee Department of Health recommends children and adults drink water with optimal amounts of fluoride and brush their teeth twice a day with fluoride toothpaste.Dr. David Kirschke is the Northeast Regional Health Officer for the Tennessee Department of Health in Johnson City.