Drinking for Oral Health

March 1, 2013
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By Teresa Liccardi, M.D.

Do you know which disease the World Health Organization has deemed the No. 1 worldwide epidemic?

Dental caries. In the United States, it is the most common disease in children affecting 25 percent of 6-11 year olds, 59 percent of 12-19 year olds, and adults between 18-28 percent.

Dental caries, otherwise known as tooth decay or cavities, are an erosion of tooth enamel. Bacteria, saliva and food form plaque on tooth enamel. The bacteria then release acid that erodes tooth enamel.


Do you know what has been one of the 10 greatest, most successful public health initiatives in the United States?

The Fluoridation of Com­munity Drinking Water (CDW) for the prevention of dental caries. Now in its 60th year, water fluoridation has significantly reduced the incidence of dental caries in all ages. The incidence is reduced 29 percent in children, ages 4-17 years old, according to the U.S. Task Force on Community Preventative Services, a branch of the Centers for Disease Control and Prevention. Even with other available sources of fluoride, maintaining fluoride levels between .7-1.2 ppm in CDW reduces dental caries by 20 to 49 percent.

Maintaining fluoride in drinking water is a proven cost-effective method of preventing tooth decay. Every $1 spent on fluoridation saves $38 spent on dental caries. A 25 percent reduction in tooth decay over a lifetime saves the United States $4.6 billion annually in dental health care.

A total of 79 percent of CDW in the U.S. is now fluoridated. However, there are groups concerned about the addition of fluoride to CDW. There are claims that the addition of fluoride in the water may be linked to lower IQs, bone cancer and hypothyroidism. To date these claims have not been substantiated.

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Fluorosis, another concern, is a white streaking in the tooth enamel. It is often subtle and does not affect the integrity or health of the tooth, just the tooth’s appearance. It occurs while baby and permanent teeth are forming under the gum. Once the tooth has erupted, fluorosis does not occur.


What are sources of fluoride other than CDW?

• Toothpaste

• Oral rinses

• Food

• Dental varnishes and sealants

• Fluoride supplements by prescription


Most bottled waters do not contain fluoride.

In 2004 in the U.S. we consumed 6.8 billion gallons of bottled water. Only a few manufacturers add fluoride to their water and it is not always on the label. With the increasing use of bottled water, there is concern that the incidence of dental caries in our youth is on the rise.


Does the water in New Jersey contain fluoride?

According to CDC, in 2010 New Jersey ranked 49th out of 50 states with only 13 percent of CDW containing sufficient fluoride.

In early 2012, bills were introduced to our state Assembly and Senate addressing state requirements of CDW fluoridation. Some say it will cost too much money to implement fluoridation across the state. Others are concerned about public reaction to adding a treatment to our water.

Despite the continuing political controversy, since 2009, in Monmouth County, New Jersey American Water Co. has followed U.S. Environmental Protection Agency and state Department of Environmental Protection standards maintaining fluoride levels in our CDW at .9 to 1.2 ppm.


Do home water purification devices affect the content of fluoride in tap water?

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Yes. Treatment devices including osmosis, distillation and deionization remove fluoride from the water, whereas ion-exchange water softeners that remove calcium and magnesium, do not remove fluoride.


How much fluoride should be ingested daily?

The Food and Nutrition Board of the National Institute of Medicine has recommended daily dietary intake of fluoride at different ages. Information is at www.nlm.nih.gov/medlineplus/ency/article/002420.htm.

Other recommendations are:

• Consult your dentist and doctor to determine what are appropriate amounts of fluoride to ingest daily.

• Consult your health-care provider about types of water supplements to use in infant powder formulas.

• Avoid fluoride toothpaste in children younger than 2 years.

• Avoid fluoride mouth rinses in children younger than 6 years.

• Use a pea-size amount of fluoride toothpaste for children older than 2 years.

• Speak to your health-care provider before using any fluoride supplement.


Additional information is available on the CDC website at: www.cdc.gov/fluoridation/fact_sheets/index.htm.


“We prevent dental caries through a complete regimen of oral hygiene,” said Dr. Julie Molin, a family dentist in Red Bank. “Brush at least twice a day after eating and floss daily. When children are young, parents should encourage and teach their children how to brush and floss properly. Fluoride in drinking water, toothpaste and oral rinses are very important to prevent tooth decay in appropriate amounts and ages.”


I’ll drink (CDW) to that!


Dr. Teresa Liccardi, who is board certified in internal medicine and nephrology, maintains a clinic for hypertension and chronic kidney disease at the Parker Family Health Center in Red Bank.

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