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.

Water Fluoridation San Francisco

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 20th 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.