Severe tooth decay is responsible for 2/3 of hospital visits by children under six in New York State (1), where almost 70% of the population drinks fluoridated water which is supposed to stop that sort of thing. Evidence shows we are on the wrong track in defeating early childhood cavities.
New York City spends anywhere between $6 and $14 million annually on water fluoridation. Yet more New York City children required cavity-related hospitalizations, proportionately, than two of New York State’s largest non-fluoridated counties, Suffolk and Nassau, whether payment was made by Medicaid or privately.
In New York City, where fluoride is added to water supplies to prevent tooth decay, one hospital charged from $929 to $12,199 to treat 96 children with severely decayed teeth, excluding the dentist and anesthesiologist fees. Children needed extensive work including stainless steel crowns, extractions, root canal therapy, fillings, other restorations, periodontal procedures, surgeries and/or more.
New York State hospital charges for the 2,726 early childhood cavities-related surgical visits required by children under six, in 1999, lie anywhere between $2.5 and $33 million, report NYS Department of Health Dentists, Kumar and Green, and others, in the Winter 2003 Journal of Public Health Dentistry, who also report they may be underestimating the numbers of children so treated.
National Medicaid costs for hospital treatment of early childhood cavities are between $100 to $200 million annually.
Even after hospital treatment, these children return with new lesions, say Kumar and colleagues.
Besides fluoridation, the New York State government provides dental screenings, dental sealants, early childhood cavity prevention, fluoride mouthrinse and fluoride supplement programs. (5)
The U.S. Centers for Disease Control predicts that “Every dollar spent on community water fluoridation saves from $7 to $42 in treatment costs.” (2) The American Dental Association says fluoridation will prevent early childhood cavities. But that doesn’t seem to be happening in New York City.
Dentists continue to tout fluoride, brushing, visits to see them and less sugary drinks as the antidote to tooth decay, but neglect nutrients essential to create teeth that won’t fall apart in childhood.
Early childhood cavities, once called baby-bottle tooth decay, is still blamed on inappropriate feeding practices (non-nutritive sucking, prolong bottle/breast feeding, nap-time feeding). But the majority of children put to sleep with bottle or breast do not develop cavities. The association of early childhood cavities with low-socioeconomic status is stronger and more consistent. And low-socioeconmic groups are more apt to be ill-fed and/or malnourished.
Teeth begin formation in utero. “Prenatal deficiencies of calcium and vitamin D can lead to enamel defects, and enamel defects in turn predispose teeth to caries,” report Smith and Moffatt in their article, “Baby-bottle tooth decay: are we on the right track?” (3)
“Baby-bottle tooth decay (BBTD) is especially prevalent in Aboriginal people, for whom studies have consistently reported diets deficient in vitamin D and calcium. BBTD may be a consequence of the poor socioeconomic conditions and malnutrition. Perhaps more attention should be given to primary prevention,” report Smith and Moffatt.
While few dispute sugary drinks are bad for teeth, federal surveys identify low calcium intake as a public health concern; 53% of 2-5 year-olds consume inadequate calcium.
Calcium is essential for strong teeth. Ingested fluoride is not essential to prevent cavities and has no nutritional need, write Warren and Levy in Dental Clinics of North America, April 2003.
Recently, a staunch fluoridation promoter, dentist Howard Pollick, had to admit: “It may...be that fluoridation of drinking water does not have a strong protective effect against early childhood caries (ECC),” in the Winter 2003 Journal of Public Health Dentistry.
Another fluoridation supporter, Columbia University's Burton L. Edelstein DDS, wrote: “...children with extreme (dental) disease often overwhelm the expected benefits (of fluoridation) and continue to develop new cavities despite fluoridated water availability." Edelstein reports that (88.8% fluoridated) Connecticut's poor, pre-school children's cavities increased despite water fluoridation.
Basil, the only Swiss city fluoridating water supplies, recently stopped because no evidence indicated fluoridation reduced decay. In fact, Basil children’s cavities increased despite decades of water fluoridation. And several studies show cavities decreased when fluoridation terminated.(4)
Acids and bacteria pull calcium and other essential minerals from teeth, constantly, but are replaced almost as fast by the same components in saliva. When outgo exceeds input, it’s a cavity.
Dentists might be the heroes they think they are today if they lobbied for calcium in water supplies, rather than fluoride.
“...fluorides are most effective in preventing decay on the smooth surfaces of teeth.” according to the 1984 Director of the National Institute of Health, Dr. Harold Loe. But early childhood cavities usually occur on the smooth surfaces and the incidence is growing. And fluoridation isn’t stopping it.
If governments want to spend money preventing children’s tooth decay, tax-dollars would be better spent feeding children required nutrients, not fluoride. Their teeth as well as their bodies would be stronger with less of a strain on the health care system.
Most poor children, turned away by most dentists who refuse Medicaid patients, must wait until their decay spreads and abscesses before they can get treatment at a hospital’s emergency room. Preventing one cavity over a lifetime through water fluoridation may save $42, but not filling another cavity may cost $12,199 to the taxpayers.
Dentists who graduate owing upwards to $100,000, and sometimes more, in student loans, didn’t get into the business to do charity work. They should be paid the same amount they get from private insurers. Government would save money in the long run; and children wouldn’t have to live in pain. And every American wouldn’t have to drink water that has unnecessary, harmful fluoride chemicals added.
(1) “Early Childhood Caries-related Visits to Hospitals for Ambulatory Surgery in New York State,” Wadhawan, Kumar, Badner, Green, Journal of Public Health Dentistry Vol 63 No.1, Winter 2003
(2) http://www.cdc.gov/nccdphp/pe_factsheets/pe_oh.htm (Accessed June 1, 2003)
(3) “Baby-bottle tooth decay: are we on the right track?” by Smith PJ, Moffatt ME, International Journal of circumpolar Health 1998; 57 Suppl 1:155-62.