Fluoridation Fails New York State

Jonathan Kozol explains life in 100% fluoridated South Bronx (a NYC borough) in his book, Savage Inequalities, “Bleeding gums, impacted teeth and rotting teeth are routine matters for children..... Children live for months with pain that grown-ups would find unendurable. …I have seen children with teeth that look like brownish, broken sticks. I have seen teenagers who were missing half their teeth....”

Almost three fourths of New Yorkers have consumed tap water injected with fluoride for decades. Yet, New York State’s fluoridated counties and cities suffer worse dental health than those without fluoride-laced water supplies.

America’s oral health crisis is not due to lack of fluoride but because poor people can’t get dentists to fix their teeth. In fact, the American Dental Association says, “Low income is the single best predictor of high caries experience in children,” not lack of fluoridation. Low-income populations have the highest levels of dental disease but are least likely to be cared for, according to the General Accounting Office (1).

Despite fluoridation, severe tooth decay is responsible for two thirds of hospital visits by children under six in New York State, reported in 2003 (2).

Kumar et al reported: 

    "Between 1996 and 1999, the rate of hospitalization for dental caries in children younger           than 6 years of age ranged from 180 to 193 cases per 100,000. Approximately two-thirds           of the visits by children younger than 6 years old were due to dental caries. The                          highest rate was observed in 3-year-old children (346.5). The most frequent type of                   procedure performed was placement of stainless steel crowns. Medicaid was the primary           source of reimbursement."

In New York City, fluoridated since 1965, more children required cavity-related hospitalizations, proportionately, than two of New York State's largest non-fluoridated counties, Suffolk and Nassau (Long island) whether payment was made by Medicaid or privately.(2)

One New York City hospital charged from $900 to $12,000 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. (2)

NYS hospital costs were between $2.5 and $33 million for the 2,726 childhood cavities-related surgical visits required by children under six, in 1999. (2) Even after hospital treatment, these children return with new lesions.

The most recent New York State ER hospital visits for toddlers doesn't happen less often in fluoridated areas.

 Data from the Statewide Planning and Research Cooperative System (SPARCS) indicates that the 2017-2019 caries hospital outpatient rate in New York City children aged 3-5 years was 146 per 10,000, however the New York State Community Health Indicator Report (CHIRS) notes that this may be an underestimate (Severity of dental caries in New York City children receiving school-based prevention and the role of SARS-CoV-2: Results from the CariedAway pragmatic trial 2022)

According to Dr. Jayanth Kumar, Director, Bureau of Dental Health, NYS Department of Health, Tooth decay "is more of a problem in poor children...We have data for New York State where it shows about 32% of poor children actually have oral health problems compared to only about 12% of non‐poor children. So what has happened over the years is tooth decay

was a problem of the rich in the last century and shifted to poor children around 1970s or so, mainly
because of access to refined sugar and processed foods."

Kumar said, "about 4,800 children are taken to operating rooms every year and more children also go to emergency rooms with dental problems. So we have been tracking these indicators. This is one of the indicators where we haven't seen improvement. Actually, it went in the opposite direction. We wanted to reduce emergency department and ambulatory surgery facility visits from 2,900 to about 1,500 over the last decade. Instead of that, it actually doubled."

According to Dr. Melinda Clark, "dental exams of preschoolers and early Head Starts in New York State reveal that 40% of children have already had dental disease. And 70% of that 41% have untreated dental decay."

Further evidence shows fluoridation neither saves NYS money nor reduces cavities:

. A 2009 NYS Dep't of Health Report reveals that, in 100% fluoridated New York City (since 1965), one third (38%) of third grade children have untreated cavities. And  25% of NYC adults (65 and older) are toothless. Compare that to the rest of the state where 16% are without teeth but is only 40% fluoridated. 

New York City’s  Chinese-American 2-to-11-year-olds, living in the low-income area of [fluoridated]Manhattan's Chinatown have much more primary tooth decay when compared to white and other minority groups nationally (NYS Dental Journal June/July 2011).

Most of NYC's Chinese-American children are U.S. born - 63% have primary tooth decay compared to only 38% of children in a national study.


The authors write, "This high prevalence of caries in the primary dentition is also similar to a national survey of children in mainland China, where three out of four children were found to be affected by caries in primary teeth," averaging about 5 decayed teeth

.  A 2001 study revealed that in northern Manhattan (New York City), 34% of predominantly black and Hispanic low-income  pre-schoolers had rampant tooth decay, with a staggering 6.4 decayed surfaces cavities per affected child.      

• According to New York University’s School of Dentistry, "The need for dental care is especially acute among impoverished (NYC) children, who have 60 percent more untreated cavities than their peers at higher socioeconomic levels." (4)

• Lack of oral health care for adults in Harlem is a hidden crisis, write researchers in the American Journal of Public Health. (5)

• "Adolescents in northern Manhattan (another NYC borough) have higher caries prevalence than their national counterparts,” The Journal of Public Health Dentistry, reports." (6)


• Latinos and African American seniors suffer high rates of tooth decay and tooth loss in Northern Manhattan (7), according to the Journal of Community Health.

• A higher prevalence of dental decay is found in New York City African Americans, aged 18 - 64, than found nationally, reports Dental Clinics of North America. (8)

• Dental caries, among disadvantaged 3 to 4-year-old children in northern Manhattan, are higher than the national average (9), according to Pediatric Dentistry.


• After over fifty years of water fluoridation, many children in Newburgh, New York have more cavities and more fluoride--caused discolored teeth (dental fluorosis) than children in never-fluoridated Kingston, New York, according to a New York State Department of Health study published in the New York State Dental Journal (10).

• Second-graders from non-fluoridated Long Island, New York, are more cavity-free than second graders nationally (11) where two thirds of Americans drink fluoridated public water supplies.

• Despite a tremendous effort to improve oral health in fluoridated Rochester and Monroe County, lack of dental care has created a tooth decay crisis.(12)

• In fluoridated Syracuse and Massena, many children are raised in homes where they feel it's their destiny to have tooth decay and tooth pain.(13)

• "Poor oral health was identified as the number one complaint in a population-based survey of Central Harlem conducted in 1992-1994." (14)

• In Harlem, N.Y., forty-six percent of African-American seniors were missing teeth, compared with twenty-two percent of Latinos. (15)

• "The state also has increased dental payment rates by 250 percent over the past few years, with little success in improving access to dental care." in fluoridated Syracuse, New York.(16)

• Cavities are rising in fluoridated Rochester’s 10-year-old population. (17)

• Eighteen percent of older New Yorkers lost six or more teeth due to dental disease, (18) while only sixteen percent of non-fluoridated Long islanders did. (19)

• Similarly twenty-one percent of Brooklyn’s and twenty percent of Queens’ residents have less teeth (20), than non-fluoridated Suffolk and Nassau Counties.

• Cavity crises occur in many fluoridated cities and states. (21)

By neglecting the poor, organized dentistry helped create an oral health epidemic (22). Promoting fluoridation may deflect government regulators from forcing dentists to actually treat poor children (23).

Besides, after six decades of water fluoridation, cavity rates have increased recently in America’s 2 to 4 year-old population who should be the most “fluoride-protected.” (23a)

And, according to the American Dental Association News, average net income of a full time independent non-solo pediatric dentist was $336,860 in 2001, up more than twenty-five percent since 1998. Since eighty percent of all decay occurs mostly in the dentist-abandoned poor, some public health dentists ask, what kinds of necessary dental services are provided to higher socio-economic kids to generate a net income of $336,860 annually?

In 1984, NYC spent $2.4 million for fluoridation chemicals, equipment and manpower, according to the NYC Department of Environmental Protection. In 2003, fluoride chemicals, alone, cost NYC $6 million, according to the New York Sun.

Fluoridation money, literally flushed down the toilet, should be earmarked to treat poor NYC children’s dental pain immediately.

Even more worrying is that higher blood lead levels are found in New York State (and other) children whose water supplies contain the fluoride chemicals, silicofluorides, when compared to non-fluoridated or sodium fluoridated communities, reports Masters and Coplan and substantiated by CDC scientists.(24) Ironically, higher blood lead levels are linked to more cavities. (25)

The cost of fluoridation isn’t the only price we pay when silicofluorides are put into drinking water. “Silicofluorides have very costly side-effects,” says Roger Masters, PhD, co-author of the silicofluoride/lead studies. “Lead lowers IQ and influences behavior in many ways. Epidemiology shows that where silicofluorides are used, there are higher rates of learning disabilities, substance abuse, and violent crime. Our studies do not find similar effects for sodium fluoride,” says Masters.

“The result is that silicofluoride usage has the effect of increasing public expenses and taxes,” says Masters. For example costs of jailing criminals, adversely affected by silicofluorides and special education classes for children with lower IQ due to high-blood-lead levels could be diminished if the offending silicofluorides were removed from public water supplies, Masters explains.

"The oral health crisis facing America today shows fluoridation and public health dentistry is failing America’s neediest children. Why is organized dentistry less supportive of a public health approach to improving access to care? Perhaps that’s because Americans spent roughly $64 billion on dental procedures last year with more than half of those procedures being cosmetic—fillings, crowns, implants, and high-end restorative procedures, according to government data," reported in Access, an American Dental Hygienists' Association publication.(26)

Organized dentistry often hinders programs designed to reach out to America's underserved, protecting their monopoly rather than America's neediest. The ADA publicly invalidates dental hygienists solo practices along with their "Give-Kids-A-Smile" public relations materials. The hygienists lash back with their own news release (27) The ADA also frowns on dental therapists, specially trained hygienists who can fill the cavities dentists refuse to.(28)





References:

(1) September 2000 “Oral Health Factors Contributing to Low Use of Dental
Services by Low-Income Populations,” General Accounting Office
https://www.gao.gov/assets/hehs-00-149.pdf

(1a) Colgate Oral Care Report Volume 14 No. 4, November 4, 2004 http://www.colgateprofessional.com/app/cop/repository/article-201/frameset.jsp

(1b) (1b) http://www.orgsites.com/ny/nyscof/_pgg6.php3


(2) "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


http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12597585

(3) “Dentists' pay tops doctors' Even with fewer cavities to fill, dentists' earnings are skyrocketing.” By Mark Maremont, The Wall Street Journal, January 11, 2005
http://www.bradenton.com/mld/bradenton/business/10614433.htm

(4) New York University, School of Dentistry, “Speaker Miller and City Council Expand Dental Services for Needy Children” http://www.nyu.edu/dental/news/needychildren.html

(5) “Lack of Oral Health Care for Adults in Harlem: A Hidden Crisis,” Zabos, et al, American Journal of Public Health, January 2002, Vol 92, No.l
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11772760


(6) Journal of Public Health Dentistry, Summer; 63(3): 189-94
"Dental caries experience in northern Manhattan adolescents.".
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12962473



(7) Journal of Community Health, August 2003, " Oral disease burden and dental services utilization by Latino and African-American seniors in Northern Manhattan."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12856796


(8) Dental Clinics of North America, January 2003 "Dental caries prevalence among a sample of African American adults in New York City,"
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12519005&dopt=Abstract


(9) Pediatric Dentistry, May-June 2002, "Dental caries among disadvantaged 3- to 4-year-old children in northern Manhattan"

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12064497


(10) NYS Dental Journal,"Recommendations for Fluoride Use in children," February 1998 by dentists Kumar and Green. Figure 1, Page 41, http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9542393


(11) Page four of ERIE COUNTY HEALTH DEPARTMENT COMMUNITY HEALTH ASSESSMENT - FAMILY HEALTH
http://wings.buffalo.edu/wny/health/den.pdf

(12) Democrat and Chronicle, "Dental care is luxury for many locals," October 2004
http://www.democratandchronicle.com/apps/pbcs.dll/article?AID=/20041002/NEWS01/410020317/1002/NEWS

(13) Small Smiles gives kids a reason to grin
Updated: 12/1/2004 by Al Nall, News 10 Now Web Staff
http://news10now.com/content/all_news/?ArID=32340&SecID=83

(14)
Abstract presented at meeting of American Public Health Association
“Community DentCare Network: Community-academic partnerships as a model in identifying, addressing, and reducing oral health disparities”

http://apha.confex.com/apha/132am/techprogram/paper_85424.htm

(15) U.S. News and World Reports 11/9/04
Open wide
A report looks at the dental health of African-American males,
By Elizabeth Querna

http://www.usnews.com/usnews/health/briefs/oral/hb041109b.htm?track=rss

(16) Cost Concerns Grow Despite New Health Plan Competition in Syracuse
Community Report No. 7
Summer 2003
http://www.hschange.org/CONTENT/572/

(17) University of Rochester News Release
Dental cavities on the rise again; back to 'drill and fill'
http://www.eurekalert.org/pub_releases/2000-04/UoR-Dcot-0704100.php

(18) U.S. Centers for Disease Control statistics: http://apps.nccd.cdc.gov/brfss/display.asp?cat=OH&yr=2002&qkey=6605&state=NY

(19) http://apps.nccd.cdc.gov/brfss-smart/MMSARiskChart.asp?yr=2002&MMSA=83&cat=OH&qkey=6605&grp=0

(20) http://apps.nccd.cdc.gov/brfss-smart/MMSACtyRiskChart.asp?MMSA=61&yr2=2002&qkey=6605&CtyCode=91&cat=OH#OH

(21) Cavity Crises in Fluoridated Cities and States compiled by New York State Coalition Opposed to Fluoridation http://www.orgsites.com/ny/nyscof2/_pgg6.php3


(22) “FIRST-EVER SURGEON GENERAL'S REPORT ON ORAL HEALTH FINDS PROFOUND DISPARITIES IN NATION'S POPULATION,” News Release, May 2000, U.S. Department of Health and Human Services
http://www.surgeongeneral.gov/news/pressreleases/pr_oral_52000.htm

(23) Oregon Dental Association newsletter, April 2004, Volume 9, Number 11 (Page 6)
http://www.oregondental.org/oda/section.cfm?wSectionID=1277


(23a)
Data Presentation by Dr. Edward Sondik
Director, National Center for Health Statistics
http://www.cdc.gov/nchs/about/otheract/hpdata2010/focusareas/fa21-oral.htm


(24) More Lead in Children Who Drink Fluoridated Water, by Sally Stride, June 2004
http://www.suite101.com/article.cfm/fluoridation/109036

(25) Moss, M.E. 1999. Association of dental caries and blood lead levels. Journal of the American Medical Association 281(June 23/30):2294.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10386553&dopt=Abstract

(26) "Why Millions Suffer with preventable oral disease," by Bryan L. Scott, June 2002 . Access, an American Dental Hygienist Association’s publication
By Bryant L. Scott
http://www.adha.org/downloads/0506lead.pdf

27) ADHA’s Response to ADA Study: The Economic Impact of Unsupervised Dental Hygiene Practice and its Impact on Access to Care in the State of Colorado , February 4, 2005
http://www.adha.org/news/012805-study.htm

(28) "First Alaskan dental therapists to qualify," RDH
http://de.pennnet.com/Articles/Article_Display.cfm?ARTICLE_ID=219527&p=56