The Tribune

By Dr Andre Clarke

WHAT is drinking water fluoridation? It is when a small amount of the mineral fluoride is added to drinking water. When the term is used in this column, it is speaking specifically to the addition of a small amount of fluoride to the public drinking water supply in order to reduce tooth decay (“rottenin’”).

The fluoride added to the drinking water is always in small amounts, but in enough quantities to be effective at preventing cavities. Sometimes fluoride does not need to be added by the design of man, but will naturally occur in drinking water due to the water’s course through a fluoride rich region.

One major effect of having fluoride in drinking water is that it creates a low level of fluoride in the saliva (spit), which makes teeth more resistant to the early stages of decay. The ultimate goal of governmental orchestrated drinking water fluoridation is to prevent tooth decay by adjusting the concentration of fluoride in public water supplies.

Tooth decay is a chronic (long standing) disease that affects the entire world. It is not directly life-threatening, but causes pain, impairs eating, impairs speaking and affects facial appearance.

As a result, the quality of life of persons, in particular children, especially those in the lower socioeconomic stratum, is often times adversely affected.

Drinking water fluoridation is generally considered one of the most effective means of achieving community wide fluoride exposure.

The other strategies employed include fluoride toothpastes, mouthwashes, gels, dental sealants and varnishes.

The fluoridation of drinking water is termed mass fluoridation and presents a conflict between what is perceived as necessary for the common good and what is infringing on the rights of the individual.

The decision to mass fluoridate is controversial and many oppose it. People oppose it based on ethical, legal, safety, and efficacy grounds. Nonetheless, many health and dental organisations worldwide endorse its safety and efficacy. These organisations view drinking water fluoridation as a way to free individuals from the agony associated with a bad tooth, especially those who are in a low socioeconomic stratum. Is it then unethical to fluoridate or is it unethical not to fluoridate?

The US Centers for Disease Control and Prevention (CDC) has listed water fluoridation as one of the 10 great public health achievements of the 20th century. Of note, vaccination and family planning are also on that list.

Other organisations also endorse drinking water fluoridation and include the World Health Organization (WHO); the US Surgeon General; the American Public Health Association; the European Academy of Paediatric Dentistry, and the national dental associations of Australia, Barbados, Canada and the US.

In 2004, approximately 400 million persons in the world were being exposed to fluoridated water. Most of these persons were citizens of countries that implemented governmental orchestrated drinking water fluoridation. The list of countries included Argentina, Australia, Brazil, Barbados, Canada, Chile, Colombia, Hong Kong, Ireland, Israel, Jamaica, Korea, Malaysia, New Zealand, the Philippines, Singapore, Spain, the United Kingdom, Trinidad and Tobago and Vietnam.

Paralleling the introduction of water fluoridation is the opposition it faces. There has been a general distrust of the governments implementing the drinking water fluoridation system and a distrust of the experts that have advised the government officials to pursue such a course of action.

The political and legal issues surrounding the perception of fluoridated drinking water as a medicine and its prescription to the populace are ingrained in the minds of the persons who fight against drinking water fluoridation.

Literature speaking against the fluoridation of drinking water commonly link fluoride exposure to a wide variety of ailments including HIV/AIDS, Alzheimer’s, arthritis, cancer, and low IQ. Diseases of the gastrointestinal tract, kidneys and thyroid are also cited.

The supporters of drinking water fluoridation recognise dental fluorosis as the only significant side effect of using fluoridated drinking water. Dental fluorosis is a defect of the enamel (white part) of the teeth.

It usually commences during a child’s early years, causing damage to the child’s enamel forming cells. Once these cells are affected, visible discolourations of the teeth occur. The discolourations range from white to brown spots/stains on the enamel.

The spots/stains are usually managed by dental professionals, who commonly utilise filling materials, veneers and crowns to hide the stains. The discoloured areas can also be lightened by using teeth whitening techniques.

The drinking water in the Bahamas is not fluoridated. Should it be fluoridated? Will it benefit the persons in the archipelago or will it harm them?

The final decision rests in the hands of the people.

An effective method to control the tooth decay disease must be developed in the Bahamas in order to ensure we keep our beautiful smiles and our mouths alive. Do you agree?

• This article is for informational purposes only. It is not intended and may not be treated as, a substitute for professional medical/dental advice, diagnosis, or treatment. Always seek the advice of a physician or dental professional with any questions you may have regarding a medical/dental condition. Never disregard professional medical/dental advice or delay in seeking it because of a purely informational publication. If you have questions, please send email to dr_andreclarke@hotmail.com