Drink up! Tap water key to dental health

By Sally Greenberg, NCL Executive Director

The Washington Post had an interesting piece yesterday by writer Juliet Eilperin about using filtered or bottled water when she was pregnant and losing out on the important benefits that fluoridation in tap water provides. What I found interesting is that she expressed surprise about this fact. If a reporter for the Washington Post doesn’t know this important health information, then we need to do a whole lot more educating.

Bottled water consumption has doubled over the past decade and as a result, the exposure to fluoride from tap water, which can not only prevent tooth decay, it can repair tooth decay, has been reduced as well. Eilperin quotes a professor of dental sciences who says we should “look at this issue.” That’s an understatement. Eilperin opted for bottled water because of various trace chemicals found in the District of Columbia’s water system that are potentially harmful to health. She’s right that water that contains dangerous concentrations of harmful chemicals can be a threat to health of adults and children. But whether DC’s water reaches those levels is another question and whether it’s the right calculus to trade away the benefits of fluoride because of fear of these trace chemicals is another matter. That really does need to be studied. I also live in DC and make a point of drinking the water here and using ice cubes from DC water for my family because I want all of us to benefit from the fluoride. I guess I’ve made the decision that having healthy teeth is more important than worrying about ingesting tiny concentrations of chemicals.

But the value of fluoride cannot be understated. United States municipalities began adding it to public drinking water systems in the 1940s. Today, about 65 percent of Americans get fluoridated tap water, including 95 percent of people in Virginia, 99 percent in Maryland, and 100 percent in the District. It’s a huge public health advancement, because tooth decay and dental disease has such a ripple effect on health. If a child has a toothache, she can’t go to school, her parent has to take time off work to see a dentist, and the costs involved can be very high. For families with low and moderate income, dental care can be prohibitively expensive. So fluoride, as a prevention tool, is a very important health measure. And for an adult with tooth decay, missing a front tooth can prevent them from getting a job or getting a promotion.

Eilperin’s DC dentist told her that after officials began fluoridating public water supplies, “the cavities rate was cut in half. The only thing they could attribute it to was fluoridating the water.”

The Centers for Disease Control and Prevention identifies fluoridation of public drinking water as one of the top 10 public health achievements of the 20th century, noting that studies show it reduces cavities in adolescents by between 8 and 37 percent, and among adults by 20 to 40 percent.

Still, a South Australia study conducted between 1991 and 1995 showed that children who drank only rainwater and bottled water had a 52.7 percent higher rate of cavities in their baby teeth than those who drank only public, fluoridated tap water.

Not all filtered or bottled waters are totally devoid of fluoride: Brita filters do not strip it out of tap water, and some bottled brands such as Nursery Water advertise that they add the mineral. The ADA has introduced a certification program for foods and beverages that are beneficial to oral health, including fluoridated bottled water, in part to encourage bottlers to provide optimally fluoridated water.

Martha Ann Keels, the division chief of pediatric dentistry at Duke University, tells parents that taking a fluoride supplement (if you don’t drink fluoridated tap water) as effective as fluoride toothpaste in helping your teeth resist the impact of acid they’re exposed to during the day.

“The main benefit of fluoride is topical: You put it on the enamel to recharge it,” Keels said. “It’s like putting shoe polish on your shoe.”

That sounds good to me. Oral health is a critical component of overall health, and we need to spread the word about the importance of brushing with fluoridated toothpaste twice a day, drinking tap water wherever possible, and seeing the dentist twice a year. The benefits will pay off exponentially.