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Letters: Promoting fluoridation

July 10, 2017 I read with interest Dr. Mark Bronson’s, “Community Water Fluoridation: A Prevention Strategy” My View in the June 5 ADA News. Having gone to dental school at Northwestern University in fluoridated Chicago and practicing for four additional years prior to relocating to nonfluoridated Portland, Oregon, in May 1980, I didn’t appreciate what fluoridation did for public health until practicing in a community without it.

While people in the lower socioeconomic status populations had more decayed/missing/filled teeth as compared to higher socioeconomic status populations in Chicago, I saw more of everything in Portland. Across every demographic there were more caries, especially root caries in adults and rampant caries in children, and more restorations or filled teeth. I always played a little game during my career in Portland. When a new adult patient came to my practice, part of my exam would be my guessing what part of the U.S. they grew up in. Seldom was I fooled in identifying which of my patients grew up with fluoridation from those who did not.

Over the last 37 years, I have witnessed a drop in the decayed/missing/filled teeth in my middle and upper middle class millennial patients — my two daughters included — but the children in the lower socioeconomic status populations have not fared so well. There is a wider disparity that, disproportionately, affects children who live in poverty.

While there are other factors involved with good oral health, such as education, diet and access to care, fluoridation should be the foundation of a sound dental public health policy. Fluoridation has helped level the playing field between rich and poor. Evidence-based science has confirmed that fluoridation benefits everyone, not just children.

My concern with our profession is twofold. First, dentists do not properly educate themselves on the science and politics of fluoridation. Second, the vast majority of millennial dental students and young dentists, who are replacing the baby boomer generation of dentists, have not experienced oral disease like their parents’ and grandparents’ generations, and often, do not appreciate the role that fluoridation has played in the prevention of oral disease.

Like vaccinations, fluoridation is a victim of its own success. If one has not personally experienced or witnessed a disease, one truly doesn’t appreciate what a particular preventive strategy has contributed to reducing the burden of disease in our communities. My generation of dentists, who were born in the late 1940s and 1950s, all were on the receiving end of the dental drill growing up, but I suspect many of the millennial-aged dentists have grown up virtually cavity-free. Will they be as supportive of fluoridation as they move into the leadership of our profession?

Dr. Bronson asked in his article, “Are we engaging in effective strategies to promote community water fluoridation in our communities?” The short answer is, “No.” Every day in our practices we should be inoculating our patients from the fear-mongering pseudoscience of the opponents to fluoridation. The entire dental team can be involved, especially our hygienists. Why not encourage them to engage their patients about the benefits of fluoridation while they have them captive in their chair?

Sadly, back in 2012 and 2013, Portland had an opportunity to end our city’s distinction of being the largest city in the U.S. that doesn’t fluoridate its public water supply. While the ADA and the Oregon Dental Association were very proactive in their support during the campaign, the 500 rank-and-file dentists in Portland were mostly a no-show. Many dentists told me that they would vote for fluoridation, but they were fearful of losing patients and wouldn’t put supportive information in their waiting rooms or pro-fluoridation lawn signs in front of their offices or in front of their homes. In the end, the fluoridation referendum was defeated. What a missed opportunity to bring a proven, effective public health measure to our community.

Yes, while there was a high degree of vitriolic rhetoric from the opponents during the campaign, I believe that most dentists did not have the confidence to engage their patients’ concerns about fluoridation, because, as I stated earlier, they hadn’t properly educated themselves on the subject. How many of our colleagues know about the ADA Fluoridation Facts, ADA.org/fluoridationfacts, or the Campaign for Dental Health ilikemyteeth.org? These resources give in-depth answers to the myriad of A to Z allegations against fluoridation.

Dr. Bronson asked, “Wouldn’t it make sense to prepare for that possibility, just in case?” I ask, “Wouldn’t it be better if we had these discussions about the safety and effectiveness of fluoridation all along?” I also ask, “Who is going to educate the next generation of dentists on fluoridation?” If, as Dr. Bronson mentioned, dentists are trusted sources of information for patients and the public, we should be advocating for fluoridation just as pediatricians and family physicians advocate for immunizations. Anything less, in my opinion, is a failure of our professional responsibilities.

Kurt Ferré, D.D.S.
Portland, Oregon