The recent legal victory against the EPA isn’t the only fluoride-related news of note. Nor is it the only bad news for fluoridation. Recently, Cochrane published an updated review of the evidence of fluoridation’s impact on tooth decay. It made a lot of headlines, most looking something like this:
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You’d think such a finding would make it even easier and more convenient to finally end the practice of spiking our drinking water with fluoride, a mineral that doesn’t even naturally occur in tooth enamel and can cause a wide range of health problems in children and adults alike. After all, Cochrane reviews are highly respected, considered to be among the most reliable when it comes to evidence for clinical decision-making.
For the update, researchers tapped 7 major medical databases for studies that compared decay rates between fluoridated and non-fluoridated communities. Twenty-one studies published after 1975 made the cut, plus an additional study that looked at the effects of stopping fluoridation. Only tooth decay in children was measured.
Analysis showed that while “adding fluoride to water may lead to slightly less tooth decay in children’s baby teeth,” there was scant evidence that it reduced decay in permanent teeth.
The researchers also noted that while fluoridation seemed to really help reduce decay in the years before fluoride could be found in every big brand toothpaste, “it is unlikely that we will see this effect in all populations today.”
Indeed, that perceived benefit may be very slight, no matter how the fluoride is delivered. For instance, one study that looked at the impact of varnish and high fluoride toothpaste found only a modest difference in decay rates in children. While 39% of kids in the fluoride-free group developed cavities by the end of the study, so did 34% of those in the fluoride group.
“This well-conducted trial,” wrote the authors,
failed to demonstrate that the intervention kept children caries free, but there was evidence that once children get caries, it slowed down its progression.
Can this really be considered “prevention”? Most understand that term to mean that you stop something from happening altogether, not just mitigate damage. Real prevention means tackling root causes, such as nutrition and diet quality. It’s the path to optimal mouth/body health.
“While water fluoridation can lead to small improvements in oral health, it does not address the underlying issues such as high sugar consumption and inadequate oral health behaviors,” says co-author Janet Clarkson, Professor of Clinical Effectiveness, University of Dundee. “It is likely that any oral health preventive program needs to take a multi-faceted, multi-agency approach.”
Meantime, in the wake of the ruling against the EPA, several cities around the US have already chosen to stop fluoridation. As of this writing, they include Abilene, TX; Yorktown, NY; Somers, NY; and Utah’s Weber Basin Water Conservancy District, which serves over 700,000 residents within 5 counties in northern Utah.
We’d love to see St. Louis join them sooner rather than later – along with every other city, county, or district that’s been hanging their hopes on fluoride rather than more effective policies to support good oral health.
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