Respect to Dr. WH, but I do not understand the logic animating the notion that this is a "1950s" solution and instead we need to come up with a slick, modern, new-fangled technoutopian solution fueled by solar powered bicycle widgets or something. This seems to rely on a notion of the onward march of scientific progress that doesn't make sense in a public health context.
Some public health solutions are just super basic and fixed. Like mechanical refrigeration (a 1910s solution), or improved sanitation, or vaccination (a 19th century solution?), or mosquito nets or not using lead paint anymore (a 1970s solution?), or getting rid of handguns.
Like, most people won't ever be exposed to polio, but we vaccinate everyone because we're better off as a society if we do (and yeah obvs tooth decay is not contagious, but the heavy social cost of rotting teeth means the comparison stands)
And obvs adopting these basic solutions is not a substitute for good education policy or comprehensive health care, but it is miles better than doing nothing.
Backing up a second... Dr. WH, you said, "Fluoride tablets cost $.50 per year per person, Portland fluoridation: over $40 per year per at risk kid."
Did you mean, "Fluoride tablets cost $.50 per year per AT RISK KID, Portland fluoridation: over $40 per year per at risk kid."
Because if you didn't, you're comparing apples to oranges. I don't know how much fluoride tablets cost, but the estimated cost of water fluoridation in Portland is a little less that $1 per person per year.
owls - didn't someone in this thread say that you have to have parental permission to take the tablets? That might be a big barrier for lots of poor kids. I don't know, though!
By the time you can line up and take fluoride tablets in school, it's too late for a lot of kids. For it to work, you'd have to figure out a way to get tablets to kids starting when they are 6 months old.
Not all school districts offer the tablets. I was at a PPS school for a year that did (and it meant the teacher managing a list of kids that had permission from parents and going around to them every day at snack time and giving them a tablet and presumably monitoring to make sure they took it.) My current district doesn't offer fluoride tablets.
Regardless, one tablet 5x/wk for 9 months of the year isn't going to be as beneficial to dental health as every day/every drink of water.
I am definitely pro-fluoride. Yes it's a band aid, but without band aid solutions we'd go without funding for libraries, or music classes for kids, or new firehouses or a million other things that the government should be generously supporting but can't because of flaws in our political system. My school will be able to hire a teacher and lower our ridiculous class sizes if a district "foundation" is able to collect enough donations to pay for the position. This means on a Saturday a bunch of teachers are going to have to pile in to the district office and call every family in the district asking for money because it's hard to say no to the (mostly) nice ladies who take care of your kids all day. Ultimately teachers shouldn't be begging families for money to lower class sizes! And it's unfair that our relatively affluent district is able to raise that kind of cash when neighboring districts that are poorer or less organized aren't able to! But just because our national model for funding schools is fucked up and inequitable doesn't mean we should turn our nose up at the opportunity to lower our class sizes. And just because fluoridating water isn't the best way to address institutionalized poverty and inequity in our country doesn't mean we should turn our noses up at it. It will prevent cavities! Every teacher and scientist and medical/dental person I know is pro-fluoride. Band aids come in handy.
Kdawg, my post was already long, so I left stuff out. And your line of criticism is legit.
The '50's comment was an exploration of how we got to a proposal to fluoridate Portland water today. My start point is that people are rational and generally good intentioned within their experience frame.
The 1950's was characterized by post WWII technological optimism. The chemical industry particularly turned war research on chemical weapons into herbicides and pesticides. That idea was questioned by Rachel Carson in her book Silent Spring, though it took another almost 10 years for that movement to gain traction. The 1950's birthed many technological and cultural items that were later discovered to have undesirable side effects.
Briefly I believe public health measures should be questioned and revised as necessary. I question the idea of public health that all the uncontrolled variables come out in the wash. Today we can do research to understand those variables and devise dental health programs that are much more customized than putting fluoride in everyone's water, the soil, the rivers. I would also be willing to bet that access to dental care in 1950 per capita was much slimmer than today.
So I think we can do better and we should do better.
Bravo to Dr. WH and Wanda, who both have made very convincing arguments! Now I want to fluoridate AND do better than fluoridate!
However, at the risk of slipping back into paternalistic mode, Dr. WH, I'd love for you to elaborate on our alternatives to fluoridation and why you think they would be effective. "And at the same time, through those existing systems, we could engage behavior with those kids: diet, brushing, flossing - each much more effective than dietary fluoride. Hey, give out fluoridated toothpaste too! Free." What makes you think this works? I'm being super skeptical and probably making people hate me, but I think it's a legit question. Why would you think giving out fluoridated toothpaste for free would work better than water fluoridation? Out of curiosity, I tried to figure out what Oregon is doing in terms of dental education outreach to low socioeconomic kids, and what I found (in my super brief google search) was a handful of non-profit orgs who, notably, all support water fluoridation. So they're there at the front lines, trying to educate kids, and they're basically saying, "this is not enough." I think that's interesting, because they could just as easily be saying, "Boo to fluoridation! What we're doing is where it's at! Give us more money instead of fluoridating the water!" But they're not.
Oh wow. There is (of course) so much good stuff out there on dental education! I better read some of it before I continue talking out my ass.
Here's one on the "access" point I was trying to make...
The impact of universal access to dental care on disparities in caries experience in children Authors Abstract
Background. The authors investigated the association between socioeconomic status and the severity of dental caries in 6- and 7-year-old children who had had access to dental care throughout their lives. The children had lived since birth in Nova Scotia, Canada, a province with a universal publicly financed dental care program. Methods. The authors selected a representative sample of first-grade children using a stratified multistage sampling method of primary schools (n = 1,614). The response rate was 78.8 percent. Two dentists were trained to diagnose dental caries using modified World Health Organization criteria. Intra-and interexaminer reliability was excellent (κ ≥ 0.88). Of the children who were examined (n = 1,271), 955 were lifelong residents of Nova Scotia, Canada, and so were included in this analysis. Data were weighted and adjusted for clustering (design) effects.
Results. Only 8.4 percent of the children had visited a dental office before the age of 2 years (!!!!!! - FL's !'s), and 88.5 percent of the children had their first dental visit between the ages of 2 and 5 years. Children whose parents had completed a university education had a significantly lower mean number of decayed, missing and filled surfaces, or dmfs, in their primary teeth than did children whose parents had a lower education level. A Poisson regression model indicated that parents’ high education status, optimal fluoride concentration in schools’ water supplies, daily toothbrushing and dental visits for checkup were significantly associated with low dmfs scores.
Conclusion. Having access to a universal publicly financed dental insurance program since birth did not eliminate the disparities in caries experience.
Practice Implications. This analysis of a highly utilized universal dental insurance program suggests that disparities in oral health status cannot be reduced solely by providing universal access to dental care. Focused efforts by professional and governmental organizations should be directed toward understanding the socioeconomic, behavioral and community determinants of oral health disparities.
"Focused efforts by professional and governmental organizations should be directed toward understanding the socioeconomic, behavioral and community determinants of oral health disparities."
I am very compassionate, but I am primarily motivated by improving the big picture. Would be curious others' experience in relation to their belief patterns on the issue.
Here is another curiosity. Cavities are primarily correlated with sugar consumption. But there is variation in the oral micro biome that is a factor. The microbiome is the specific mix of bacteria that colonize the tooth surface.
We have a microbiome in our intestines. Tens of thousands of individual bacterial species that digest the food. Current thinking is that if you have a really efficient biome, you will be fat, inefficient thin. So the medical profession is working up to intestinal biome transplant therapy for weight loss.
There is research that the oral biome is transferred from parent to child. So if you have an oral biome that is really efficient at making cavities, you might pass it on environmentally to offsprings.
And at Shine a Light: experimental dental club 6PM-10
Comments
Some public health solutions are just super basic and fixed. Like mechanical refrigeration (a 1910s solution), or improved sanitation, or vaccination (a 19th century solution?), or mosquito nets or not using lead paint anymore (a 1970s solution?), or getting rid of handguns.
Like, most people won't ever be exposed to polio, but we vaccinate everyone because we're better off as a society if we do (and yeah obvs tooth decay is not contagious, but the heavy social cost of rotting teeth means the comparison stands)
And obvs adopting these basic solutions is not a substitute for good education policy or comprehensive health care, but it is miles better than doing nothing.
Does anyone know why this isn't a feasible solution?
Targeted fluoride?
Did you mean, "Fluoride tablets cost $.50 per year per AT RISK KID, Portland fluoridation: over $40 per year per at risk kid."
Because if you didn't, you're comparing apples to oranges. I don't know how much fluoride tablets cost, but the estimated cost of water fluoridation in Portland is a little less that $1 per person per year.
Regardless, one tablet 5x/wk for 9 months of the year isn't going to be as beneficial to dental health as every day/every drink of water.
I am definitely pro-fluoride. Yes it's a band aid, but without band aid solutions we'd go without funding for libraries, or music classes for kids, or new firehouses or a million other things that the government should be generously supporting but can't because of flaws in our political system. My school will be able to hire a teacher and lower our ridiculous class sizes if a district "foundation" is able to collect enough donations to pay for the position. This means on a Saturday a bunch of teachers are going to have to pile in to the district office and call every family in the district asking for money because it's hard to say no to the (mostly) nice ladies who take care of your kids all day. Ultimately teachers shouldn't be begging families for money to lower class sizes! And it's unfair that our relatively affluent district is able to raise that kind of cash when neighboring districts that are poorer or less organized aren't able to! But just because our national model for funding schools is fucked up and inequitable doesn't mean we should turn our nose up at the opportunity to lower our class sizes. And just because fluoridating water isn't the best way to address institutionalized poverty and inequity in our country doesn't mean we should turn our noses up at it. It will prevent cavities! Every teacher and scientist and medical/dental person I know is pro-fluoride. Band aids come in handy.
Kdawg, my post was already long, so I left stuff out. And your line of criticism is legit.
The '50's comment was an exploration of how we got to a proposal to fluoridate Portland water today. My start point is that people are rational and generally good intentioned within their experience frame.
The 1950's was characterized by post WWII technological optimism. The chemical industry particularly turned war research on chemical weapons into herbicides and pesticides. That idea was questioned by Rachel Carson in her book Silent Spring, though it took another almost 10 years for that movement to gain traction. The 1950's birthed many technological and cultural items that were later discovered to have undesirable side effects.
Briefly I believe public health measures should be questioned and revised as necessary. I question the idea of public health that all the uncontrolled variables come out in the wash. Today we can do research to understand those variables and devise dental health programs that are much more customized than putting fluoride in everyone's water, the soil, the rivers. I would also be willing to bet that access to dental care in 1950 per capita was much slimmer than today.
So I think we can do better and we should do better.
However, at the risk of slipping back into paternalistic mode, Dr. WH, I'd love for you to elaborate on our alternatives to fluoridation and why you think they would be effective. "And at the same time, through those existing systems, we could engage behavior with those kids: diet, brushing, flossing - each much more effective than dietary fluoride. Hey, give out fluoridated toothpaste too! Free." What makes you think this works? I'm being super skeptical and probably making people hate me, but I think it's a legit question. Why would you think giving out fluoridated toothpaste for free would work better than water fluoridation? Out of curiosity, I tried to figure out what Oregon is doing in terms of dental education outreach to low socioeconomic kids, and what I found (in my super brief google search) was a handful of non-profit orgs who, notably, all support water fluoridation. So they're there at the front lines, trying to educate kids, and they're basically saying, "this is not enough." I think that's interesting, because they could just as easily be saying, "Boo to fluoridation! What we're doing is where it's at! Give us more money instead of fluoridating the water!" But they're not.
Here's one on the "access" point I was trying to make...
The impact of universal access to dental care on disparities in caries experience in children
Authors
Abstract
Background. The authors investigated the association between socioeconomic status and the severity of dental caries in 6- and 7-year-old children who had had access to dental care throughout their lives. The children had lived since birth in Nova Scotia, Canada, a province with a universal publicly financed dental care program.
Methods. The authors selected a representative sample of first-grade children using a stratified multistage sampling method of primary schools (n = 1,614). The response rate was 78.8 percent. Two dentists were trained to diagnose dental caries using modified World Health Organization criteria. Intra-and interexaminer reliability was excellent (κ ≥ 0.88). Of the children who were examined (n = 1,271), 955 were lifelong residents of Nova Scotia, Canada, and so were included in this analysis. Data were weighted and adjusted for clustering (design) effects.
Results. Only 8.4 percent of the children had visited a dental office before the age of 2 years (!!!!!! - FL's !'s), and 88.5 percent of the children had their first dental visit between the ages of 2 and 5 years. Children whose parents had completed a university education had a significantly lower mean number of decayed, missing and filled surfaces, or dmfs, in their primary teeth than did children whose parents had a lower education level. A Poisson regression model indicated that parents’ high education status, optimal fluoride concentration in schools’ water supplies, daily toothbrushing and dental visits for checkup were significantly associated with low dmfs scores.
Conclusion. Having access to a universal publicly financed dental insurance program since birth did not eliminate the disparities in caries experience.
Practice Implications. This analysis of a highly utilized universal dental insurance program suggests that disparities in oral health status cannot be reduced solely by providing universal access to dental care. Focused efforts by professional and governmental organizations should be directed toward understanding the socioeconomic, behavioral and community determinants of oral health disparities.
Here is another curiosity. Cavities are primarily correlated with sugar consumption. But there is variation in the oral micro biome that is a factor. The microbiome is the specific mix of bacteria that colonize the tooth surface.
We have a microbiome in our intestines. Tens of thousands of individual bacterial species that digest the food. Current thinking is that if you have a really efficient biome, you will be fat, inefficient thin. So the medical profession is working up to intestinal biome transplant therapy for weight loss.
There is research that the oral biome is transferred from parent to child. So if you have an oral biome that is really efficient at making cavities, you might pass it on environmentally to offsprings.
And at Shine a Light: experimental dental club 6PM-10