DISCLOSURE: Noelle Copeland RDH is an Oral Care Specialist and Dental Consultant who provides content for Brilliant Oral Care and Baby Buddy.
I’m a unicorn in dentistry because I don’t bow down and praise the inclusion of fluoride in drinking water as the miracle elixir that saved everyone’s teeth. I don’t drink tap water for many reasons, and the addition of fluoride just happens to be one of those reasons.
Fluoride was added to community drinking water in 1945 in Grand Rapids, Michigan. Soon after, other towns and cities followed suit by adding fluoride to their water supply. Yet, throughout the decades, tooth decay in children has remained the most chronically diagnosed disease in the United States. Dental cavities in children are more common than obesity, asthma, hay fever, and diabetes, and one in every four adults has untreated tooth decay. The question that no one seems to be asking is, why?
In the United States, tooth decay is more prevalent in low-income households and communities. These are also the populations most likely to cook with and drink tap water versus the alternative of drinking bottled water. So if having low socioeconomic status puts you at a much higher risk of tooth decay, then exposure to fluoridated water should show a decrease of tooth decay in those populations, but it doesn’t. The decay rate is almost 50% higher.
The only obstacle to choosing your water source nowadays is honestly just money and resources. If you can afford it and get to it, you have many options to choose from for bottled waters. However, naturally occurring fluoride is still found in trace amounts in bottled water and is a regulated part of every bottled water available for consumption. So don’t think just because you’re drinking bottled water that you aren’t getting any fluoride!
So the question is this:
- If everyone is being exposed to fluoridated water in one way or another, on top of the fact that almost every tube of toothpaste on the shelf has added fluoride, then why is it that specific populations still have a greater overall risk rate for tooth decay?
When you combine lack of access to professional oral care with the stress, influence, and life experiences of those in poverty-stricken communities… you get higher rates of tooth decay, regardless of systemic fluoride consumption. You also see more cases of other conditions like diabetes, obesity, and heart disease.
Factors that link poverty to tooth decay:
Food deserts/Poor diet.
Limited access to nutritious and affordable food creates food deserts, making the corner convenience store the closest option for food. Sugar and carb-filled snacks are what’s commonly available, with limited access to fresh fruits and vegetables. An estimated 19 million people live in food deserts across America, with the majority living in low-income areas. Low-income communities make poorer food choices out of necessity and lack access to better options. Sodas, highly refined carbs, bread, high sodium fast foods, and added sugar will rapidly contribute to tooth decay when consumed regularly.
Lack of dental hygiene care.
Lack of professional dental care is a huge problem, but just as absent is a lack of dental care at home. Ineffective homecare is probably the number one contributing factor. Without early oral care intervention, most low-income households have children that don’t receive early infant oral care. They also undervalue the ritual of toothbrushing and flossing at home on a regular daily basis. Often, a misconception on the importance of healthy baby teeth is assumed. The assumption is that baby teeth don’t matter because they fall out eventually. So tooth decay is left untreated or ignored, and when this happens, the bacteria that leads to tooth decay spreads and grows, affecting multiple teeth.
Those are just a few of the statistics surrounding economic disparities in tooth decay patterns. So now, let’s talk about fluoridated community water!
Fluoride in the water
Fluoride can reverse tooth decay when applied topically, but systemic fluoride is a bit different. Research shows that fluoride ingestion should produce saliva with fluoride ions, which should help prevent tooth decay by being absorbed into the enamel of the teeth! However, as we’ve discussed, the results just don’t show that happening. The most vulnerable communities have the highest decay rate, and they consume the most fluoridated water.
There are many different types of fluoride and they are not created equal. There are both naturally occurring and synthetically made forms of fluoride. In fact, fluoride itself is not a naturally occurring element but Fluorine is. Fluorine is a naturally occurring element that creates Fluoride when salts from the element fluorine combine with minerals in soil or rocks. Fluoride is found naturally in soil, water, and many foods like spinach, grapes, wine, tea, and potatoes.
Calcium fluoride (CaF2) is the most common form of fluoride found in natural water sources. CaF2 exists in soil, so any time e you have a natural spring or another natural water source, there will always be traces of calcium fluoride. When CaF2 fluoride is consumed excessively or when the amounts of CaF2 are unnaturally higher than the “safe-trace-amount,” it can cause health problems like skeletal fluorosis and calcification of the joints.
Sodium fluoride (NaF) is another type of fluoride that is commonly used. NaF is a synthetic industrial fluoride and is more harmful to humans. In its purest form, NaF can eat through concrete. In 1945, NaF was the first compound to be added to the country’s water system, but since then, it has been replaced with fluorosilicic acid.
Fluorosilicic acid (FSA).
Fluorosilicic acid (FSA), also known as Hexafluorosilicic or Hydrofluorosilicic (HFSA) acid, is mainly used in water fluoridation, metal sterilization, electroplating, animal hide tanning, and glass etching. My community uses fluorosilicic acid as the fluoride source for its water fluoridation, and so do most other cities that participate in community water fluoridation. That means every bath/shower, every water fountain, every restaurant, every school system has HFSA in the water.
Unlike pharmaceutical-grade fluoride found in toothpaste and dental products, the fluoride in community water is an untreated synthetic industrial waste byproduct, with trace elements of arsenic and lead, called Fluorosilicic Acid.
How does this happen?
- Hydrogen fluoride gases are by-products of fertilizer production.
- Before the 1970s, these gases were released into the atmosphere and produced harmful air pollution for farmers.
- Farmers & Ranchers forced reluctant manufacturers to invest in pollution abatement scrubbers that converted toxic pollutants into fluorosilicic acid (FSA), aka hydrofluorosilicic acid (HFSA), a dangerous but more containable liquid waste.
- Just to relay the seriousness of this chemical, the U.S. National Institute for Occupational Safety and Health (OSHA) cautions that FSA, an inorganic fluoride compound, has dire health consequences for anyone that comes into contact with it. Breathing its fumes causes severe lung damage or death, and an accidental splash on bare skin will lead to burning and excruciating pain.
- However, FSA can be contained in high-density cross-linked polyethylene storage tanks.
- Those storage tanks allow FSA to be transported from fertilizer factories to water reservoirs throughout the United States. Once there, it is drip-fed into drinking water.
According to the Federal Register of National Archives, the EPA has said the following about the concerns surrounding the use of fluorosilicic acid in community water:
- After careful consideration, the EPA has denied a petition to remove HFSA from community water primarily because the EPA concluded that the petitioners had not set forth sufficient facts to establish that HFSA presents or will present an unreasonable risk that exceeds the EPAs maximum containment level.
- In terms of Arsenic and Lead exposure, The EPA cannot conclude that the use of HFSA in community water will result in enhanced exposure risks.
The Safe Drinking Water Act requires the EPA to determine the level of contaminants in drinking water at which no adverse health effects are likely to occur. The EPA has set these levels based on the best available science, which just so happens to indicate there is no safe level of exposure to arsenic or lead. While arsenic levels in Hexafluorosilicic (HFSA) acid are higher than in pharmaceutical-grade NaF, the arsenic levels in drinking water due to HFSA are considered low enough to be reasonably safe according to the EPA.
Here are my thoughts:
- Adding a chemical with fluoride ions into drinking water has not decreased the overall incidence of tooth decay in the most at-risk communities.
- Why has the EPA allowed this particular chemical, HFSA, into our water under the guise the science isn’t settled on the risk of lifetime exposure? Shouldn’t this chemical have to be proven safe above all else versus the much more protracted process of showing how it’s harmful over time?
- The only benefit that HFSA appears to have in our water supply is for the fertilizer industry, which would have a pretty expensive waste disposal problem if it weren’t for water fluoridation.
- There’s enough fluoride floating around in the environment; we don’t need it added to our water, especially a low-grade industrial byproduct version. What we do need is better access to care, mobile dental units, free educational seminars to support at-risk communities, and for people to value their oral health the same way they should value their systemic health.
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Noelle Copeland RDH is an Oral Care Specialist and Dental Consultant who provides content for Brilliant Oral Care and Baby Buddy.