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Filling the fluoride cavity

CHARLESTON, W.Va. -- After a chemical leak into the Elk River impacted the water supply of 300,000 West Virginians Jan. 9, many residents and parents have stopped drinking their tap water for fear of its potential health risks.

But according to area dental professionals, there's a risk to not drinking tap water too -- the lack of fluoride in most bottled water means that people, especially children under 16, are at a greater risk for developing cavities and other health problems.

"Water fluoridation is important -- it has been shown over the last century to be one of the top 10 greatest public health initiatives, according to the CDC, and that's because of the reduction in cavities that has been seen since its implementation nationwide," Dr. Steven Ghareeb, a Charleston dentist at Ghareeb Dental Group, said. "It has been shown to be effective in preventing cavities nationwide."

Ghareeb, a contributor to Parenting magazine, Men's Health magazine and Consumer Reports, said cavities are the most preventable disease in medicine, and fluoridated water is one of the primary means of prevention for most people. Ingesting fluoride is more effective than applying it directly to the teeth, he said.

Ghareeb said many adults may get enough fluoride from their toothpaste or regular dental treatments, but a lack of it can cause problems for children who are still developing.

"It also causes developmental issues -- strengthening of bones, teeth, upper and lower mandibles. Fluoride is important for more than just preventing cavities," said Richard Stevens, executive director of the West Virginia Dental Association.

In 1945, Grand Rapids, Mich., became the first city in the U.S. to introduce fluoride into its water system. Since then, many other parts of the country have followed suit. In 2006, 69 percent of the U.S. population was served by public water supplies with fluoridation.

Lee Allen, president of the WVDA and an oral surgeon in Charleston, said parents who are concerned that their children may be susceptible to cavities should ask their dentist to perform a risk assessment on the child. From there, the dentist can determine whether the child is in danger of developing cavities or other medical concerns and can prescribe fluoride supplements if necessary.

"Depending on the risk assessment, if the patient has a high risk of [tooth decay] or cavities and they're drinking bottled water exclusively, they may want to look at different options for that child," Allen said. "They may prescribe a toothpaste with a higher level of fluoride, or actually prescribe fluoride drops to add as a supplement to the bottled water; they may even say, instead of coming two times a year for an in-office fluoride treatment, we're going to do it four times a year. There are different ways to get fluoride, and it all depends on the individual patient."

Nearly two months have passed since the chemical leak, and Ghareeb said children who haven't been drinking the water might start to experience some delayed effects of that missing fluoride, depending on their risk level.

"One month or two might not be too bad with a lack of exposure to fluoride in the water, but after a few months, it's a significant amount of time that can give time for the teeth to demineralize and weaken a little bit and for cavities to take hold," he said.

Ghareeb said the most common treatment he prescribes is a chewable tablet for children as young as 6 months. The number of times a child brushes a day, as well as whether their permanent teeth are exposed, can also impact the effectiveness of fluoride toothpaste, Ghareeb said.

"Ingested fluoride is present in saliva, and coats the teeth constantly," he said. "It actually inserts itself into the enamel structure to strengthen the teeth as they grow. Adults have already formed their enamel and can't do much to strengthen it, at least not to the extent that we see in children. For children, it's very important, because those teeth are still developing."

Reach Lydia Nuzum at lydia.nuzum@wvgazette.com or 304-348-5189.


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