Building Effective Statewide Teams for FluoridationAmericanFluoridationSociety.org Itasca, IL. March 20-21, 2018. Johnny Johnson, Jr., DMD, MS. Building Effective Statewide Teams for

AmericanFluoridationSociety.org

Itasca, ILMarch 20-21, 2018

Johnny Johnson, Jr., DMD, MS

Building Effective Statewide Teams for Fluoridation


Community Water Fluoridation:

• Where it started• How it works• Building a village to support it


Fluoride & Fluoridation:

400 mile view Grassroots view


Fluoride is Naturally Occurring

• 13th most abundant mineral in the earth’s crust

• Surface water (rivers) -- typically low concentrations, 0.2 mg/L (ppm) or less

• Groundwater (wells) --higher concentrations, 0.1 mg/L to over 5.0 mg/L

• Ocean water is typically 0.8 to 1.4 mg/L


Courtesy CDC Water Fluoridation Course Materials, 2015

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How Did We Discover the Scientific Benefits of

Fluoride on Reducing Decay?



Frederick S. McKay

• 1901 – established practice in Colorado Springs, CO

• “Colorado Brown Stain”

Only life-long residents (or those who had moved there as

infants) had stain

• 1908 – began to investigate extent of condition in surrounding areas

Key Observation: very few cavities in this population

History of Fluoride’s Benefits

https://www.nidcr.nih.gov/health-info/fluoride/the-story-of-fluoridation

https://www.nidcr.nih.gov/health-info/fluoride/the-story-of-fluoridation


•1930 - H. V. Churchill used a newly available method of spectrographic analysis that

identified high concentrations of fluoride (13.7ppm) in the water of a community in

Arkansas with high rates of mottled enamel

•1931 – McKay contacted Churchill and sent him water samples. Fluoride was

discovered in each sample that McKay sent for analysis (2.0ppm to 12.0 ppm)

•It was now known what substance in the water was causing the staining of teeth:

FLUORIDE


Mother Nature is Replicated:Community Water Fluoridation Begins

• A 21 city study is undertaken to replicate what Mother Nature has taught us

• Grand Rapids, Michigan was the first city to adjust fluoride concentration in public drinking water (1945)

• Cavity rates dropped dramatically

At the time CWF was initiated…– Almost everyone had tooth decay– No one knew how to prevent it– Not uncommon for 13-year-olds to have lost one or

more permanent teeth to decay– About half of older Americans (age 65+) had lost all

their natural teeth– Recruits into WWII rejected because of poor oral

health (6 opposing teeth -10% rejection rate; 40% needed immediate treatment for relief of pain)

How Does Fluoride Work?



How fluoride works

Topical Effect• From the outside of the tooth• Saliva, fluoridated toothpaste

and other topical products

Systemic Effect• From the inside and outside

of the tooth• Saliva bathes the teeth

enamel 24/7/365

Adults also benefit from fluoride, rather than only children (as was once assumed)

http://www.cdc.gov/fluoridation/basics/index.htm


• Fluoride inhibits demineralization

• Fluoride enhances remineralization of surface enamel

Dental plaque is fluoride reservoir releasing small amounts of fluoride when pH is lowered as we eat

Fluoride is taken up more readily by demineralized enamel than by sound enamel

Fluoride in saliva continuously bathing the tooth in fluoride

Koulorides. J Dent Res 1990;69(Spec Issue):558.

Flu

orid

atio

n B

asic

sHow Fluoride Works Topically



1. Community Water Fluoridation: The Gold Standard

0.7mg/L (ppm): Reduces cavities by 25% Adults and children

2. Closest thing to a Magic Bullet we have

3. Fluoride toothpaste is not a replacement: CWF + TP

4. Fluoride Supplements: Compliance –Terrible!

5. No alternative works as well or is as cost effective as CWF

Are There Alternatives to Water Fluoridation-NO!!



HEALTH BENEFITS OF WATER FLUORIDATION?

“CAVITIES ARE REDUCED FOR ALL”


P.S.-Ya still gotta brush, floss, eat well, get dental checkups, and sealants


YES!

Effect of Starting Community Water Fluoridation: 25% cavity reductions

Effect from Stopping CWF: Huge increases in cavities Calgary, Alberta, Canada-stopped 2011 Cavity rates have skyrocketed 146%

Is Water Fluoridation Still Necessary?

Why do cavities matter?

• Severe pain (toothaches)

• Difficulty in chewing

• Poor weight gain

• Difficulty concentrating

• Predictor of cavities later in life

• Costly to treat

• Deaths

The most common chronic disease for children and teens. It’s at least 2-3 times more common than asthma and obesity, 20 times than diabetes


• Low income kids are more than twice as likely to experience tooth decay

• The disadvantaged bear a disproportionate burden of cavities

CAVITIES: Unevenly Distributed


Operating Room Full Mouth Restorations reduced by 2/3 to 3/4ths by CWF

• U.S. and International studies confirm benefits for children

• CWF decision-makers & Water Operators prevent more cavities by fluoridating the water than all of us can do

(Sources:. An alternative marker for the effectiveness of water fluoridation: hospital extraction rates for dental decay, a two-region study, Elmer et al, British Dental Journal 2014; 216: E10; J. Dental services, costs, and factors associated with hospitalization for Medicaid eligible children, Louisiana 1996-97. Griffin SO, et al, Public Health Dent. 2000 Winter;60(1):21-7; Hospitalizations for dental infections - Optimally versus non-optimally fluoridated areas in Israel. Amir Klivitsky, MD; et al, http://jada.ada.org/article/S0002-8177(14)00115-9/)


Operating Room Full Mouth Restorations reduced by 2/3 to 3/4ths by CWF

(Sources: Centers for Disease Control and Prevention, “Ten Great Public Health Achievements in the 20th Century,” web content updated on April 26, 2013; CDC’s 2014 Fluoridation Statistics; CDC, “Water Fluoridation Basics,” web content updated on June 17, 2016.)

• The CDC has called fluoridation one of “10 great public health achievements of the 20th century.”

Fluoridation reduces tooth decay by 25% over a lifetime — protection beyond what is offered by fluoride toothpaste and other preventive methods.

Over 211 million U.S. residents, 3 out of 4 people on community water systems, have access to optimally fluoridated water.

A (big) ounce of prevention

Variations in tooth enamel (fluorosis)

(Source: Information from the Centers for Disease Control and Prevention’s website, accessed in October 2017 at http://www.cdc.gov/fluoridation/faqs/dental_fluorosis/index.htm)

Normal

Questionable

Very Mild

Mild

Moderate

Severe

Improper use of

fluoride products

Not caused by CWF


Fluoride & Fluoridation:

400 mile view Grassroots view

The Village


The Two Villages

Immediate Challenge:• Timeline-extremely short• Key claims being made• Department of Health• Local, state, and national

group support-healthcare, coalitions

• Key influencers in community

• Faith-based community

Building support for initiation• Timeline-months to years• Key claims being made• Department of Health• Local, state, and national group

support-healthcare, coalitions• Key influencers in community• Faith-based community


The Two Villages

Immediate Challenge:• Timeline-extremely short• Key claims being made• Department of Health• Local, state, and national

group support-healthcare, coalitions

• Key influencers in community

• Faith-based community

Immediate Challenge:• Who will lead?• Who will follow?• Who’s in the sandbox?• It takes a Village


Collaborative project between CDC and KC Industries to Fluoridate the remaining 25% of U.S.

Sodium Fluorosilicate tablets-Standard 60 approved


Johnny Johnson, Jr., D.M.D., M.S.President, American Fluoridation Society

www.AmericanFluoridationSociety.org@AFS_FLUORIDE

https://www.facebook.com/americanfluoridationsociety

Thank You!!

http://www.americanfluoridationsociety.org/

https://www.facebook.com/americanfluoridationsociety

Documents

Building Effective Statewide Teams for FluoridationAmericanFluoridationSociety.org Itasca, IL. March 20-21, 2018. Johnny Johnson, Jr., DMD, MS. Building Effective Statewide Teams for