FRIDAY, Aug. 17, 2001 (HealthDayNews) -- Bottled-water companies should list how much fluoride is in their product; parents should monitor how much toothpaste their kids use, and communities should expand the amount of fluoride in their drinking water.
These are just a few of the new government guidelines released today for this common mineral additive.
For more than 50 years, fluoride has been added to drinking water and been credited with dramatically decreasing tooth decay in this country. Even so, at least 100 million Americans still do not have fluoride added to their water, said the new government report.
Now, prompted by an explosion of products that contain the mineral, the Centers for Disease Control and Prevention (CDC) has issued new guidelines. Fluoride is commonly put into toothpaste, tooth gels, foams and protective coatings for teeth. But because bottled water has become so popular, and may contain unknown amounts of fluoride, the CDC is calling for labeling changes.
"With all these different methods of getting fluoride, it was time for the experts to look at all those methods and make recommendations about who would most benefit from certain approaches and certain methods of receiving fluorides," says Dr. William Maas, director of the CDC's oral health division in Atlanta, Ga.
"The news here is the multitude of choices people now have. 'Should I brush my teeth with fluoridated toothpaste and use a fluoride mouth rinse and drink fluoridated water, and should I go to my dentist for professional treatments?' Those are the choices people have nowadays," Maas says.
Fluoride bonds to the surface of teeth, making them resist decay. The mineral, naturally formed in the environment, hinders the ability of organisms on the surface of teeth to produce acid, makes tooth enamel less soluble in acid and encourages the remineralization of tooth enamel. Studies show that adding fluoride to drinking water -- in the range of 0.7 to 1.2 parts per million -- can slash the number of cavities children get in their baby teeth by as much as 60 percent and can reduce tooth decay in permanent adult teeth by almost 35 percent.
Getting the mineral into drinking water remains the primary aim of the CDC, Maas says. "There's no dangerous amount of fluoride, aside from some cosmetic issues, and we continue to recommend that adding fluoride to municipal drinking water is an efficient strategy to reduce the inequalities in dental disease among Americans."
Despite more than 50 years of community fluoridation programs, most people, particularly in the Southwest, don't have fluoride in their drinking water, Maas says.
"With the migration patterns in this country, it's a very common problem that when a family moves from a fluoridated to an unfluoridated community, they don't often realize it until after they go to the dentist and find themselves with a rash of new cavities," he adds.
Deciding how to use fluoride has become more complicated, Maas says. "Most people are at low risk for dental decay," he says, "and they can maintain that low risk by drinking fluoridated water every day and brushing their teeth twice daily with fluoridated toothpaste."
"For children, however, the message is to make sure that children are receiving optimal fluoride in their drinking water," he adds. "We are reminding people that we are surrounded with multiple sources of fluids that kids are drinking -- like bottled waters and juices -- and most bottled water does not have fluoride, unless it's clearly stated on the label."
"And for children under the age of 6, we are reiterating that parents need to supervise their children's use of toothpaste," Maas continues. "Make sure kids under 6 are brushing every day, but only using a pea-sized amount of toothpaste. If the child ingests too much, they can develop cosmetic marks on their teeth -- white, chalky marks. It's only in extreme cases where too much fluoride causes brown spots, and that's where fluoride is occurring naturally at high levels."
The CDC is also calling for the bottled water industry to use labels to alert customers to the amount of fluoride in their product, Maas says.
FDA regulations already require that bottled water must list fluoride if it has it, says Cindy Yablonski, vice president of research, science and technical affairs for the International Bottled Water Association in Alexandria, Va. "But we do not support additional labeling [for the amount]. There are roughly more than 20 brands of bottled water with fluoride available on the market," she adds.
In 1981, bottled water consumption represented 1.8 percent of the U.S. Liquid Consumption Trends, according to Wheat First Securities. In 1997 that percentage increased to 6 percent. Bottled water sales in the United States bounced up to 13.9 percent in 1999, a $5.2 billion industry, according to Beverage Marketing Corp., a New York-based consulting firm.
The American Dental Association, in Bethesda, Md., heartily supports the use of fluoride.
"Overall, there's been a sizeable decrease in dental decay, up to about 60 percent in the past 20 years," says Dr. Hershel Horowitz, an ADA spokesman and a retired dental researcher for the National Institutes of Health. "And it's largely attributable to the use and availability of fluoride in a variety of vehicles."
Los Angeles only started putting fluoride in the water in 1998, Horowitz notes. That city and many others in California hadn't fluoridated until the state passed laws mandating it. Las Vegas started fluoridation in March 2000.
Horowitz dismisses groups who oppose fluoride in drinking water.
"The use of fluorides has been studied more than anything else used in the medical field," he says. "That research has showed its effectiveness and its safety."
"That safety is borne out in the drop in dental decay in this country," he adds.
The decay-fighting property of fluoride was discovered in the early 1900s when dentists in Colorado stumbled on the fact that not only was naturally occurring fluoride in drinking water causing brown harmless stains on teeth, it was making them surprisingly decay-resistant. After studies showed that smaller amounts of the mineral would not cause staining and were safe, the government began to encourage community fluoridation programs after 1936. The first community water fluoridation program began in Grand Rapids, Mich., in 1945.
What To Do
For more on the government's fluoridation recommendations, see the CDC. And for more on fluoride itself, visit the American Dental Association.
If you'd like to take a look at the whole report, you can read it here.
