On the long list of cavity culprits, soda pop and sugary fruit juices rank high. Now public health officials are pointing the finger at bottled water.
By itself, water does not cause cavities. But a recent report from the U.S. Centers for Disease Control and Prevention says bottled water has become so prevalent in children’s diets it often entirely replaces fluoridated tap water, leaving kids more vulnerable to cavities.
One-fourth of U.S. children between the ages of 2 and 5 have had decay in their baby teeth, and half of kids between 12 and 15 have had cavities, according to the CDC.
“Soda is worse. Let’s be clear about that. It has sugar and is carbonated, which creates acid that wears away the enamel,” says Dr. Jarvis Chan, an adjunct professor at the University of Texas Dental Branch at Houston. “But if you aren’t getting fluoride through water, you are missing out on decay-preventing benefits.”
Fluoride is naturally occurring in some spring water.
Where absent, most major U.S. cities have adopted fluoridation programs, adding small doses of fluoride to water supplies — usually between 0.7 and 1.2 parts per million, Chan says.
Houston’s water supply is fluoridated to 0.7 parts per million, but many suburbs and rural areas with well water sources do not have fluoridation.
According to CDC statistics, the per-capita cost of water fluoridation over a person’s lifetime is less than the cost of one dental filling.
A series of surveys by the CDC-sponsored task force on Community Preventive Services found tooth decay in children ages 4 to 17 dropped 30 percent on average when fluoride was added to water supplies.
On its Web site, the CDC cites fluoridation as one of the major reasons that cavities have been on the decline since the 1960s and calls it one of the 10 greatest public health achievements of the 20th century.
But for the first time in decades of decline, the trend of tooth decay in both children and adults appears to be going in the opposite direction.
A recent CDC report analyzed data from two six-year periods, from 1988 to 1994 and from 1999 to 2005. Researchers compared the number of small children between the ages of 2 and 5 and found the instances of cavities in baby teeth increased to 28 percent from 24 percent.
Four percentage points may not sound like much, but it represents tens of thousands of children who have at least one cavity in their baby teeth.
Dr. Rodney Rayburn, a family dentist in southwest Houston, says the bottled-water issue isn’t new.
“I remember talking about this in dental school in the late 1970s,” he said. “Back then it was primarily the rich people who were setting up those five-gallon Ozarka stations in their houses. They were getting cavities. Today it’s just more prevalent because the bottles are seen as so convenient.”
According to the International Bottled Water Association, the U.S. market has more than doubled in the last decade. In 1997 Americans drank 13.5 gallons of bottled water per capita. In 2007 it was 29.3 gallons.
Not everyone is a fan of fluoride.
The Internet is abuzz with theories demonizing fluoride, linking it to everything from Down syndrome to mind control. Several Web pages cite Harvard research linking water fluoridation to bone cancer, but Elissa Miller, a spokeswoman for Harvard Medical School, says there have been no peer-reviewed journal articles out of Harvard that make that link.
There are prominent groups giving pause to fluoridation, though.
The National Research Council issued a statement saying high levels of fluoride in drinking water might be linked to hypothyroidism, and it needs further study.
The American Dental Association has issued a warning against using fluoride-infused water to mix up baby formula. The ADA warns that infants can get too much fluoride, causing dental fluorosis, a discoloring of the teeth with either white streaks or brown stains.
Chan of the UT Dental School says he doesn’t worry about children getting too much fluoride through drinking water, but does advise parents to supervise how they brush their teeth until the age of 7.
“Use a pea-sized amount of toothpaste and make sure they spit it out,” he says. “Many children use too much. Houston’s water has about 0.7 parts per million in it. Fluoride toothpaste has 1,100 parts per million.”
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A comment posted at the end of the article by NYSCOF [New York State Coalition Opposed to Fluoridation]:
Here’s the study that Harvard spokesperson says doesn’t exist:
Cancer Causes Control. 2006 May;17(4):421-8.
Age-specific fluoride exposure in drinking water and osteosarcoma (United States).
Bassin EB, Wypij D, Davis RB, Mittleman MA.
Department of Oral Health Policy and Epidemiology,
Harvard School of Dental Medicine, and Clinical Research Program, Children’s Hospital, USA.
OBJECTIVE: We explored age-specific and gender-specific effects of fluoride level in drinking water and the incidence of osteosarcoma.
METHODS: We used data from a matched case-control study conducted through 11 hospitals in the United States that included a complete residential history for each patient and type of drinking water (public, private well, bottled) used at each address. Our analysis was limited to cases less than 20 years old. We standardized fluoride exposure estimates based on CDC-recommended target levels that take climate into account. We categorized exposure into three groups (99% of target) and used conditional logistic regression to estimate odds ratios.
RESULTS: Analysis is based on 103 cases under the age of 20 and 215 matched controls. For males, the unadjusted odds ratios for higher exposures were greater than 1.0 at each exposure age, reaching a peak of 4.07 (95% CI 1.43, 11.56) at age 7 years for the highest exposure. Adjusting for potential confounders produced similar results with an adjusted odds ratio for males of 5.46 (95% CI 1.50, 19.90) at age 7 years. This association was not apparent among females.
CONCLUSIONS: Our exploratory analysis found an association between fluoride exposure in drinking water during childhood and the incidence of osteosarcoma among males but not consistently among females. Further research is required to confirm or refute this observation.