The Centers for Disease Control and Prevention recognizes community water fluoridation as one of the 10 great public health achievements of the 20th century, ranking right up there with the likes of vaccination and the recognition of tobacco as a health hazard.
But money woes and a tight economy could be making it harder for some water systems in the state to provide the service that has proven to help prevent tooth decay across the country.
Sherry Goode, interim director for oral health with the state Department of Public Health, said most Alabamians — nearly 83 percent — enjoy the benefits of fluoridated water whether they know it or not. Though fluoride is a naturally occurring mineral that could be found in water, when added to water at certain levels, Goode said that it provides significant protection against tooth decay.
But in the past decade, Goode said, 27 water systems have discontinued the service. Of those 27, nine water systems have started back, but 18 have not.
Goode said that unlike some states that mandate by legislation that public water systems add fluoride to their water, Alabama does not.
“Water systems may decide to discontinue fluoridating, which is a concern for the department and the communities.”
A Big Concern
In fact it was so much of a concern that the state’s top doctor, Don Williamson, expressed his concern to the State Committee on Public Health.
He told the members of the committee that the state might be “losing the battle on fluoridation.”
Williamson said that the economy might be causing some systems to decide that it is too costly to maintain the equipment that provides the fluoride, or they have done away with the service all together.
“That’s a problem,” he said.
In the tri-county area, 100 percent of Elmore County residents receive fluoridation and 97 percent of residents do in Montgomery County, according to data provided by the state Department of Public Health. In Autauga County, 76 percent of residents receive fluoride through the tap water that comes into their homes.
There are five counties in the state — Washington, Hale, Cherokee, Bullock and Geneva — that do not currently provide fluoridated water. Goode said that the percentage of fluoridation changes periodically.
Williamson said that while ending fluoridation services might save municipalities and counties some money, it is a drop in the bucket compared to the cost it would create for pub lic health.
A Practical Investment
Providing fluoride services through water treatment isn’t a flashy thing that water boards pat themselves on the back for doing. But Goode said that the cost of fluoridation, which averages about $1 per person, per year, is miniscule compared to the average estimated cost of dental treatment, which is about $38 per person.
“It is a very wise and practical investment,” she said. “A large percentage of families in Alabama do not have dental insurance which may prevent them from accessing routine dental care and place them at greater risk for experiencing dental disease.”
The fluoride treatment that most people in Alabama get through the water that comes into their homes helps drive down the cost of their dental care even if they don’t know it. And Goode said that while there is fluoride in toothpaste and mouth rinses, and fluoride supplements provided by a dentist would all be helpful in the prevention of tooth decay, some of these options are more expensive and not easily accessed by low-income people.
That means if a water system discontinues providing fluoridation services, it might be cutting off the only form of regular dental care some people in the state receive.
Keeping Up The Fight
Dr. John Thornton, a pediatric dentist and associate dean of University of Alabama at Birmingham’s School of Dentistry, said with decades of research backing it up, it is a proven fact that drinking fluoridated water reduces tooth decay by 40 per cent or more.
“When we implemented fluoridation in Alabama and around the country we had a dramatic drop in cavities around the country,” said Thornton, who also serves as a consultant for the Department of Public Health.
Thornton said when a system discontinues the fluoridation service the incidence of cavities, particularly for children who do not have adequate access to a dentist, goes up.
Many of these children don’t have access to a dentist because they don’t live in a community with a dentist, don’t have the ability to travel to a dentist or they simply can’t afford treatment.
Thornton said another challenge is keeping up with which systems are providing the service and which have discontinued it. While water systems have to provide notification if they discontinue a service, it’s usually not front-page news.
Goode said there might be a small notice in the newspaper, or it could be a sentence on a customer’s water bill. Thornton said most people don’t know or don’t care that the service is discontinued because they don’t recognize the value it has for their oral health.
Thornton pointed out that oftentimes the people who make decisions about fluoridation services don’t realize how much impact those services have because most of them visit regularly with a dentist and make sure their children do the same.
Thornton said that good oral health also means better overall health. People with higher incidences of gum disease have higher rates of stroke, heart problems and premature deliv eries. He recently had to point these grim facts out to a water board considering the end of the service for its community. That board ultimately decided not to discontinue their fluoridation program.
But it’s an ongoing battle.
“If we start losing the fluoridation that we already have in the state and around the country, we’re going to start regressing,” he said. “We might not regress to those pre-fluoridation days, but I believe we are going to see more and more children with abscess teeth, and more children going to school with toothaches and not being able to concentrate or eat.”