Local health professionals have proposed what they say is a cost-effective way to treat tooth decay before it starts – add fluoride to the city of Buffalo’s drinking water. But, the city is looking at cost and concerns that too much fluoride isn’t healthy.
At a July 7 Johnson County health board meeting, Janet Berry, a community oral health coordinator for Johnson and Sheridan counties, and Dr. Mark Schueler, a physician at the Johnson County Healthcare Center, suggested that Buffalo look into fluoridating its water. Schueler also encouraged fluoridation at the Buffalo City Council meeting July 21.
Johnson County has the highest rate of untreated tooth decay in the state, according to a 2010 study by the Wyoming Department of Health. The state average for untreated tooth decay is 27.24 percent. Johnson County almost doubles that at 41.54 percent. According to Schueler and Berry, the low level of naturally occurring fluoride in the area’s water is a contributing factor to tooth decay.
Fluoride occurs naturally in varying amounts. In Gillette, there was once too much fluoride, and the city had to combine different water sources to bring the fluoride down to the optimal level of 0.7 parts per million, according to Berry.
But adding fluoride to the communal water supply can be a contentious issue, as it was for Sheridan, Berry said. Berry fought for five years to have fluoride added to that city’s water supply before she succeeded. Sheridan has been using fluoridated water since January.
Opponents of fluoridation have two main concerns, Berry said – health risks and consent.
Berry said there are some health choices that the health community is best able to make, like immunizations, for the betterment of the community. And she said there really isn’t a health risk when it comes to fluoride in drinking water. As a result, education about the safety of fluoridation has been one of her main concerns for years, she said.
According to Berry, some people worry that once fluoride is in the water, people will be in danger of overdosing, particularly on hot days, or that athletes, who tend to drink more water, will be at risk. But overdosing is not possible at 0.7 parts per million, Berry said.
“You are getting just the right amount, no matter how much you drink,” Berry said. “You can’t drink enough water to get too much fluoride – you can’t do it, at that level.”
The health community in the U.S. is in accord with Berry. Fluoridated water is used by 75 percent of the U.S. population, Berry said. The American Dental Association, the U.S. Public Health Service and the World Health Organization all agree that fluoridated water prevents tooth decay, according to the ADA’s executive summary on the issue.
What is fluoride?
Fluoride ion is a naturally occurring compound, found in all food and water at various concentrations, according to the ADA. The ideal amount for drinking water is between 0.7 and 1.2 parts per million, Schueler said.
Under a microscope, Berry said, enamel looks like a net or a sponge. Consistent fluoride washes remineralize the enamel. An early cavity that hasn’t penetrated the enamel can actually be sealed off by fluoride, preventing the formation of a cavity that burrows into the core of the tooth, Berry said.
“Your tooth is the only thing in your body that doesn’t repair itself,” Berry said. “But fluoride can.”
Why do it?
Berry has been an oral hygienist for 10 years, the last five in public health, and she is adamant that tooth decay is preventable. It is a disease that is expensive to treat, hits the poorer communities harder and can affect the overall health of the body, Berry said.
“I really felt strongly, because in my job, doing what I do, trying to treat the disease and trying to educate is a piece of it, but it’s not enough,” Berry said. “Some of these kids were not getting their fluoride. When I have a child that is 2 years old with severe decay and has to go into surgery – I’ve had that a lot.”
The biggest selling point for fluoride is the benefit to children, Berry said. From birth to age 12, when children’s teeth are still developing, fluoride makes the enamel, the thin veneer on the outside of the tooth, harder and stronger, Berry said. For children, there is a dual benefit to having fluoride in the tap water. Every time they take a drink of water, they are washing with fluoride, providing a topical treatment, and they are also benefiting from a systemic application, Berry said.
But adults, and particularly the elderly, benefit as well. The elderly may have the same level of consistent cleaning that younger adults do, Berry said. With fluoride in the water, they are getting a topical fluoride treatment every day.
Why not to do it
Though the annual cost to fluoridate the water in Buffalo would likely be modest, the cost to overhaul the system, Berry admits, will cost the town money.
Rob Young, operator at the Buffalo Water Treatment Plant, says the undertaking would be significant.
“We don’t want to see fluoride,” Young said. “We would have to put in a whole new system.”
Buffalo currently adds three components to its water. The first is bleach.
“We use certain chemicals to clean it (the water),” Young said. “We have an onsite generator, and we make 1 percent bleach. We put that in for disinfection.”
The city also adds phosphate, which limits corrosion of the pipes, and a polymer, a coagulant to collect dirt or debris.
But, the idea of adding fluoride doesn’t sit well with Young or the other operators at the plant.
“None of the stuff we have is really harmful – well bleach is, but we keep it at such a low does and we have alarms in place,” Young said.
Fluoride, Young said, is too harmful. If the operators overfeed chlorine, it wouldn’t be disastrous, Young said. If they added too much polymer or phosphate, it wouldn’t harm anyone. Fluoride, Young said, could be dangerous in an overdose.
What will Buffalo do?
In Buffalo, naturally occurring fluoride hovers around 0.03 parts per million, barely registering and far below the amount needed to promote healthy teeth, Berry said.
Schueler said in speaking with Buffalo’s dentists, he found that even though less tooth decay may mean less business, the dental community is behind adding fluoride to the water.
Mayor Mike Johnson said he was interested in the proposition but would need to hear feedback from the community before anything was decided.
Schueler’s presentation to the council was a preliminary step in bringing the fluoride discussion to the table, Johnson said. But he said he found the statistics surprising.
“We want to get some public input,” Johnson said. “And we want to get some costs – both the cost of the material and operational cost that requires additional monitoring.”
Johnson added that people had valid concerns about the health issue, but he encouraged the public to come to the council meetings, to call city hall and be a part of the dialogue.
“Virtually anything will hurt us in enough of a quantity,” Johnson said. “People have legitimate concerns for sure. Hopefully, they will get those concerns to us before we make a decision.”
The council has no set date for a second discussion about flouridation. But Johnson said he hoped that by the end of October, the council will have heard from enough constituents to make a decision.