The featured Cover Story of the July 2000 Journal of the American Dental Association (JADA) is a 13 page article authored by John Featherstone, M.Sc., Ph.D., Professor and Chair, Department of Preventive and Restorative Dental Sciences and Department of Dental Public Health and Hygiene, University of California, San Francisco.

If that sounds like a mouthful, it is. And that is exactly what Dr. Featherstone delivers.

Following in the footsteps of 16 other cited articles that he has either authored or co-authored, Featherstone reminds the reader (in this case the dues-paying members of the American Dental Association) that fluoride‘s preventive action is topical rather than systemic.

Before you begin jumping up and down in delight or horror, depending on whether you are an avid promoter of using the public water for mass medication or a modern-day Keeper-of-the-Well, hold your horses.

Featherstone continues to give water fluoridation credit for helping reduce tooth decay __ not because it is ingested __ but because, he states, fluoridated water and other fluoride-containing beverages, foods, and oral care products contribute to the daily topical application of fluoride by bathing the teeth.

In his article, The Science and Practice of Caries Prevention, Featherstone concludes that fluoride is a key agent in battling caries, but that it is accomplished by three principal topical mechanisms of action: inhibition of demineralization, enhancement of remineralization, and inhibition of bacterial enzymes. He notes that remineralization of early lesions also requires calcium and phosphate, which are derived primarily from saliva and plaque fluid.

Featherstone makes it clear, as he has in other publications, that fluoride incorporated during tooth development is insufficient to play a significant role in caries protection. He cites, as an example of the weak pre-eruptive effects of fluoride, a study of two groups of Okinawa nursing students which showed that there was no difference in caries status between those who had received fluoridated water only until about 5 to 8 years of age (and none thereafter) and those who had never received fluoridated drinking water.

“Importantly, this means that fluoride incorporated during tooth mineral development at normal levels of 20 to 100 ppm (even in areas that have fluoridated drinking water or with the use of fluoride supplements) does not measurably alter the solubility of the mineral,” writes Featherstone. “Even when the outer enamel has higher fluoride levels, such as 1000 ppm, it does not measurably withstand acid-induced dissolution any better than enamel with lower levels of fluoride.”

This is not new information to those who have thoroughly researched the issue, nor is it new for Dr. Featherstone to write or lecture on this and many other findings with the same results. Dr. Featherstone was a featured speaker at the 1997 Canadian conference on controlled-dose fluoride supplements at which he reminded representatives of Canada’s dental and medical stakeholders of the reports given at their 1992 conference on the same subject. These reports indicated that ingested fluoride can not raise the fluoride concentration in the glanular saliva sufficient to meet the bacterial challenge present in the oral cavity.

As a consequence of that conference, the Canadian Dental Association no longer recommends fluoride supplements if a child brushes his teeth twice a day with fluoridated toothpaste, and if individual practitioners are determined to increase fluoride exposure for high caries-risk patients in non fluoridated regions, CDA recommends that supplements be used as topical lozenges rather than swallowed.

With a title as all-inclusive-sounding as The Science and Practice of Caries Prevention, it is all too easy to erroneously dismiss its importance by pointing to what was not covered, such as irrigation devices, baby bottle tooth decay, and early childhood exposure to oral infections from primary care givers; yet many readers may be surprised at the introduction of other topics that may warrant further exploration.

Other detractors may be angered by the avoidance of any mention about what constantly bathing the teeth with fluoride will do for total fluoride exposure and the consequences to every other organ and systemic function; but alas the dental industry has no responsibilities in other health arenas, so this publication may never be seen as the appropriate venue for that discussion.

And yes, one topic that is glaring by its omission in a dental discussion is the incidence of dental fluorosis, which has risen to include 66.5% of our children in fluoridated communities displaying the visible signs of fluoride overdose on at least one tooth.

So why is this article so important? Contrary to promotional brochures printed by the dental trade organizations touting the safety and effectiveness of fluoride at virtually any exposure level, previous articles published by JADA warned of high concentrations of fluoride in chicken and other baby foods, and advised dentists to warn parents to restrict children’s consumption of fruit juices because of fluoride pesticide residues. Once again the Journal of the American Dental Association has confirmed that the dental community is not all of one mind, that the portrayal of the oral ingestion of fluoride as magically-effective but never-unsafe can now be corrected by the dental association membership.

It matters not whether Featherstone does or does not have the proof for his contention that 1 ppm in the water flowing past the teeth plays any significant role in caries reduction compared to the 1000 ppm in fluoridated tooth paste. The true question remains: Will an informed public, a deliberative body such as a water board or city council, or health professional with no other axe to grind than the overall well-being of their patient, continue to support the forced everyday ingestion of a substance that is functional only as a topical application?