Bill Jones doesn’t apologize for sounding like a missionary.
Quite the contrary: When it comes to fluoridation, he readily admits to being a zealot.
Jones and his son have a dental practice in Kalispell.
Earlier this year, he led a successful petition drive that will allow Kalispell voters to decide in November whether fluoride should be added to the city’s public water supply.
“This campaign is more like going to church,” Jones says. “It’s a moral issue. And the reason we’re going to win is because of the type of people we have in this community — there’s an underground of good people who are concerned about the less fortunate.”
Fluoridation — the process of adjusting the fluoride content in water to about one part per million — is considered by the American Dental Association to be “the single most effective public health measure to prevent tooth decay.”
However, many people are strongly opposed to the practice, primarily because they’re concerned about fluoride’s overall health effects, or because they view it as compulsory medication.
Proponents dismiss the health concerns as baseless, and they argue that the benefits to the community as a whole — particularly to disadvantaged groups such as the elderly, the uninsured and the mentally handicapped — outweigh any impact on individual rights.
“I feel fluoride is without risk,” said Kalispell dentist Doug Smith. “In my mind, the only argument (against fluoridation) is individual rights. I respect that, but the government has certain policies to prevent disease — for example, Kalispell adds chlorine to its water — and there’s more dental caries (decay) than any other disease.”
Smith is the only dental anesthesiologist in Montana, and one of only 150 in the United States.
Consequently, he sees the worst cases throughout western Montana — young children or elderly nursing home residents who have to be knocked unconscious because they require so much dental work.
“Every tooth has five surfaces — the top and four sides,” he said. “I work with 2-year-old, 3-year-old, 4-year-old kids, and it isn’t unusual to see 30 or 40 surfaces with decay.
“Many of the kids I see are low income. Most never come in for routine dental care, either because their families can’t afford it or because it isn’t a priority. And there’s no oral hygiene in nursing homes. It’s a disaster. If we had fluoridated water, we could eliminate a lot of this.”
However, opponents say people who want fluoride have a number of alternatives — alternatives that don’t force an entire community to conform.
For example, local school districts offer a voluntary fluoride rinse program for students. Fluoride drops or chewable tablets also are available by prescription, and fluoridated products are on the market as well.
Furthermore, fluoride isn’t a magic bullet. It doesn’t eliminate the need for a good diet, periodic dental care or other factors that contribute to healthy teeth.
“Whether fluoridation works or not, I’m not sure it’s the best way to go about improving dental health,” said Kalispell resident David Brown.
Brown is a patient of Smith’s, and helped build Bill Jones’ house.
Where Jones is a missionary for fluoridation, Brown is a zealot about good nutrition. He’s been studying the subject for 25 years, and frequently distributes nutritional information to the Kalispell City Council.
“I don’t blindly follow the advice of experts where health is concerned,” he said. “I really don’t trust professional organizations. They’re so easily manipulated by special-interest groups — such as the $27 billion sugar industry.”
Brown referred to one 1959 pamphlet on dental health in which a director of the Sugar Research Foundation stated that the goal of that organization’s research into dental disease was “to find out how decay can be controlled effectively without restriction of sugar intake.”
“I think we live in an age where we have all this technology,” Brown said. “A lot of it serves to improve our circumstances, but some of it is damaging, and our ability to assess that damage lags. By the time you establish the negative effects, the technology is firmly entrenched.”
Smith, a frequent target of Brown’s nutritional lectures, doesn’t dispute the benefits of a good diet. He just doesn’t think it’s a total solution to the complex socioeconomic problems that contribute to rampant dental disease.
“If Dave could follow me around for a day, I’d show him why nutrition isn’t the only answer,” Smith said. “There will always be people who don’t do what you tell them to do. Perfect nutrition isn’t the real world.”
Smith’s interest in helping the underprivileged stems from his own background. As a child, he suffered from so many toothaches and earaches that he thought life was all about pain.
“There were times when I cried all night,” he said. “I get calls like that from parents now. Do you have any idea the number of kids who miss school because they’re in pain from a toothache? It’s a routine thing. We can’t keep shutting our eyes to this.”
Fluoridation: How it works
• Dental caries is a disease caused by bacteria that reside in dental plaque. By metabolizing sugars and carbohydrates from our diet, the bacteria produce acids that dissolve the surfaces of teeth.
Left unchecked, the result can be pain, cavities and tooth loss. Occasionally, the disease leads to acute systemic infection.• Fluoride from drinking water or from fluoridated products helps inhibit dental caries — in adults and children — in three primary ways:
First, it reduces the amount of acid that some varieties of bacteria produce.
Second, fluoride makes it harder for acid to demineralize or dissolve the tooth. By combining with other minerals, it creates a stronger that resists decay more effectively.
Finally, partially demineralized areas can be rebuilt using the calcium and phosphate contained in saliva. If fluoride is also present, it can speed up this remineralization process.
• In a July 2000 article in the Journal of the American Dental Association, John Featherstone, head of the Department of Preventative and Restorative Dental Sciences at the University of California-San Francisco, noted that fluoride must be present in the saliva throughout a person’s life for the above processes to provide continuous protection.
“Fluoride incorporated during tooth development (in young children) is insufficient to play a significant role in caries protection,” he said.
Featherstone described dental disease as a kind of ongoing battle between protective factors, such as a good diet and adequate dental care, and destructive or pathological factors, such as a poor diet or too much bacteria in the plaque.
Fluoride can help tip the balance in a positive direction, he said, but it can’t win the war by itself.
“The balance between pathological factors and protective factors is a delicate one that swings either way several times daily,”
Featherstone said. “For the prevention or reversal of dental caries, the sum of the preventative factors must outweigh the pathological factors.”