We have long maintained that the push for fluoridation is an attempt to deflect from two obvious problems with respect to dental health in America’s children. The first problem, is that America, despite its enormous wealth, provides very poor dental care for children in families of low income. The second is that American kids are getting overloaded on sugar. The latter problem has reached obscene proportions with the introduction of Coke and Pepsi machines into schools.
Even the more honest fluoridation promoters are recognizing that fluoridation can solve neither of these problems, a fact emphatically born out by the high levels of tooth decay among inner city children who live in communities ( e.g. Boston) which have been fluoridated for over 20 years. Moreover, when pro-fluoridation folks are asked to explain why it is that “unfluoridated” European children have just as good, if not better, teeth than American kids, they will mumble something about “socialized medicine”. In other words they recognize that many European governments do a better job of getting health care to the families of low income than we do.
Of all the history associated with the promotion and practice of fluoridation in this country, the two events that stand out as massive pillars of embarassment occurred in 1950. The first was the fact that the mighty US Public Health Service endorsed mass fluoridation of the American people before one single fluoridation trial had been completed and before they had any idea of any long term health effects of dosing every man, woman and child with this toxic substance for a lifetime. The second was the agenda of the Sugar Research Foundation, Inc., an association of about 130 corporations with interests in sugar. In their Seventh Annual Report, they expressed the aim of the research they wished to fund: “To discover effective means of controlling tooth decay by methods other than restricting carbohydrate (sugar) intake” ( quoted in by Waldbott, Burgstahler and McKinney in “Fluoridation the Great Dilemma, 1978, page 310).
52 years later, we are still trying to catch up with these massive misdirections in public policy. We are still having to deal with those who would deflect us from the real issues of tooth decay in America. However, the Health Board of Missoula should be congratulated for refusing to be deflected, as the following articles by Reporter Ginny Merriam from the Missoulian indicate.
May 5, 2002
Officials: It’s time to take a bite out of tooth decay
Health officials say the amount of sugar available to kids during the day, including pop machines in the school hallways, is a leading cause of dental problems.
By GINNY MERRIAM
Too much sugar biggest threat to dental health
Every day at the dental clinic at Missoula’s community health center, about 40 people call in severe pain. They cry. They beg. And most are turned away because of a waiting list that’s 2,000 people and at least a year long.
Every week, the average child eats 7 cups of sugar. Much of that comes through soft drinks and candy that are close at hand in vending machines at schools. One 12-ounce can of pop can deliver up to 12 teaspoons of sugar, along with acid that helps the sugar start decaying the teeth that bathe in it.
This is a connection that could be interrupted, say those who work in public health. And it might be the easiest first attack on Missoula’s severe problems with tooth decay: Deflect the youngster from the pop machine and reduce the long-term problem that piles up as dental crises.
“This is the easiest thing,” said Mary Pittaway, nutrition services supervisor at the Missoula City-County Health Department. “This is one thing we can do at the policy level.”
Sugar is the No. 1 additive in American food, she said. It’s no wonder the results are seen at the dental office and in obesity figures in children, where the numbers of overweight have nearly tripled in the past 20 years.
“The goal is to reduce frequency and exposure,” she said. “That’s the responsibility of adults. And we’re not doing our job.”
Members of Missoula’s Health Board recently heard seven recommendations from the Preventive Oral Health Advisory Committee. The volunteer committee’s members – physicians, dentists, a dental hygienist, nurses, an environmental health advocate and a dietitian convened by the health department’s health promotion director Greg Oliver – met for five months. The recommendation to improve the nutritional content of foods and beverages in high school vending machines brought enthusiastic discussion from Health Board members.
For board chairman Bill Rossbach, the notion had more appeal than community water fluoridation, which would bring political opposition and would reach only 45 percent of Missoula County’s households if done through Mountain Water Co.
“Given the fight we’d have to get 45 percent of the kids’ water fluoridated, I’m not convinced it’s the best use of our resources,” Rossbach said in an interview last week.
However, he said, “There’s multiple factors to this, and one of them is the volume of sugar that we’re purveying to our children.”
Missoula physician Hal Braun, a member of both the Health Board and the oral health committee, likes the “menu” approach of the seven recommendations working together. But Braun, for years a leading cardiologist in Missoula and the first to suggest that cigarette machines in St. Patrick Hospital were inappropriate, also sees sugar as a place to start.
“It’s one of the directions,” he said. “Going for the vending machines and the high-sugar foods is definitely something that should be done.”
The most formidable barrier is big and green: It’s money. Area schools depend on vending machines to fund student activities. And some schools sign exclusivity contracts with soft drink companies that bring extra benefits. In the Frenchtown School District, an agreement with Coca-Cola brought an electronic sign for the high school, said superintendent Peggy Anderson. And vending machine money brought money to the activity fund that bought reflective trick-or-treat bags for elementary school students.
The money directly benefits the students, she said.
“It provides them with additional things that we wouldn’t have without it,” she said. “And that we don’t have to go to the voters for.”
Consider the responsibilities of Brian Fortmann, associate principal and activities director at Big Sky High School. Vending machines throughout the school provide the backbone of the budgets for 30 to 40 clubs and activities.
“They would have to go out and fund-raise,” he said. “And we do a lot of fund-raising anyway.”
The money buys equipment and software for clubs, and it buys transportation. For instance, Big Sky has a policy against transporting students in vans, a practice reinforced by a recent wreck that killed a student from another school. That meant that last week when eight students went to Lewistown to compete in a science fair competition, they had to go on a full-size bus with room for 45. The bus cost $1,500. If the students had to raise the entire bus fee with bake sales and car washes without help from vending machine money, they probably couldn’t go. Big Sky students have won first place in the contest six years running.
“The school would survive, no doubt about that,” Fortmann said. “But it would be just another place where we would have to do some belt-tightening.”
In addition, he said, the school’s contract with Pepsi brings extra benefits, like refreshments at school functions and the scoreboard in the new stadium.
“Pepsi bought us that $15,000 to $20,000 scoreboard,” he said. “They want our business. And we appreciate it.”
Fortmann supports healthy choices in foods and drinks, but he’s not sure students would buy them. When he was a student at Big Sky in the early 1980s, the school had vending machines with fruit and juices and other healthy foods. His predecessors tell him the items didn’t sell.
“I don’t think we’re in disagreement in what we should be offering,” he said. “But in order for kids to purchase them, we’d almost have to take away the other choices.”
On that, the jury is still out.
Joy Huber, a University of Montana graduate who’s working toward a graduate degree in dietetics, surveyed students at Hellgate High School about their food choices in December 2000. Working with interns as a volunteer at the health department, Huber gathered 947 responses from distributing 1,363 surveys.
“The thing that struck me the most from the survey,” she said in an interview last week, “is that the students really want healthy choices.”
Last spring, Huber and the interns worked with the school on the logistics of putting in a refrigerated vending machine and stocking it with the most-wanted items in the survey: yogurt, chocolate milk, deli sandwiches, fresh fruit, bagels and cream cheese and juices. Huber and the interns raised money from local contributors to buy the machine.
It worked for three months.
“Right now, our refrigerated vending machine is sitting in the lunchroom at Hellgate, unplugged,” she said.
Its problem, she said, was that it required constant stocking by the lunchroom staff, who also had to order the foods. Unlike nonperishable foods serviced by vending companies, milk expires, and deli sandwiches have to be made every day.
The enterprise was labor-intensive, said Paulie Homer, supervisor of food and nutrition services for Missoula County Public Schools.
“Stocking it was a problem because they wanted everything in it to be fresh,” she said. “It was just becoming too hard to do it. It took constant upkeep because the foods have a short shelf life.”
In the past three years, the food program has grown by 120 meals a day, she said, but the staff is the same.
They also found, she said, that many of the items did not sell, despite what students said they wanted in the survey. The staff threw away quite a bit of expired milk, for instance.
“My staff relayed to me that it wasn’t as beneficial as they thought,” she said.
The school lunch program already serves many healthy foods at lunch in its a la carte program, she said. So the machine’s appeal was mostly after hours, when the volume is not high enough.
“We don’t mind helping them at all,” Homer said. “The biggest problem with healthy choices in the machines is getting them to buy them. That’s the biggest problem. Healthy choices are one thing. But if they don’t eat them, you haven’t done anything.”
Huber would like to see a club or activity or group of adults take on the offering and stocking of machines with healthy choices in schools.
“It’s frustrating,” she said. “It’s hard to know what to do about it. I do know that we can’t just be apathetic about it anymore. It comes back to bite us all. It should be the responsibility of all of us.”
The long-term health effects of too much processed foods turn up throughout the health care system, said Pittaway. As empty calories replace calories from whole foods, nutrients are lost, she said. For instance, as young people, especially girls, replace milk with soda pop, the level of calcium intake goes down. A recent bone screening of seniors at UM found that 25 percent of the college-age women showed signs of osteoporosis.
“They’ve never even built up to their optimum bone mass,” Pittaway said. “And those girls drank milk.”
Teens today drink three times more pop than 20 years ago, consuming twice as much pop as milk. A 20-ounce bottle of Coca-Cola contains almost 17 teaspoons of sugar. The U.S. Department of Agriculture says that per-capita soft drink consumption has increased almost 500 percent over the past five years. Fifty-six percent of 8-year-olds drink soft drinks daily, one-third of teen-age boys drink at least three cans a day, and on average adolescents get 11 percent of their calories from soft drinks.
Missoula dentist Lori Aleksic, who said she can tell when a patient has grown up with water fluoridation or fluoride treatments by the low level of decay, said that consumption shows up in the mouth. Processed foods and pop foster decay by beginning to break down in the mouth. Whole foods don’t break down until they’re farther along the digestive tract.
“The more processed the foods are, the sooner they start to break down,” she said.
The foods also tend to be stickier, clinging to the teeth.
The issue extends beyond the schools, she said. Adults, too, need to look at the kinds of foods Americans eat and the drinks they drink.
“If you want to blame somebody,” she said, “blame corporate America.”
Pittaway suggests Montana could look to other states, such as California, which has written nutrition standards for schools that involve students in the decisions.
Christine Emerson, director of School Nutrition Programs at the state Office of Public Instruction in Helena, said the only regulations governing Montana are federal. The USDA dictates, for instance, that “foods of minimal nutritional value” can’t be sold in the cafeteria areas at lunchtime. OPI encourages schools to write policies on nutrition standards.
“We’re encouraging healthy options so the schools have a choice,” she said. “But we have no legislation.”
Ryan Huckeby, the half-time dentist at Partnership Health Center, said he and the six regular volunteer dentists and Missoula’s oral surgeons and endodontists who do volunteer work in their offices are “maxed out.”
“Most of the children I see, they don’t need just one or two little cavities filled,” he told the Health Board. “They need most of their teeth pulled. And they’ve been living in pain.”
Health department director Ellen Leahy said the department is not going to let go of working on the dental problem, and sugar consumption education is a good place to start. Many public health issues that once seemed hopeless are now standard, she said – car seats, seat belts, drinking and driving, bicycle helmets, secondhand tobacco smoke control. Leahy remembers a time when improving Missoula’s air quality seemed hopeless.
“At first it seems daunting and impossible,” she said. “But then it happens.”
Health educators can be the catalysts for change, she said. But the people who make change happen are citizens who care. And adults have to change their habits too.
“You really do have to take the long view,” she said. “It takes years.”
Reporter Ginny Merriam can be reached at 523-5251 or at email@example.com.
April 19, 2002
Health board rooting out tooth problem
By GINNY MERRIAM
Of the Missoulian
MISSOULA – Young people should eat no more than a cup and a half of sugar each week. But the average American child gets 7 cups, much of it in soft drinks that he buys from his school vending machines, nutrition specialist Mary Pittaway told the Missoula Health Board on Thursday.
Tackling that problem may take less time and require less political argument than community water fluoridation in an attack on Missoula’s severe tooth decay, Health Board members said.
While studies have found that water fluoridation can reduce tooth decay by as much as 50 percent, board member and chemist Garon Smith said the evidence pales when compared to the effort it would require.
“I’m just saying if we have to put our efforts somewhere,” he said, “I’m guessing that our time will be better spent on the other things.”
Both community water fluoridation and improving the nutritional content of foods offered in school vending machines were among seven recommendations of a group of specialists who met for the past five months as the Preventive Oral Health Advisory Health Committee. They included physicians, dentists, a dental hygienist, nurses, an environmental health advocate and Pittaway, who is the Missoula City-County Health Department’s nutrition services director.
The committee’s work is finished, and the Health Board will consider its recommendations in moving forward against Missoula’s severe oral health problem.
Instead of making headway against decay and disease, Missoula is losing ground, said dentist Ryan Huckeby. Huckeby began work last July as the half-time dentist at Partnership Health Center, Missoula’s community health clinic. When he began, the waiting list stood at about 1,500. Now, it’s about 2,000. More people began calling when they learned the clinic had hired a dentist.
Huckeby typically gets 40 calls a day from people in dental pain, he said. He is able to see two or three emergencies, working them in around people who have appointments after waiting one to two years.
The six regular volunteer dentists and Missoula’s oral surgeons and endodontists who do volunteer work in their offices are “maxed out,” Huckeby said. The dental clinic’s receptionist is often emotionally broken down.
In 2000 in Missoula, 7,287 children were eligible for Medicaid-paid dental care. Only 1,368 children through age 17 received that care. Dentists say they can see only limited numbers of Medicaid patients because of the low rates paid for the care, at cost or below for most dentists.
“We’re not meeting the needs of the community,” Huckeby said. “A lot of these people are waiting in pain for one to two years.”
In what the U.S. Surgeon General calls “a silent epidemic,” 80 percent of the dental decay in permanent teeth in children 5 to 17 occur among 25 percent of the children. Missoula mirrors those numbers, the oral health committee writes in its report. Decay is concentrated in households where the incomes and levels of parental education are low and where there is often no dental insurance. Among low-income children, the report says, almost 50 percent of tooth decay is untreated.
“Most of the children I see, they don’t need just one or two little cavities filled,” Huckeby said. “They need most of their teeth removed. And they’ve been living in pain.”
Missoula health and human services specialists have wrestled with the problem during the past few years. Two years ago, the Health Board heard an afternoon of testimony from people who were unable to access dental care and people who worked with them.
Among the suggestions the oral health committee includes in its report is bringing the dental care to the children who need it. That could mean lobbying to increase the state’s Medicaid payments to dentists and providing a mobile dental van that could visit schools.
Missoula’s 2nd District Dental Society members are unconvinced that such a van could be more helpful than simply putting the money that would pay for it toward hands-on dental care, said dentist Lori Aleksic, a member of the oral health committee.
Missoula children could also benefit from tooth sealants, varnishes and oral fluoride treatments, the committee said. Education of parents and of students in schools could also help. Linda Simon, elementary school nurse for the Missoula Public Schools District, is the nurse for 5,000 children in 14 schools. Working with just two assistants, Simon can’t put dental education at the top of her list of priorities, she said. When she and her staff make presentations, they’re well received by students and teachers, she said.
“My guess is there are a lot of kids out there with unmet dental needs,” she said. “What we see is just the worst cases. We see it at schools all across the board, not just the reduced-price-school-lunch schools.”
Pittaway made a vivid presentation to the board using plastic bags of sugar to illustrate the committee’s recommendation that healthy foods replace the soft drinks and other low-nutrition, high-fat foods in school vending machines. A 20-ounce bottle of Coca-Cola, she said, contains almost 17 teaspoons of sugar. The average adolescent boy drinks three cans a day. American youths drink twice as much pop as milk.
“All of the high schools in Missoula are now covered with vending machines,” she said. “Most middle schools have them and many grade schools. All the foods are high sugar, high fat, low nutrition.”
The dental van, the vending machines and tooth varnish programs seem the top priorities, said Health Board and oral health committee member Beth Metzgar. While community water fluoridation is endorsed by nearly all medical authorities, including the U.S. surgeon general, it presents challenges in Missoula, said Missoula physician Hal Braun, also a member of both the board and the committee. Even if Mountain Water Co. cooperated with a program, its wells supplies water to only about half of Missoula’s children.
And, Braun said, “We do know there is going to be a vocal and flamboyant opposition.”
Missoula environmental health advocate Bryony Schwan, also a committee member, earlier this spring presented research that questions fluoridation’s safety and effectiveness. The evidence, Schwan said in an interview Thursday, says that fluoride works better to prevent tooth decay when it’s applied to the teeth than when it’s consumed in water.
Among the papers she presented to the Health Board was one by New Zealand dentist John Colquhoun, who was once an ardent advocate but now worries about fluoride’s health effects and effectiveness.
“It absolutely convinced me that water fluoridation is not the way to go,” Schwan said.
The Health Board and health department director Ellen Leahy will continue to look for funding to find a community health specialist to implement the dental recommendations.
“Of all the health problems there are and all the funding problems, there are some we’re not going to let go of,” Leahy said. “The dental issue, we’re not going to let go of it.”
Reporter Ginny Merriam can be reached at 523-5251 or at firstname.lastname@example.org