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LEARNING OBJECTIVES

LEARNING OBJECTIVES. Understand the biologic mechanism of fluoridation Understand the benefits, possible adverse effects and fluoride dosing Understand the community and well water fluoride content issues in SC. COMMUNITY WATER FLUORIDATION.

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LEARNING OBJECTIVES

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  1. LEARNING OBJECTIVES Understand the biologic mechanism of fluoridation Understand the benefits, possible adverse effects and fluoride dosing Understand the community and well water fluoride content issues in SC

  2. COMMUNITY WATER FLUORIDATION Single most effective public health measure to prevent tooth decay CDC has proclaimed fluoridation as one of the ten great public health achievements of the 20th century Fluoridation is a powerful strategy in efforts to eliminate health disparities among populations

  3. COMMUNITY WATER FLUORIDATION Fluoridated water is accessible to the entire community Individuals do not need to change their behavior to obtain the benefits Frequent exposure to small amounts of Fl over time makes Fluoridation effective throughout the life span

  4. Community Water Fluoridation Community public health measure that is cost effective and saves $ The cost of drinking fluoridated water for a lifetime is about the same as the cost of one dental filling For every $1 invested in water fluoridation, $38 is saved in dental treatment costs

  5. Water Fluoridation Reduces decay by 20-40% EVEN in conjunction with Fl from other sources (e.g. toothpaste) 26% fewer cavities in 12 y/o children living in a state with >50% community water fluoridation Healthy People 2010 objective is for 75% public fluoridation; currently @70%

  6. Public Water Fluoridation Stats • United States as a whole • 72.4% • South Carolina • 94.4% • Rank • 9th best!!! • www.cdc.gov/fluoridation/statistics/2008stats

  7. Caries Prevention and Fluoride-mechanism of action Benefit results from (a) uptake of systemic Fl by enamel crystallites during pre-eruptive tooth development & (b) uptake of topical Fl through repetitive demineralization and remineralization cycles in the oral cavity after tooth eruption Fl uptake allows formation of fluorohydroxyapatite (FHA) FHA less susceptible to acid attack than Hydroxyapatite in normal tooth enamel

  8. Dental Fluorosis Caused by excess Fl intake; @ risk 0-8y/o; highest risk boys 15-34 mos; girls 21-30 mos No significant dental risk > 8y/o MILD: chalk-like lacy marking across enamel surface; not readily apparent to casual observer MODERATE: >50% of enamel surface is opaque white SEVERE: enamel is pitted and brittle and may develop areas of brown staining (think of Dr. McKay and Colorado Brown Stain)

  9. Frequency of U. S. A. Pediatric Fluorosis Age 6-11: 40% Age 12-15: 49% Age 16-19: 42%

  10. RDA for Fl 0-6 mos: 0.01mg 7-12 mos: 0.5mg 1-3 yrs: 0.7mg 4-8 yrs: 1.0mg 9-13 yrs: 2.0mg 14-18 yrs: 3.0mg

  11. Fluoride dosing that should not result in more than mild Fluorosis Birth to 6 months: 0.01 mg/day 7-12 months: 0.05 mg/kg/day 12 months to 8 years: 0.1 mg/kg/day 1mg=1ppm 0.7 ppm is 2011 current target water fluoridation dose Community water systems are allowed to provide water up to 4.0 ppm (MCLG; Maximum Contaminant Level Goal) without taking corrective action

  12. Fluorosis True risk not clear re the variables of duration, timing, dose, biologic variability, cumulative dosing of fluoride from non-water sources (toothpaste, food, therapeutic Fl treatments, etc)

  13. Fluorosis The most critical ages of susceptibility are from 0-6 y/o with the highest risk in boys from 15-24 mos and girls from 21-30 months. After age 7-8, fluorosis does not occur because the permanent teeth are fully developed although not erupted

  14. Mild Fluorosis

  15. Moderate Fluorosis

  16. Severe Fluorosis

  17. Fl in formulaProduct/mean ppm +/- 1SD Powdered mild base/0.12 +/- 0.08 Powdered soy/0.16 +/-0.09 Liquid concentrate milk base: 0.27 +/- 0.18 Liquid concentrate soy base: 0.50 +/-0.08 Ready to feed milk base: 0.15 +/- 0.06 Ready to feed soy base: 0.21 +/- 0.01

  18. Fl in Formula Most infants exceed the upper tolerable limit of Fl if formula prepared with 1ppm water @ 0-12 months of age 6-12 month infants unlikely to reach adequate Fl intake if fed ready to feed, powdered, or liquid concentrate reconstituted with <0.4 ppm water No ready to feed formula will exceed the 0.1 mg/kg/day RDA upper tolerable limit True risk of fluorosis not clear re “brief” exposure to formula before switching to regular milk @ 1y What impact does Fl in solid food have on this Fl dose?

  19. Fluoride Content Toothpaste: 0.15% Fl ion (1.5 gm/L); 0.243% NaFl (2.43 mg/L) 5% Dental Fluoride Varnish: 50 gm/L NaFl or 2.26% Fl ion (22.6 gm/L); available in 0.4ml and 0.25 ml volumes in disposable kit form; 9.0 mg of Fl ion in 0.4 ml dish or 5.6 mg Fl ion in 0.25 ml dish

  20. Other selected fluoride sources Bottled water not required to label Fl content; assume sub-optimal content unless fluoride content labeled; the distributor can tell the customer on request Seafood: likely high content Foods/Beverages frequently prepared by manufacturer with community water; may not be included in label Breast milk: very little fluoride

  21. Fluoride content of selected foods ppm 2% milk = 0.04 Wheaties = 0.4 Cherrios = 0.9 Minute Maid OJ = 0.39 Tea = 0.1-0.6 Chicken = 0.06-0.1 Hunt’s Tomato Paste = 0.27 Sardines = 0.2-0.4

  22. COMMON WATER FILTERS Include carafe filters, faucet filters, under the sink filters, and whole house filters In general, the amount of Fl filtered depends on the type of filter, age of filter, working condition, and presence of activated alumina (up to 80% removal) or carbon in filter (generally little removal) Each type of filter needs to be assessed individually

  23. WATER FILTRATION Reverse osmosis filters remove 65-95% of Fl Steam distillation units remove 100% of Fl Water softeners do not remove significant amounts of Fl Consumers using home water treatment systems should have their water tested at least annually

  24. WELL WATER SAMPLES 1/18/10-6/22/11 339 bottles released 170 bottles returned

  25. WELL WATER SAMPLES ppm 1/18/10-6/22/11 0 to 0.69 = 129--76% 0.7 to 1.20 = 13--8% 1.21 to 2.01 = 17--10% 2.01 to 3.0 = 9--5% 3.1 to 4.0 = 1--<1% >4.0 = 1--<1%

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