The Fluoride Debate

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TABLE OF CONTENTS

INTRODUCTION

HISTORY/
ENVIRONMENT

CENSORSHIP

BENEFITS
Question 1
Question 2
Question 3
Question 4
Question 5
Question 6
Question 7
Question 8

ALTERNATIVES
Question 9
Question 10
Question 11
Question 12


SAFETY
Question 13
Question 14

OVERDOSE
Question 15
Question 16
Question 17

DISEASES
Question 18
Question 19
Question 20
Question 21
Question 22
Question 23
Question 24
Question 25
Question 26
Question 27
Question 28
Question 29
Question 30
Question 31
Question 32
Question 33

PUBLIC
POLICY

Question 34
Question 35
Question 36
Question 37
Question 38
Question 39
Question 40

COST
EFFECTIVENESS
Question 41
Question 42
Question 43

CONCLUSION

ALTERNATIVES

Question 9.
Are dietary fluoride supplements effective?

ADA's Fluoridation Facts Short Answer
For children who do not live in fluoridated communities, dietary fluoride supplements are an effective alternative to water fluoridation for the prevention of tooth decay.51, 71-73

ADA's Fluoridation Facts Long Answer
Dietary fluoride supplements are available only by prescription and are intended for use by children living in nonfluoridated areas to increase their fluoride exposure so that it is similar to that by children who live in optimally fluoridated areas.74

Dietary fluoride supplements are available in two forms: drops for infants aged six months and up, and chewable tablets for children and adolescents.12 In order to decrease the risk of dental fluorosis in permanent teeth, fluoride supplements should only be prescribed for children living in nonfluoridated areas. The correct amount of a fluoride supplement is based on the child's age and the existing fluoride level in the drinking water.16, 54, 75 Consideration should also be given to the child's risk for decay and to all sources of fluoride exposure for children. (An excellent source of information regarding decay risk assessment and prevention is the American Dental Association's, Caries Diagnosis and Risk Assessment: A Review of Preventive Strategies and Management12)

Because fluoride is so widely available, it is recommended that dietary fluoride supplements be used only according to the recommended dosage schedule and after consideration of all sources of fluoride exposure. For optimum benefits, use of supplements should begin at six months of age and be continued daily until the child is at least 16 years old.12 The current dietary fluoride supplement schedule is shown in Table 1.

The need for compliance over an extended period of time is a major procedural and economic disadvantage of community-based fluoride supplement programs, one that makes them impractical as an alternative to water fluoridation as a public health measure. In a controlled situation, as shown in a study involving children of health professionals, fluoride supplements achieve effectiveness comparable to that of water fluoridation. However, even with this highly educated and motivated group of parents, only half continued to give their children fluoride tablets for the necessary number of years.76 Independent reports from several countries, including the United States, have demonstrated that community-wide trials of fluoride supplements in which tablets were distributed for use at home were largely unsuccessful because of poor compliance.77

While total costs for the purchase of supplements and administration of a program are small (compared with the initial cost of the installation of water fluoridation equipment), the overall cost of supplements per child is much greater than the per capita cost of community fluoridation.62 In addition, community water fluoridation provides decay prevention benefits for the entire population regardless of age, socioeconomic status, educational attainment or other social variables.11 This is particularly important for families who do not have access to regular dental services.

Repeat of Question 9.
Are dietary fluoride supplements effective?

Opposition's Response

Swallowing fluoride pills is no more effective than drinking fluoridated water. (See Benefits section). There is one advantage — the supplements are made with pharmaceutical grade fluoride, therefore are free of the many contaminants found in silicofluorides.

"Fluoride tablets cause dental fluorosis in 64% of the children. (Pebbles 1974). These same tablets if swallowed provide no protection against decay. If they are chewed and dissolved in the mouth, they do appear to reduce tooth decay. The effect is topical." (David Kennedy, DDS, Aug. 31, 1998.)

"It was later learned that this protection against dental decay was primarily due to the reaction of fluoride in the mouth rather than by systemic routes. During the last 10-15 years there has been a further dramatic reduction in dental decay in several western world countries. This reduction has been a further 40-60%, depending on what survey we read, and has applied in areas with or without water fluoridation." (See 9-1: "The Mechanism of Dental Decay," by John D. B. Featherstone, M.Sc., Ph.D., F.N.Z.I.C., from Nutrition Today, May/June 1987).

Fluoride is not a food supplement like zinc or iron! "Fluorides are officially classified as dangerous drugs even when added to vitamins and may be purchased only on prescription." (Letter by Dr. William C. Black, M.D., Pediatrician, Oct. 4, 1968.)

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First Edition
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