IFIN Bulletin #233: The Real "Oral Health Crisis"

January 26, 2001

In the previous bulletin, we discussed the possible use of xylitol in chewing gum, as a means to prevent tooth decay. While we are excited to learn more about this natural sugar, and the experience Scandanavian countries have had thus far in using it, the focus on xylitol shouldn't overlook a major fact about the cause of tooth decay -- and that is poverty.

Last year, the US Surgeon General released a report titled "Oral Health in America." (See executive summary at http://www.nidcr.nih.gov/sgr/execsumm.htm#execSumm).

According to the report, dental decay is most prevalent today amongst poor and minority communities, with 43 percent of poor children, versus 23% of wealthier children, experiencing tooth decay by the age of 17.

The key reasons why poor communities are suffering from higher rates of dental decay include: 1, lack of dental insurance, 2, poor diets (low in nutrients, high in sugar), 3, the prevalence of baby bottle tooth decay (see footnote below), and, 4, the refusal of most dentists to accept Medicaid eligible patients. According to the US Government, 80% of Medicaid eligible children can't find a dentist who will treat them.

Despite the fact that the cause of the "oral health crisis" is primarily socio-economic in nature, the focus of the US Government in handling it has been to simply push for more fluoridation.

They do so in spite of the fact that most cities in the United States are already fluoridated, and in spite of the fact that most minorities live in urban areas. Take for instance Boston. Despite being fluoridated for over 20 years, the Boston Globe recently reported that the city is experiencing a "dental crisis." According to the Globe,

"With a study estimating that the number of untreated cavities among Boston students greatly exceeds the national average, public health officials are about to launch an offensive against what they say is a growing dental crisis in the city.

Other signs of the crisis include a number of infants from Roxbury and Dorchester with baby-bottle tooth decay, frequent calls to the Mayor's Health Line from people looking for dental care, a decline in the number of dentists serving the neediest patients, and the recent closing of a neighborhood dental clinic.

Things have gotten so bad, public health officials and patient advocates plan to hold a community hearing next month on the oral health needs of Greater Boston, to raise awareness among state legislators and the public" (see http://www.fluoridealert.org/f-boston.htm).

The obvious question that officials need to be asked is, If fluoridation in Boston and other urban areas hasn't prevented the current oral health crisis, why should we believe that it will somehow begin preventing it now? The key point in all of this is that we need to begin stressing that the resort to fluoridation as an answer to the oral health problems of the poor, is a convienent COPOUT -- one that avoids dealing with the substantial socio-economic issues at stake. When the focus is on fluoridation as the answer to good oral health, there is in turn less focus on the need for dentists to accept Medicaid patients, on the need for the Government to provide dental issurance for the poor, and on the need for us as a society to deal with the devastating effects poverty has on people's health - oral and otherwise.

To further abet the obvious, the recent British Government Review on fluoridation (a.k.a. the "York Review"), found, according to the Chair of its advisory board, that "There was little evidence to show that water fluoridation has reduced social inequalities in dental health" (see http://www.fluoridealert.org/sheldon.htm).

Meanwhile, the latest issue of the British Medical Journal contains an editorial written by another member of the York Review's advisory panel, George Davey Smith, a professor of clinical epidemiology. In the editorial, Smith et al. state that "the evidence that fluoridation of drinking water would reduce inequalities in dental health is scanty" (see http://bmj.com/cgi/content/full/322/7280/184).

Despite these facts - despite the current prevalence of fluoridation in minority communities, despite the evidence that fluoridation does not reduce dental health inequalities - the fluoridation program proceeds full speed ahead. Last fall, after spending $500,000, the city of San Antonio, Texas (the largest unfluoridated city in the US), voted yes to fluoridation after voting no twice before in other referendums. In Washington state and Hawaii, efforts are again underway to get mandatory statewide fluoridation, and in the AIDs stricken country of South Africa, mandatory fluoridation has just been approved - no doubt thanks to consultation from US dental "professionals."

Lastly, on a positive note - we just came across a statewide poll done in Hawaii during last November's election. The poll asked students from k through 12 a number of questions, one of which was whether they supported the addition of fluoride to water. The results: 16,546 No to 7,004 Yes (see http://community.hei.com/kvh/).

Paul & Mike Connett

p.s. It also bears noting that fluoridation has been found to be ineffective at preventing a key oral health problem facing poor children -- namely, "baby bottle tooth decay", otherwise known as "early childhood caries." To learn more about this, visit Maureen Jones' summary of the research at: http://www.fluoridealert.org/bbtd.htm.