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Dentist opposes removing fluoride from drinking water

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Dr. Kenton Ross has practiced dentistry in Fayetteville for almost 30 years.

He’s helped countless patients maintain healthy mouths over his career, reminding people to floss and brush, and he said a mineral in drinking water has made his job much easier. That mineral is fluoride, which is the ionic form of the element fluorine. It helps prevent tooth decay and stimulates new bone formation. Former governor Mike Beebe made it a mandatory addition to Arkansas’ drinking water in 2011, but its safety periodically comes under question.

“It's kind of come up through the years,” Dr. Ross said. “I really don't understand the anti-fluoride’s approach. There's, I just don't get it. It's one of the things that the World Health Organization, WHO, says is one of the top preventive health benefits of the 20th Century. So, the arguments against it are typically based around people who get too much fluoride. And just like any medication or drug or bluegrass, too much is too much.”

Last November, Arkansas lawmakers proposed two bills that could rework how Arkansas regulates fluoride in drinking water. Senate Bill 2 would repeal the statewide fluoridation program and remove the mandate for water systems to maintain fluoride content. Senate Bill 4 aims to pass the decision to fluoridate water systems on to local communities.

Republican State Rep. Aaron Pilkington co-sponsors the bills along with primary sponsors Sen. Clint Penzo and Rep. Matt Duffield and co-sponsor Sen. Bryan King.

Pilkington said he became dubious about fluoride’s benefits after reading an article in the Associated Press.

“To be honest, I was always pretty pro-fluoride, until this summer, I saw the Associated Press article about the FDA releasing a report that double dose of fluoride is shown to lower IQ numbers,” Rep. Pilkington said. “And so it just kind of, I would say, it made me fluoride skeptical. I was like, ‘Well, this is odd, even though I always have been told it's super safe and, you know, there's no adverse side effects.’ And so I just started digging in.”

Nationally, fluoride’s presence in drinking water became an issue in September when U.S. District Judge Edward Chen ordered the Environmental Protection Agency under the Toxic Substances Control Act to more strictly regulate the concentrations of the mineral in water systems because ingesting large amounts of fluoride may impair children’s intellectual development.

In Judge Chen’s order, he said that the United States National Toxicology Program reviewed 72 human epidemiological studies to consider whether fluoride poses cognitive harm. The NTP concluded that fluoride is associated with reduced IQ in children, at least at high exposure levels at or above 1.5 mg/L, more than twice the recommended limit of 0.7 mg/L.

Discovering a possible correlation between fluoride and intellectual development was alarming, Rep. Pilkington said his skepticism reached a high point when he learned that a majority of European countries don’t fluoridate their drinking water.

“I just started going, ‘Okay, this is, this is odd,’” Rep. Pilkington said. “And then I, you know, it was one of the things I just became extremely skeptical of why we necessarily need to do it. And then Senator Penzo, I believe, called me and asked me, you know, to be a co-sponsor. And I said, ‘Hey, you know?’ I said, ‘You know, I'm always open to be proven wrong on these types of things, but it just seems like I'm not getting very good information.’ So maybe, if we do push this bill forward and go, ‘Well, hey, maybe it doesn't need to be a mandate, you know, maybe we need to live it up to local jurisdictions.’ You know, what can we do? Maybe it is just a better have a local decision. Because I even know, too, like in some European countries, like some have fluoridated water, some don’t. And so I just think it's good to, you know, potentially let them come and make the argument to us. ‘No, no, we need this.’ And if they can't really make an adequate argument, then it does beg the question, okay, then, you know, do we have any controls in place to make sure that we're not double-dosing people with fluoride?”

The American Dental Association responded to Judge Chen’s order, stating that the report does not provide any new conclusive evidence warranting changes in community water fluoridation practices. Dr. Ross said the necessary revisions have already occurred.

“When I started that practice in the early 90s, we had a range of 1.5 to .7,” Dr. Ross said. “That was the best they can control it. Today, water systems, like Beaver Water System here, can dial in exactly where it needs to be. So it's that a therapeutic dose that prevents tooth decay, does not cause discoloration, doesn't harden the bones, or any of the things that get thrown out there, all of those are based on too much fluoride. There are water systems in some parts of this country. In fact, Arkansas played an early part in the story of fluoride.”

In 1931, children in Bauxite, Arkansas, reportedly had brown teeth that were particularly resistant to decay. Dentists theorized this condition was linked to an area’s drinking water, but they didn’t know what exactly was causing it. An aluminum company called ALCOA did most of their mining in Bauxite, leading experts to believe the discoloration was due to the presence of aluminum in the water.

“So the ALCOA was worried that they were going to get blamed for this and some of the efforts that they were doing,” Dr. Ross said. “And so their chemist, a guy named Churchill, actually tested the water with an electro spectrometer in the early 40s, and they found out there wasn't aluminum in the water, it was fluoride, and there was too much fluoride. And so that moved on up through the world, through the National Institute of Dental Research, and they worked to see how do we get the benefits of these brown teeth happened to be resistant to tooth decay. And so they said, ‘Well, how do we get the resistance to tooth decay without the discoloration?’ And it was the dosing that mattered on that. So rather than having 4, 5, 6, parts per million that you might have seen in some of those early well water situations, they got it down to that 1.5 to .7, and now we've got it down to .7 parts per million.”

Fluoride is naturally found in water; we add it to toothpaste and mouthwash. Dentists often apply a coat of fluoride during cleanings. But what does fluoride actually do to your teeth? Dr. Ross explains that fluoride integrates into the structure of our teeth, and it can fill the gap when we lose a calcium molecule with a stronger bond.

“So getting into a little too much chemistry there, but it makes the teeth stronger,” Dr. Ross said. “It makes them to where they're harder to dissolve. The foods that we eat feed the bacteria that naturally live in our mouth. And unfortunately, the rich American diets got lots of sugars in there, and that's a simple food for the bacteria to eat. Well, those bacteria overproduce, and therefore, they produce too much of a waste product– acid. And that acid actually dissolves the calcium out of our teeth, and that's what we talk about when we have a cavity. So fluoride actually makes that dissolving harder to do and makes the teeth resistant to tooth decay.”

There are also two ways we take fluoride into our system. One way is topically via toothpaste or mouthwash. The other is systemic, through means like consuming fluoride in drinking water and absorbing it into our gastrointestinal tract. Dr. Ross said systemic fluoride consumption since childhood positively contributes to the chemical makeup of our teeth.

“It actually gets built into the teeth as the teeth form,” Dr. Ross said. “So from birth on, our teeth are developing layer by layer by layer, and that fluoride gets incorporated throughout the teeth, if it's in the water. Now, what you get at the dentist or from your toothpaste or your mouth rinse that's all being applied on the outside surface. It's not built all the way through the enamel at that point, right? So, it has to happen systemically and topically. So, the topical is repairing the damage that happened today. The systemic is preventing that damage from the inside out.”

JT: For that full preventative effect, they both have to be at play?

“They do to get that full benefit,” Dr. Ross said. “So that you've got fluoride all the way through the tooth, you're going to have a better chance of not getting tooth decay if you had fluoride in the water. The first time this was done was in Grand Rapids, Michigan in 1945 and so what they saw in that experiment, when they were really trying to dial in that right amount, is they saw a 60% reduction in childhood tooth decay. And so that really was a public health breakthrough, that we can take this profession of dentistry that had been a constant repair profession and turn it into a preventative profession and actually prevent the tooth decay in the first place.”

He said dentists are constantly teaching and advocating for preventative oral care. To that point, Dr. Ross and his colleagues at the Arkansas State Dental Association oppose the proposed legislation.

“ I think most of us are dumbfounded,” Dr. Ross said. “You know, how can we not see the benefit that's right there in front of us? To try to prevent tooth decay, dentists work all day long to try to put themselves out of business, to teach people how to take care of their mouths, and to teach them to show them what we see in their mouths, to help them understand possibilities, talk about consequences if they don't, you know, don't know what's going on in there, and then ultimately, let them decide what they want for their mouth. So we see that there's we don't need any more work in dentistry. We need to prevent the problems that are developing out there. And so what I hear universally from my colleagues is that fluoride is beneficial to the practice of dentistry, to our patients that are out there and to the public at large.”

Rep. Pilkington said he hopes this proposed legislation encourages honest conversation about common beliefs.

“Like I said, having to be proven wrong,” Rep. Pilkington said. “But I just don't want to just go with the convention with them all the time, you know? I would say the same about things like processed foods. I think for a long time I thought everything was fine, and then I started reading about these, you know, all these chemicals and food. ‘Oh my gosh, I can't believe stuff. Stuff I'm putting my body and I'm giving my kids to eat and.’ You know? Then you read about how, you know, Europe doesn't do it, and then California bans some of these products, and Canada has too. And you're like, ‘Okay, wait, hold on a second.’ Like, you're like, ‘You know, maybe the conventional wisdom wasn't, you know, accurate,’ you know. And I always put that back to like, smoking, you know. I mean, right? You see, you could see ads from the 1940s or it's like, ‘Doctor recommends this cigarette,’ you know, you're like, ‘Well, that is hilarious.’ That's clearly not the case now, and I don't think it's anything as extreme as that, but I do just think a healthy skepticism, you know, is good, especially when you're mandating cities to do something.”

Oral health is an important and necessary component of a healthy body and life. Rep. Pilkington said he wishes to spur further conversation about Arkansas' lack of dental care by co-sponsoring these bills. He points to Lyon College’s new dental school as a step toward solving a critical issue.

“We need to make sure that we're getting more dentists in Arkansas,” Rep. Pilkington said. “I'm glad that we're providing a dental school, but I think, I think there should be, you know– oral health is very important. And I think sometimes people lean back and go, ‘Well, we fluoridate the water so we're done.’ It's like, that's not good enough. You know, we need to make sure that we have more dentists. Here in Arkansas, we have so many potential dental deserts. It's, it's really a problem.”

Senate Bill 2 and Senate Bill 4 are currently on the deferred bills list and have been referred to the senate’s Public Health, Welfare and Labor Committee and the State Agencies and Governmental Affairs Committee, respectively.

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Jack Travis is KUAF's digital content manager and a reporter for <i>Ozarks at Large</i>.<br/>
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