The Davis Enterprise on Sunday, in arguing that the addition of fluoride “to our water supply would benefit us all,” cited the US Centers for Disease Control and Prevention, recognizing “community water fluoridation as one of the 10 great public health achievements of the 20th century.” The paper concluded, “It’s time for Davis residents to reap the benefits of fluoride in their water supply.”
The editors of the local paper noted that there has been “considerable debate this summer and early fall about whether fluoride is safe, effective and worth the cost of adding it to Davis’ well water and the water that will flow from the new Woodland-Davis Surface Water Project. We believe it is.”
But, curiously, they cite no scientific studies to support their position.
Instead, they argue, “There’s also been debate about whether Davis needs fluoride, with some opponents downplaying the rate of dental decay among local preschoolers or scoffing at the notion that Davis parents aren’t doing enough to ensure their kids’ health.”
While we agree on this point, we don’t see how that necessitates fluoridation over other approaches.
The paper continues, “Tooth decay is the No. 1 chronic disease among children, says the chairwoman of the Yolo County Health Council’s subcommittee on fluoridation. It causes pain, problems with nutrition, speech issues, lack of concentration, low self-esteem and time away from school.”
They add, “And despite parents’ best efforts, Davis dentists say as many as 25 percent of local preschoolers have untreated cavities. Even with all the advancements in dental hygiene and standards of living over the recent decades, our kids still need help.”
The paper ignores any of the alternative approaches that have been floated, such as mobile dental vans that might do far better at pinpointing the problem and may have a far more profound impact on dental health.
In particular is the concern that, while fluoridation may be placed into the water, unless the intended subjects are drinking that water, it will have little impact. There was no effort by the paper to address this point.
The paper instead moves into the broader issue that everyone benefits from fluoridation, again without citing any scientific evidence.
Instead, they assert, “Fluoride enhances the body’s ability to rebuild tooth enamel when acid-producing bacteria cause it to decay. This new enamel is actually harder and more decay-resistant than the original tooth surface. Fluoride makes it harder for plaque to stick to your teeth. It also makes it more difficult for bacteria to turn sugar into acid.”
This may be true, but it avoids the more critical question as to whether a small amount of fluoride in the water will achieve this goal.
“Is the proposal going before the Davis City Council on Tuesday affordable? According to initial estimates, fluoridation could cost as much as $2 million in initial capital outlay. After that, the ongoing cost would be less than $2 per month per household,” the paper writes.
“With bids on the joint water project required to come in 20 percent below the engineers’ estimate – upon which Davis’ water rates were based – rates most likely will not have to be increased further to pay for fluoridation. In addition, state and federal grants, along with low-cost financing, are expected to further reduce the cost of the water plant project,” they argue. “We believe the cost of fluoridation even at the maximum level is easily absorbed.”
They conclude, “LASTLY, FLUORIDATION is worth the cost. The American Dental Association estimates that for every dollar invested in water fluoridation, $38 is saved in dental treatment, missed work and other costs. Or put another way, a lifetime of cavity prevention can be obtained for less than the cost of one detail filling.
“We urge the Davis City Council to say yes to fluoridating our community water supply.”
If fluoridation did as the Enterprise suggests, we might agree, but they fail to cite evidence to that effect.
Contrast the Enterprise‘s stale approach to that of Alan Pryor, who  in an op-ed cites numerous studies and current evidence to argue, “Today, our environment is assaulted with thousands of man-made toxins, from waste heavy metals and organic compounds in industrial air and water discharges; to pesticides released into our food, land and waterways; to airborne transportation-related pollutants.”
“In addition to damaging our health, these chemicals are damaging our environment in a variety of ways, including contaminated food chains, damaged ecosystems and species extinction. The current proposal to fluoridate Davis’ potable water also has the potential to cause serious local environmental harm.”
Mr. Pryor cites several critical points in his counter-argument.
First, he argues that vast quantities of fluoride will be released into the environment – he calculates about 12 tons. Of that, he argues that “most people drink or consume only about two quarts of water per day. Two quarts of water divided by 168 gallons of water means that the average citizen actually consumes about one-third of 1 percent of all the water that is delivered to our homes each year. That means that of the 24,522 pounds of fluoride that is injected into Davis potable water each year, only about 77 pounds are actually consumed by humans.”
While his concern is where the rest goes, our concern is that this seems to be an extremely inefficient means to deliver fluoride to people. Imagine if we could somehow tap into that $2 million cost to support mobile dental vans that could go to schools and make sure all of our children are receiving proper dental care.
There is also recent research on the toxicity of fluoride that seems to have been underplayed.
Mr. Pryor cites a 2010 review article that concludes: “This element interacts with cellular systems even at low doses. In recent years, several investigations demonstrated that fluoride can induce oxidative stress and modulate intracellular redox homeostasis, lipid peroxidation and protein carbonyl content, as well as alter gene expression and cause apoptosis. Genes modulated by fluoride include those related to the stress response, metabolic enzymes, the cell cycle, and cell-cell communications transduction.” (“Molecular mechanisms of fluoride toxicity,” Barbier O.. Chemico-Biological Interactions: 188, 2010).
He notes, “If our water is fluoridated, all of our fluoride-containing waste water would enter our wetlands and into the Yolo Bypass through the discharge from the Davis wastewater treatment plant. Although there would be a dilutive effect as the fluoride dispersed through the wetlands, it would seem incongruous that we try to invite salmon back to spawn in our local creeks and rivers through proper water management in the Yolo Bypass but then make them fend off the toxicity of the additional fluoride presented in our discharged waste water before spawning.”
In conclusion, Mr. Pryor writes, “Even if fluoride were shown to be effective if ingested compared to the proven efficacy of topical applications as is otherwise recommended, it would be far less wasteful and environmentally harmful and far more cost-effective if pharmaceutical-grade fluoride were made available to at-risk populations through fluoride supplements such as drops or pills.”
Increasingly, from both a health standpoint and a political standpoint, we think that is the way to go. We will see how the council comes down on the issue.
—David M. Greenwald reporting
[quote]it would be far less wasteful and environmentally harmful and far more cost-effective if pharmaceutical-grade fluoride were made available to at-risk populations through fluoride supplements such as drops or pills.”[/quote]
To which they already are available for free.
You bring up the same point every single time. You can’t use the straw man argument on me because I don’t support fluoridation, so I’ll ask you this simple question: why do you believe the sins of the parents should be visited upon helpless children?
” Imagine if we could somehow tap into that $2 million cost to support mobile dental vans that could go to schools and make sure all of our children are receiving proper dental care.”
I agree but tapping into that money is the problem in this scenario.
Besides 5 year olds know how to ride the bus, the could just ask their parents to show them the correct bus route to the dentist office. If their parents won’t tell them then they can ask their teachers. Not only will their cavities be filled but they will escape the “take care of me” mindset so many of our young children have today. That’s the problem with these pre-schoolers today they expect the grown-ups in their life to do everything for them, we are turning them into victims!
“I agree but tapping into that money is the problem in this scenario.”
I was being a little something (pick an adjective) – it would be complicated because we couldn’t use enterprise funds to do this.
Who’s going to make sure that parents are making their children do their homework, not smoking or drinking around them, buckling them up and driving safely, making sure they wear their jackets on a cold day, getting them to bed on time, keeping an eye on them while they are out playing, etc……?
Should we all pay for a live in home monitor for every bad parent?
Your argument is because we can’t do everything, we should do this?
Once again, we are doing something, fluoride is provided for free in communities that don’t fluoridate their water.
In your opinion, that’s sufficient, but not in mine. Since I agree with you on fluoridation, I would think a mobile dental van, much of which we could fund with medi-cal and grants would be a reasonable alternative and acceptable to you.
[quote]Once again, we are doing something, fluoride is provided for free in communities that don’t fluoridate their water.[/quote]
Seriously, if they can ride the bus to the dentist office they could ride it to the pharmacy too…
[quote]I was being a little something (pick an adjective) – it would be complicated because we couldn’t use enterprise funds to do this.[/quote]
I realize that, which makes it the sticky part. As has been brought up numerous times, especially by medwomen, while the anti-fluoride crowd argues adding fluoride to the water is not the most effective use of the money, and I agree, is enough community support/interest in getting something more effective going, or is a bird in the hand better…
[quote]But curiously they cite no scientific studies to support their position.[/quote]
Why would they ? Theirs is an opinion piece just as is yours, You have offered no studies to show that the mobile dental vans ( even if funding were found ) would be more effective, and they would provide service only to a limited population, not the entire community who might desire the service. So, overall, without studies, you really have not demonstrated that this would be a better solution than fluoridation.
Alan Pryor’s piece is advocacy.
To compare an opinion piece with advocacy in a critical manner is a little disingenuous.
[quote]Imagine if we could somehow tap into that $2 million cost to support mobile dental vans that could go to schools and make sure all of our children are receiving proper dental care?
[/quote]
Yes, but we can’t. So what you have done is to have compared what is possible within the next couple of years with that which we cannot and will not choose to pay for and which does not address the needs of the entire community. While fluoride is far from a perfect solution, it is a step in the right direction.
I would much rather see enacted a proven beneficial measure that is imperfect, than no preventive measure which is where this “imaginary solution” will be headed unless someone comes up with a certain, reliable and renewable funding source which I certainly have not seen proposed. Have you ?
[quote]There is also recent research on the toxicity of fluoride that seems to have been underplayed.
[/quote]
Since this issue has been addressed before the WAC, I don’t see how you can consider it to have been “underplayed”. Fluoride occurs in many, many areas of the country and world in much higher levels than are being proposed here without evidence of his speculative “oxidative stress”. Alan’s own quote contains the weakness of his “overplayed” argument.
[quote]This element interacts with cellular systems even at low doses. In recent years, several investigations demonstrated that fluoride can induce oxidative stress and modulate intracellular redox homeostasis, lipid peroxidation and protein carbonyl content, as well as alter gene expression and cause apoptosis. Genes modulated by fluoride include those related to the stress response, metabolic enzymes, the cell cycle, and cell-cell communications transduction.” (“Molecular mechanisms of fluoride toxicity,” Barbier O.. Chemico-Biological Interactions: 188, 2010).
He notes, “If our water is fluoridated, all of our fluoride-containing waste water would enter our wetlands and into the Yolo Bypass through the discharge from the Davis wastewater treatment plant. Although there would be a dilutive effect as the fluoride dispersed through the wetlands, it would seem incongruous that we try to invite salmon back to spawn in our local creeks and rivers through proper water management in the Yolo Bypass but then make them fend of the toxicity of the additional fluoride presented in our discharged waste water before spawning.”[/quote]
The article that Alan is quoting is purely speculative with regard to whether or not these “oxidative stressors” have any real world impact at all. “Stressors” in and of themselves are neither good nor bad. Some may be harmful, some may convey a survival advantage. What you will note is that Alan does not offer is any evidence that there is harm to salmon ( or any other wild life ) from exposure to various levels of fluoride. If we are going to make an evidence based decision, which is certainly what we should be doing, I do not think that speculation should be considered as scientific evidence.
Even the fluoride proponents admit that fluoride works topically rather than systemically. The money would be better spent providing fluoridated toothpaste to the city’s children and providing education on dental hygiene. Of course, if the CC really wishes to do something to address the cause of dental disease and obesity, it would consider restricting sales of sugary drinks to children in much the way that we currently restrict sales of alcohol and tobacco.
B. Nice
[quote]Seriously, if they can ride the bus to the dentist office they could ride it to the pharmacy too… /quote]
Or they could just get you B. Nice to shuttle them or maybe even more logical their parents could buy fluoridated toothpaste at their grocery store. Even bad parents have to eat don’t they?
[quote]The money would be better spent providing fluoridated toothpaste to the city’s children and providing education on dental hygiene. [/quote]
But we can’t use this money for that, where we these funds come from?
[quote]Of course, if the CC really wishes to do something to address the cause of dental disease and obesity, it would consider restricting sales of sugary drinks to children in much the way that we currently restrict sales of alcohol and tobacco.[/quote]
And the federal government could stop subsidizing corn production.
[quote]
And the federal government could stop subsidizing corn production.[/quote]
amen to that!
ebowler
[quote]Even the fluoride proponents admit that fluoride works topically rather than systemically[/quote]
What I have admitted is that regardless of the means of administration, the action of fluoride is at the molecular level. I do not believe that biochemically speaking, the dental enamel reacts fundamentally differently whether the topical application is made by toothpaste or whether it is made by saliva. All drugs work at the local molecular level. This is simply not an argument for which means of administration is more effective.
Davis Enterprise:
[quote]While water bills likely would increase by a couple of bucks each month, if the council OKs fluoride, the city would not have to restart the rate-setting process, as the rates the council adopted in March still would cover the cost of fluoridation.
Water rates set by the Proposition 218 process are the maximum amounts a city can charge residents for water.
[/quote]
So in turn if we decide not to fluoridate should our rates drop from the proposed rates as it sounds like the cost of fluoridation is already baked in on the Prop 218 schedule?
medwoman, on a prior thread you wrote:
[quote]the mechanism of action of ingested fluoride is direct application to the teeth, continuously applied by our saliva.[/quote]
application of a substance directly onto the surface of the tooth is topical application, whether it be via saliva or fluoridated toothpaste
David M. Greenwald said . . .
[i]”I would think a mobile dental van, much of which we could fund with medi-cal and grants would be a reasonable alternative and acceptable to you.”[/i]
One other (better in my mind) alternative would be to have the mobile van arrive at one school or the other each day and dispense dental treatment to students throughout each and every school day. We do that now with immunizations, why not dental treatment? You would have a captive audience of students who would get their fluoride as part of prophylactic dental care rather than simply as drops . . . and the schools could make it a policy that any child who goes through the school year without getting their teeth attended to gets a report card with every course grade as an “Incomplete.”
B. Nice . . .
[i]”Seriously, if they can ride the bus to the dentist office they could ride it to the pharmacy too… “[/i]
Far too passive a public health initiative. See my post above for as true prophylactic alternative solution.
David Greenwald said . . .
[i]”Imagine if we could somehow tap into that $2 million cost to support mobile dental vans that could go to schools and make sure all of our children are receiving proper dental care?”[/i]
medwoman replied . . .
[i]”Yes, but we can’t. “[/i]
If we did it with a roving van at the schools we could add the $2 million to our School Taxes.
Matt:
[quote]If we did it with a roving van at the schools we could add the $2 million to our School Taxes. [/quote]
Yeah, great idea, like our school taxes aren’t already high enough.
[i]why do you believe the sins of the parents should be visited upon helpless children?[/i]
Just curious, what percentage of these people being denigrated as having such lousy parenting skills that they would not ensure that their children brush their teeth and take advantage of the free dental care provide them, are uneducated, English-illiterate, immigrants?
“One other (better in my mind) alternative would be to have the mobile van arrive at one school or the other each day and dispense dental treatment to students throughout each and every school day. “
That was my original thought.
“Just curious, what percentage of these people being denigrated as having such lousy parenting skills that they would not ensure that their children brush their teeth and take advantage of the free dental care provide them, are uneducated, English-illiterate, immigrants? “
I don’t know, but my nephew’s mother doesn’t fall into that category. One of the problems is that we have a meth epidemic in this county and that bleeds into Davis as well. That’s not necessarily an immigrant population.
Here is the way I look at it. If you are poor, uneducated and illiterate and are a parent and you don’t have enough sense to tell your kids to brush their teeth or take advantage of the free dental care, then there are probably a whole lot of things you are doing or not doing that will damage your kids beyond their dental problems.
If you are a meth addict (and probably poor too) are a parent and you don’t have enough motivation or brain cells functioning to tell your kids to brush their teeth or take advantage of the free dental care, then there are probably a whole lot of things you are doing or not doing that will damage your kids beyond their dental problems.
What we are talking about is breaking the cycle of crappy family circumstances so that next generation becomes self-sufficient, well-functioning members of society.
So, how do you do that?
You do it with education.
I would cut out some of the useless junk humanities and the junk science from the public school curriculum and replace it with “Life Skills” classes. Teach kids personal hygiene and healthy eating habits. Teach them how to use a computer and to balance a checkbook and how to prepare a tax form. Provide a class on parenting… and teach them the responsibilities of a good parent so they recognize where their own parents are screwing up their lives.
We spend HOW MUCH money fighting the war on poverty, on hunger… and now this new war on lack of adequate health care? There is also a movement to fight a new war on unhealthy food. We ban plastic bags, and wood burning fireplaces. We move more and more away from an environment of freedom and choice with a population of people having a common tacit sense of morality and personal standards and we try to FIX EVERYTHING about them that we see as inadequate.
This approach is wrong. It is that soft bigotry of low expectations. People, especially children, generally rise to the expectations surrounding them. By attempting to solve all of their problems for them you are training them that this is what you expect. You are, in fact, helping them be locked into the same cycle of poor choice and dependency needing your liberal orthodoxy to help “save” them.
Teach the people to do for themselves and you creating a lasting solution that multiplies because they then teach their children the same.
Teach them that others will do for them what they will not do themselves, and that too will multiply.
Matt and or David
A few questions
1) how are you estimating the actual costs or your proposals ?
2) who is going to purchase and operate the planned dental out reach vans ?
3) how much does each cost to purchase and or lease ?
4) How much does it cost to outfit them appropriately ?
5) How many would be needed to meet the needs of our school children alone understanding that if you are a preschooler or out of school, you derive no benefit .
6) Who do you envision staffing these vans. Who will provide their salary, benefits and malpractice insurance
7) How much to provide and ensure a driver ?
8) And finally what makes you think that funding such a proposal would be acceptable to those in the community who simply have no interest in the community beyond economic factors ?
I could be wrong, but I suspect that given all of these considerations you are unlikely to come in at the same price as fluoridation and are serving a potentially more limited portion of the population all of whom would chose by virtue of drinking or not drinking the tap water whether or not they want to avail themselves of the protective effects of fluoride.
While I do not agree fully with how he frames the issue, I think Frankly makes a useful suggestion about the role of education in dealing with personal health and hygiene concerns. I am NOT claiming that education alone will solve health problems but I think it could help.
I grew up in a rural school district in Eastern PA–a very conservative area of the country. At all levels of education we had life skills training that ranged from dental hygiene to family planning. That’s right, we talked about contraceptives as early as the 6th grade. We were also taught how to handle a gun safely (lots of hunters in our area) and about personal finance. I recall that I learned about dental floss–and how to use it–in school. I took that knowledge home and asked my parents to buy floss (they had no idea what it was or how to use it). I also remember my mom coming home from a PTA meeting at which the introduction of a family planning curriculum was discussed. She was nervous about it but also said something like: “I wish they had done this when I was in school, my mom never talked to me about these things.”
Maybe times have changed. Maybe they have not changed as much as we think. It is not always only the children from “uneducated” families who may need information on these things. The question is whether we value these things enough to include them in the standard curriculum of all students. In Davis, I am doubtful.
As to the idea of “mobile clinics” or other programs talked about here: I have no doubt we could find some funding to create such programs but the rub is ALWAYS going to be how to sustain them over the long term.
[quote]And finally what makes you think that funding such a proposal would be acceptable to those in the community who simply have no interest in the community beyond economic factors ?
[/quote]
Wrong, wrong wrong, that’s so wrong. Many of us in the community have already shown interest by paying our taxes to fund programs like Medicare, Medi-Cal and Obamacare that supply free fluoride for the underprivileged. We just don’t believe that one should have to hold one’s hands to get them to use what is being given to them at the cost of others.
Completely agreeing with Frankly today. Education. Completely disagreeing with medwoman, she’s just being obstinate and her lists of tedious questions are an attempt to disguise it.
Additionally, I agree that the unknowns of where the excess fluorides go, how they accumulate, and to which organisms they will become toxic outweigh some shiny teeth.
Matt: re
[quote]One other (better in my mind) alternative would be to have the mobile van arrive at one school or the other each day and dispense dental treatment to students throughout each and every school day.[/quote]
Spot on, Matt! And if they have free time we could send it to the Senior Center too.
To medwoman:
[quote]Matt and or David: A few questions [/quote]
Councilmember Lee had an intern who has done a thorough analysis of costs of providing the mobile van and running it based on recent experience in Napa/Sonoma. Obviously details of who will operate the equipment and how they would be reimbursed needs to be worked out but based on real world local experience, this CAN be done for less than the costs of water fluoridation and it will almost certainly be more effective in reducing caries ratesfluoridation.