Five Fast Facts on Fluoridation from the Science Moms of Fluoride Exposed

The following is a unique guest post from two accomplished scientists (and moms). I hope you enjoy it.

What is the government really up to putting fluoride in the water?  Are dentists part of a mass conspiracy?

We are two science moms, Effie Greathouse, Ph.D. freshwater ecologist, and Kylie Menagh-Johnson, MPH public health educator, and we say yes – a conspiracy to strengthen enamel and prevent caries!

Today, we’ve got five fast facts about fluoridation and oral health for you:

1) Fluoridation works together with fluoride toothpaste.

The baseline recommendations from the U.S. Centers for Disease Control’s oral health section, as well as other science organizations like the American Dental Association and the American Academy of Pediatrics, is to brush twice a day with fluoride toothpaste (a pea size for adults, a small pea size for kids 3-6 years old supervised by parents, a rice-grain smear for kids under three years old) and drink fluoridated water.  Brushing with fluoride toothpaste twice a day makes fluoride available to teeth for topical mechanisms of counteracting demineralization, while also counteracting gum disease via the mechanical action of brushing.  Fluoridated water delivers fluoride to saliva to counteract demineralization topically throughout the day in between brushing, and it strengthens kids’ developing teeth, too, prior to eruption.

Periodic table showing fluoride

Fluorine, the element from which fluoride comes from, is located on the periodic table next to oxygen

2) The recommended level for fluoridated water is now 0.7 parts per million (ppm).

In 2015, the U.S. Public Health Service (USPHS) reviewed and updated the recommended level of fluoride for community water fluoridation.  Based on a review of the science by a panel scientists from environmental, agricultural, and health agencies, USPHS determined that the previous climate-based range for fluoridation (0.7– 1.2 ppm) could be changed to a single level for the whole country (0.7 ppm).  After addressing hundreds of unique public comments, the new level was published in the Federal Register and Public Health Reports and became official.

3) At both the new and the old recommended levels of fluoridation, rates of severe dental fluorosis are nearly zero.

Severe dental fluorosis – the kind that involves pitting and brown stains – is seen at very high levels of fluoridation. This rate of this adverse effect – when studied by the U.S. Environmental Protection Agency and a 2005 panel commissioned by the National Academies of Sciences – is nearly zero when fluoride levels are below 2 ppm.  So there’s no severe fluorosis associated with the new level of 0.7 ppm or the old level of 0.7-1.2 ppm.  Mild fluorosis does occur below 2 ppm, but it consists of white spots and markings that are often only noticeable to dental professionals and not to the general public.  Mild fluorosis will decrease with the move to the single 0.7 ppm level.

dental fluorosis caused by levels far greater than the CDC recommendations.

Severe Dental Fluorosis. The amount of fluoride needed to produce this defect is FAR greater than the levels recommended by the CDC. Photo courtesy Dr. Nicholas Calcaterra at Calcaterra Family Dentistry.

4) Fluoridated water is not just for kids.

Most of the studies of fluoridated water – especially historically – have looked at prevention of cavities in kids.  But in recent years, there’s been much interest in how fluoridated water prevents decay in adults.  A 2007 meta-analysis of 20 studies of fluoride and fluoridation effects on adult teeth points to the importance of fluoride for preventing cavities among adults, including root cavities.

5) Fluoridation of drinking water is one of 10 great public health achievements in the 20th century named by the U.S. Centers for Disease Control and Prevention.
Surgeon General Dr. Richard Carmona.

Surgeon General Dr. Richard Carmona was involved in declaring fluoridation as one of the top 10 public health achievements.

Fluoridation ushered in a new era of prevention in dentistry.  The development of all modern fluoride products – including fluoride toothpaste – built on the initial classic public health measure of fluoridation.  And the result was a dramatic decrease in cavity rates from the 1950s to the 2000s.  The other public health achievements with which fluoridation ranks include vaccines, motor vehicle safety, workplace safety, and tobacco control.  CDC judged fluoride and fluoridation to be right up there with seat belts, worker’s compensation, refrigerators, and cigarette ad bans for promoting health and wellness.

Those are five quick facts about community water fluoridation.  Our non-profit website is Fluoride Exposed. From oral health to public health, from drinking water treatment to chemistry, from geology to nutrition, and everything in between, we use real science to expose all the facts about fluoride and fluoridation.

If you’d like more fluoride facts, check out our articles and features on the Fluoride Exposed website.  We’re also up on social media at Twitter and Facebook, you can sign up for the Fluoride Exposed newsletter, and we have a custom T-shirt you can get to support the non-profit, and show off the 10 great public health achievements, including fluoridation.

Webmasters note: I am very selective on guest posting and linking to other sites. I was happy to publish this unique article and then link to Fluoride Exposed because of the scientific and non-profit nature of Effie’s and Kylie’s site.

Dental MythBuster #2 – Diet Soda is Better for My Teeth?

Dental MythBuster #2 – Diet Soda is Better than Regular Soda for my Teeth.

Another common dental myth that I see nearly every day in practice in Orange, Connecticut is the notion that drinking diet soda is better for your teeth than non diet soda.  Frequently when I see a new patient with a lot of decay (a.k.a tooth cavities), both my dental hygienists and I discuss the dietary factors that influence decay.  While many people with cavities will admit to a sweet tooth or drinking lots of coffee with sugar, others will try to say “well I don’t understand why I have cavities because I only drink diet soda now.”  

The most accurate way to describe diet soda with respect to your oral health is as follows:

Diet soda is only marginally less destructive to your teeth than regular soda.  Frequent, daily consumption of either diet soda or regular soda will significantly increase the likelihood of dental cavities.

Soda vs. Regular Soda - both will cause tooth cavities for the dentist

In a previous blog post on Sports and Energy drinks, I wrote that dental decay was caused by sugary foods and acidic foods.  In the case of regular soda, you are ingesting sugar in an acidic liquid.  With diet sodas, there is no sugar, but the artificial sweetening is still being delivered in a very acidic mixture.  The acids in soda first weaken and then ultimately begin to wear away the tooth enamel.  Enamel is the hard outer layer of the tooth; without it, your teeth have little to no protection.

Differences between Diet Soda and Regular Soda on Teeth

As mentioned above, both acidic and sugary foods and drinks will cause dental decay.  We know that regular soda contains sugar.  I won’t bore you with the math, but on average, there are the equivalent of about 10 teaspoons of sugar in a typical 12 ounce can of soda.  Most sodas these days contain high fructose corn syrup but the distinction between high fructose corn syrup and sugar is not important for this blog post.  The key difference is that regular soda has large quantities of sugar while diet soda does not.  So when it comes to sugar content alone, diet soda is actually better for your teeth.

But what about acidity? There is lots of research on this topic.  In a widely cited 2007 study by the Academy of General Dentistry, the pH of Regular Coca Cola is 2.52.  Compare that to Diet Coke which has a pH of 3.28.  I won’t bore readers with chemistry here, but pH is a logarithmic measure of how acidic a liquid is.  A lower pH means greater acidity. Stomach acid has a pH of approximately 1.5 to 3.5.  Tap water has a pH of 7.  A key point to remember when you’re drinking diet soda then is:

Both diet and regular sodas are only slightly less acidic than stomach acid!

That’s very acidic!  If you’ve ever experience heartburn (GERD) you know the acidity of the stomach.  But what about the difference in acidity between Coke and Diet Coke? That can be best be summed up in the graph below:

Alt Text

Graph showing the percent weight loss of tooth structure by type of Soda.  From the Academy of General Dentistry, March/April 2007

I included this graph from the same Academy of General Dentistry showing the percent weight loss of teeth immersed in different sodas for 48 hours.  A tooth immersed in Regular Coke for 48 hours would have 6% of its mass dissolved away, while that same tooth immersed in Diet Coke would lose “only” 1.5% of its mass.  Note that for 7 Up, the percent weight loss does not vary significantly between regular versus diet.

So what does this all mean? It is worth repeating what was stated in bold earlier in this post, which is:

Diet soda is only marginally less destructive to your teeth than regular soda.

Frequent consumption of diet soda will place you at increased risk for dental decay, resulting in the need for dental fillings. And if the decay is not treated in a timely fashion, you could end up needing crowns, root canals, or even having the tooth or teeth extracted, requiring dental implants!  Keep that in mind next time you reach for that Diet Coke or Diet Pepsi.

Thanks for reading, and stay tuned for the next Dental MythBuster in a couple of weeks.

Gatorade Versus Red Bull

Is Red Bull four times worse for your teeth than Gatorade?

Nearly every day, I get questions from patients in practice about the effects of diet on dental caries (a.k.a teeth cavities).  I can’t think of an instance in all my years as a dentist when a patient was not aware of the relationship between sugar intake and tooth decay.  Nearly all patients are aware of the harmful effects of regular soda on their teeth.  Many patients ask me if diet soda is better than regular soda (it is only marginally better and still very destructive – that will be addressed in another blog post).  But very few patients have ever asked me about sports drinks and energy drinks and the effects on their teeth.

Sports drinks like Gatorade cause tooth decay requiring fillings from the dentistSports drinks became first commercially available in the late 1960s after the University of Florida’s athletic teams achieved improved performance after consuming a beverage with high concentrations of carbohydrates and electrolytes.  The electrolytes include potassium, sodium, and others lost during rigorous physical exercise.  Not surprisingly, sports drinks such as Gatorade include large amounts of sugar designed to fuel the athlete.

Energy drinks like Red Bull cause tooth decay requiring fillings from the dentistEnergy drinks came to the United States in the late 1990s but did not become popular until approximately 10 years later when large marketing campaigns were launched around these beverages.  Energy drinks contain significant quantities of caffeine in addition to sugar.  They are being marketed not just for athletic performance but also for other uses including weight loss, stamina, and concentration.  Energy drinks are frequently associated with the “toxic jock identity” in adolescent males.  Like sports drinks, they are very acidic.

Like it or not, sports and energy drinks are very popular in the United States.  One study showed that 30% – 50% of adolescents and young adults in the U.S. consume energy drinks regularly.  Marketing for the various brands such as Gatorade, Red Bull, 5-Hour Energy, Powerade, and others ensure that the names are becoming nearly ubiquitous. Just recently, Red Bull sponsored Felix Baumgartner’s free fall record as chronicled in this article.  I routinely see patients in this age demographic consuming energy drinks.  I suspect many readers of this blog consume these drinks as well.

So what does all of this mean with respect to dental care, teeth and cavities? The short answer is that both sports and energy drinks have destructive effects similar to sugary soda (Coca Cola, Pepsi, Mountain Dew, etc.).  This is because of the high sugar content in the drinks as well as the acidity.  Acidic foods and drinks dissolve the protective enamel coating on all teeth, weakening them and making them susceptible to decay.  Sugars are used by specific bacteria (S. Mutans, as seen in this recent blog post) as food.  When these specific bacteria consume the sugar, they produce acids that cause cavities.

So this brings us to the big question, which is:

Energy drinks vs. Sports drinks: which are worse for your teeth?

Energy drinks are on average four times worse for your teeth than Sports drinks. This is based on a research paper by the Academy of General Dentistry. I won’t go into the fine details of how the researchers reached their conclusion.  But on average, energy drinks require four times the amount of “dilution” from saliva to get your mouth back to normal. Or stated another way, your oral cavity has to work four times harder and longer to neutralize the teeth destroying effects of an energy drink than it does for a sports drink!

Tips on reducing teeth cavities from Sports and Energy Drinks:

  • Minimize your consumption of them.
  • Do not brush your teeth directly after consuming one as your brushing action will wear away the weakened enamel.
  • Attempt to either rinse your mouth out with water or drink milk directly after.  The milk will help to neutralize the acidic effects of the drink.
  • Do not sip one throughout the day.  You will be bathing your teeth in a constant supply of acid and sugar. If you are going to drink sports and energy drinks it is best to drink them more rapidly.  However, consumption of highly-caffeinated energy drinks quickly can lead to very high blood levels of caffeine with possible fatal side effects.  Just another reason to avoid them!
So which is the worst energy drink?  The answer is Rockstar which is almost five times worse for your teeth than Propel Grape, a popular Sports Drink.

Like it or not, sports and energy drinks are here to stay.  Whether you are a dentist in Orange, CT like me or work in another health profession or are a frequent consumer of these beverages, you should be aware of the risks to not only your teeth but also your overall health.  With proper knowledge, you can consume them sensibly and safely.