Dental professionals do much more than examine our patients’ mouths, offer them guidance on proper home care, and restore decayed teeth. Many of us also advise public officials on appropriate policies to improve access and promote good oral health.
For example, history shows that dentists played an extraordinary role in solving a mystery that was truly a game-changer. As we celebrate the 75th anniversary of community water fluoridation this year, let’s remember two extraordinary dental professionals who helped us recognize the crucial role of fluoride in protecting teeth from tooth decay.
Dr. Frederick McKay received his dental education in the northeast, but he traveled to Colorado in 1901 to open his dental practice. He soon became aware of “Colorado brown stain,” the discoloration of teeth experienced by lifelong residents of Colorado Springs or by those who had moved there at a young age. Adults who moved to Colorado Springs did not exhibit this discoloration.
Dr. McKay’s curiosity was enhanced by noticing that people with this stain experienced a far lower rate of tooth decay than people in other Colorado communities. Years later, Dr. McKay suspected that something in the local drinking water was causing the stains. Time and additional research proved him right.
Fluoride exists naturally in all water, even the ocean. Staining and mottling can occur on teeth when its natural levels are unusually high. In the 1930s, another dentist started to build on the foundation of knowledge left by Dr. McKay and others. Dr. H. Trendley Dean, who worked at the National Institute of Health, began a deeper investigation of fluoride. Eventually, Dr. Dean saw the need to test whether a specific level of fluoride in water could reduce tooth decay without imparting stains on teeth.
In January 1945, a series of three studies was launched to test Dr. Dean’s question. The first of these studies paired two cities in Michigan. Grand Rapids was the test city, adjusting the natural level of fluoride in its drinking water to the level believed to be optimal for preventing tooth decay. Over a 10-year period, health investigators found a dramatic drop in the city’s cavity rate. Among 11-year-olds, the number of decayed, missing, or filled teeth dropped by 54%.
Fluoride’s cavity prevention benefit was a crucial discovery in an era when toothaches and tooth loss were something that people took for granted. The Grand Rapids study and similar studies in other cities prompted a number of communities to engage in water fluoridation. Today, more than 201 million Americans on community water systems receive drinking water that is fluoridated.
After 75 years of fluoridation, our mouths (and our patients’ mouths) are much healthier. Fluoridation helped reduce the share of adults in the United States who lost all of their teeth from about one in five in the 1950s to only one in 20.
It’s easy to see why the Centers for Disease Control and Prevention named fluoridation one of 10 “great public health achievements” of the 20th century.Of course, we know that other factors affect dental health, including eating a healthy diet, getting regular dental care, and brushing teeth twice each day with fluoride toothpaste.
Today, fluoride still has some critics, many of whom use social media to spread fear. These critics claim that fluoride is harmful, but they back this claim with research that is flawed, misinterpreted, or irrelevant.
Nonetheless, the public can easily be misled by what critics say. That’s why dental professionals have a critical role to play. Taking just a minute to talk with patients about fluoride is important. These people wouldn’t show up at a dental practice or clinic if they didn’t have at least some level of trust in the people working there.
Raising the topic during a dental visit presents patients with an opportunity to ask a question they might otherwise not ask. Some patients might assume that all brands of bottled water have the right amount of fluoride. Having a brief conversation gives dental professionals a chance to inform them that most bottled water lacks enough fluoride to prevent cavities. The American Fluoridation Society’s website has fact sheets and other resources to support you in this endeavor.
Like vaccinations, fluoride plays a key role in keeping people healthy. And also like vaccines, fluoride is the subject of misinformation online. Let’s celebrate the 75th anniversary by taking a minute during patient encounters to mention fluoride and its benefits through water and toothpaste. Educating our patients is the best way to honor Dr. McKay and Dr. Dean, the oral health pioneers who elevated prevention like never before.
Dr. Johnson is the cofounder and president of the American Fluoridation Society (AFS). As an advocate of community water fluoridation (CWF), he speaks to dental organizations and municipal governments to educate their members about the benefits of CWF and to combat misconceptions and misrepresentations about it. He is an active member of the ADA, the American Academy of Pediatric Dentistry, a Diplomate American Board of Pediatric Dentistry, and other organizations as well. He holds a BA in chemistry from the University of South Florida, a DMD from the University of Florida, and an MS in pediatric dentistry from the University of North Carolina at Chapel Hill. He can be reached at johnny@americanfluoridationsociety.com.
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