FIGHT FOR FLUORIDE!

Natalie Dillon
Taylor Mozzone
Abbey Marshall
Colorado Springs

• Fluoride studies began in 1901 by

young dental graduate, Frederick
McKay
• Opened a practice in Colorado
Springs and found the natives to
have grotesque brown stains on
teeth and called it “Colorado brown
stain”
• Dr. G.V. Black came to Colorado
Springs in 1909 to collaborate of the
cause
• It was found 90% of new bourns
had signs of brown stains
Colorado Springs Study Cont.
• McKay and Black found that those teeth afflicted with Colorado Brown Stain
“were surprisingly resistant to decay”
• Black passed away in 1915
• Fast forward to 1923, Oakley Idaho where McKay ventured to meet with parents
who noticed peculiar brown stains on their children’s teeth
• The stains began appearing shortly after Oakley constructed a communal water
pipeline to a warm spring 5 miles away

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• McKay found nothing suspicious in the water and
advised the townsfolk to abandon the pipeline and use
a nearby spring source instead
• Within a few years, younger children were sprouting
healthy secondary teeth without mottling, or brown
stains
• McKay and Dr. Kempf then travelled to Bauxite,
Arkansas in 1931 to investigate familiar brown stains

• McKay tried to analyze the water supply but lacked

sophisticated equipment. McKay and Kempf published
their report which reached the Aluminum Company of
America
• At the time, the ALCOA was investigating and
disputing aluminum cookware as poisonous, and chief
chemist, H.V. Churchill became concerned that the
report would fuel ACLOA’s detractors
• Churchill conducted his own analysis of the water
using a more sophisticated technology that McKay and
found high levels of fluoride in the water
• Churchill contacted McKay and requested water
samples from towns suffering from the brown stain
• Within months, it was confirmed that high levels of
water-borne fluoride caused discoloration of enamel
The study continues
• Churchill’s lab assistant continued to investigate how to test levels of fluoride in water
• In 1945, the city Grand Rapids, Michigan became the first city in the world to allow fluoride to
be added to the public water supply, sponsored by the surgeon general
• This was a 15 year project; just after 11 years, childhood caries dropped 60% out of 30,000
school children
• One of the ten greatest public health achievements!

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Why water fluoridation one of
the top 10 greatest
publichhealth acheivements?

One of the great disease prevention measure of all time,

community water fluoridation, is a nearly ideal public
health intervention because the system has the following
characteristics:
o Inexpensive and cost-effective
o Effective (decrease caries prevalence by
about 50%)
o Eminently safe
o Equitable (i.e., benefits the entire
population on the water system)
o Not dependent on client compliance
(cooperative effort)
o Beneficial as a topical fluoride over the
client’s lifespan
o Instrumental in reducing costs for dental
treatment
o Not dependent on the professional
services of a licensed healthcare provider
(Darby & Walsh 2010)
What do we know
now? Thanks to Dr. McKay

• “Fluoride is naturally occurring

element that is present in many
minerals, water supplies, and food.
Fluoride that is delivered to the
tooth surface and the plaque biofilm
can have a dramatic caries
preventive and reparative effect if
delivered at the right concentrations
(Wilkins page 293)”
• Raw tea leaves, seafood, leafy
greens

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3 Mechanisms of Action

• Inhibit demineralization: fluoride present on the

tooth surface and in plaque fluid inhibits acid
demineralization by reducing the solubility of the tooth
mineral
• Enhancement of remineralization: fluoride
accelerates the remineralization process by adsorbing
to mineral crystal within the tooth and attracting
calcium ions. In addition, fluoride ions incorporate into
the remineralizing tooth structure, resulting in the
development of fluroapatite-like crystals. These
crystals are less soluble that the original enamel and
make remineralized lesions less susceptible to future
demineralization. Fluoride levels in the mouth from
fluoridated water are sufficient to enhance
remineralization. Fluoridated water has primary a
topical effect
• Inhibition of plaque bacteria: fluoride present in
plaque biofilm is taken up by acid-producing bacteria
and interferes with acid production
Fluoride Opposition

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As a Dental
Hygienist
● Our education has led us to become pro-
fluoride advocates
● Patients populations will not always agree and
will present opinions and data of their own
that oppose our professional
recommendations
● Many reasons for opposition:
○ Fluorosis, cancer development,
neurotoxicity, pineal gland calcification,
lack of informed consent
● Always specify to what extent are they are
opposed:
○ Fluoride as a whole
○ Only water fluoridation
○ Only dental fluoride applications
What data is out
there?
● Immense deficit in credible data that reveals
a direct correlation between fluoride use and
many of these systemic claims
● Dentists, doctors, and scientists opposed to
fluoridation in the 1950’s and 60’s, but either
changed their mind or removed themselves
from the debate after boom in pro-
fluoridation research
● In 2000, the most extensive systematic
review of fluoridation by the University of
York revealed that the quality of the fluoride
research from previous decades was dismal
Fluorosis

● Systemic consumption can result in

dental and skeletal fluorosis if
consumed in excessively high amounts
● Consuming fluoride in excess of the
WHO’s recommended upper intake level
of 1.5mg/L
● Calcified tissues become dense and
brittle thus weakening their structure
and leading to discomfort and
decreased function
Other Systemic
Complications
● Cancer, kidney damage, infertility, Alzheimer’s Disease,
Neurotoxicity

● “In the early 1990’s, there was considerable concern

that our intake of fluoride- containing toothpastes
and mouthwashes; it was speculated that this high
intake of fluoride could have been contributing to an
increased risk for cancer, bone fractures, kidney and
other organ damage, infertility, and Alzheimer’s
disease. After reviewing the potential health hazards
of fluoride, the US Department of Health and Human
Services and the National Cancer Institute found
that there is no reliable scientific evidence available
to indicate that fluoride increases our risks for these
illnesses (Thompson, Manore, Vaughan 2014).”

● It is important to discuss this lack of current research with

patients and to recommend they be aware of bias and
credibility in research of their own
Pineal Gland
Calcification
• Pineal Gland, the “third eye” produces melatonin and
regulates the body’s circadian rhythm
• Concern that damage can cause one to become more docile
and easily manipulated
• Calcification of the pineal region is a physiologic process that
occurs throughout life
• Fluoride’s high affinity for binding with calcium - the pineal
gland is a major target for fluoride accumulation in humans
• Possible that calcification could impact sleep cycles as well as
puberty and sexual maturation
– No specific research which proves this can be a result of
fluoride and
– No research to prove any relation to cognitive ability
and manipulation from fluoride’s presence in the gland
Alternatives to Fluoride
No matter how hard we try, there are going to be patients who refuse fluoride. We need to be able to offer them
alternative methods to promote oral health. These include:

- Vitamin D supplements
- Neem
- MI paste

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Vitamin D
● Natural, effective way to promote a healthy periodontium
● Vitamin D aids in the absorption of calcium
● Two main ways we receive vitamin D
○ Sunlight
○ Supplements

● One benefit of fluoride is its ability to enhance

remineralization of enamel. Since vitamin D encourages
calcium absorption, it can also be considered a
remineralizing agent.
Neem

● Formal name: azadirachta indica

● Said to inhibit the growth of streptococcus mutans,
one of the major bacteria contributing to periodontal
disease
● Neem may be recommended to patients for its
antimicrobial properties, however, its role in oral
health is not comparable to that of fluoride.
● More so comparative to chlorhexidine
MI Paste

● Contains casein-phosphopeptide- amorphous calcium

phosphate, or CPP-ACP
● Derived from the milk protein casein and is used as
an alternative remineralizing agent
● Biofilm contains both calcium and phosphate, two of
the building blocks for enamel
● MI paste has the ability to access these components
from biofilm and stabilize them so they are readily
available for our teeth to use during the
remineralization process
● Studies have proven that 1.1% NaF is more effective
in remineralization
Conclusion
• Over a century, the effects of topical and systemic fluoride exposure have been
studied and debated
• Early work of Dr. Frederick McKay and colleagues shed light on naturally
occurring fluoride in water supplies and changes to teeth
– Water fluoridation as one of the greatest public health accomplishments
• There will always be patients who are opposed or misinformed
– Concerned with associated systemic complications
• Alternatives must be provided for protection of the teeth

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References
• Carstairs, C. (2015). Debating water fluoridation before Dr. Strangelove. American Journal of Public Health, 105(8): 1559-

1569. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504307/

• Choudhri, A., Raju, A., & Whitehead, M. (2015). Physiologic pineal region, choroid plexus, and dural calcifications of the first

decade of life. American Journal of Neuroradiology, 36(3): 575-580. Retrieved from

http://www.ajnr.org/content/ajnr/36/3/575.full.pdf

• Darby, M.L., & Walsh, M. 2010. Dental Hygiene Theory and Practice. St. Louis, MO: Saunders Elsevier

• Group, E. (Nov 2015) Global Healing Center. Retrieved from https://www.globalhealingcenter.com/natural-health/the-5-best-

natural-alternatives-to-fluoride-2/

• Kurdi, M. (2016). Chronic fluorosis: The disease and its anaesthetic implications. Indian Journal of Anaethesia Indian Journal

of Anaesthesia, 60(3): 157-162. http://www.ijaweb.org/temp/IndianJAnaesth603157-7090552_194145.pdf

• National Institute of Dental and Craniofacial Research. (2018). Story of Fluoridation. Retrieved from

https://www.nidcr.nih.gov/health-info/fluoride/the-story-of-fluoridation

• Oliveira, G., Ritter, A., Heymann, H., Swift, E., Donovan, T. (Dec 2014) Journal of Dentistry. Retrieved from

https://lmcproxy.lwtech.edu:2482/docview/1626851768/F8218BB35C3E4E05PQ/1?accountid=1553

• Thompson, J., Manore, M., & Vaughan, L. (2014). The Science of Nutrition. Glenview, IL: Pearson

• Wilkins, E., Wyche, C., Boyd, L. (2017). Clinical Practice of the Dental Hygienist. Philadelphia, PA: Wolters Kluwer
Thank you

Any Questions?