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12. Fluoride in Water

Contributed by:

Dr. Khairiyah Abd Muttalib

Principal Asst. Director, Dental Services Division, Ministry of Health Malaysia.

Fluoride is a nutrient and like many other minerals in the diet, fluoride helps the body to resist disease, in this case, tooth decay. Used appropriately and in the right dosage, fluoride confers phenomenal protection against tooth decay. Fluoride has other intangible effects such as preventing pain arising from tooth decay, which in turn contribute to " wellness " of the individual. Good oral health in turn cannot be underestimated in its contribution to an individual's self-esteem.

The surface of our teeth are at constant risk to acid attacks from foods we eat, and tooth decay is by far the most prevalent and costly of oral health problems. The secret to ensuring round-the-clock vigilance against tooth decay lies in constant bathing of our tooth surfaces with fluoride. What better way to do this than to drink fluoridated water!

What is water fluoridation?

Fluoridation is the process of adjusting the fluoride contest that occurs naturally in a community's water to the best , or optimum, level for tooth decay prevention. The key word in this definition is " adjusting" - fluorine is the 13th most abundant element in nature and is present in all plants, soils, animals and water supplies. Thus a community that fluoridates its water supplies would in effect be simply modifying the amount of fluoride already found naturally to a level that is best for dental health.

Extensive experimental, clinical and epidemiological research undertaken for more than 60 years have attested to the safety and effectiveness of water fluoridation. No other public health measure has had the scientific endorsement and broad base of research which supports its use as dose fluoridation. The legality of fluoridation has been tested and upheld in the highest courts since the early 1950s.

Recommended fluoride levels in water vary with temperature. In cooler climes it can range from 0.8 - 1.2 ppm. In tropical Malaysia, the level of 0.7 ppm (parts per million) was recommended in 1971 by a special committee of inquiry appointed to report upon the fluoridation of public water supply. Cabinet approval for nationwide implementation of the fluoridation programme came in 1972.

1ppm = 1 mg F/litre of water.
This is an extremely small amount.
Think of this compared to other measurements:
1 inch to 16 miles, 1 minute in 2 years,
1 sen in RM10,000.

Everybody benefits from water fluoridation

It is a popular misconception that only children benefit from fluoridation. Several studies have shown that adults living all their lives in fluoridated communities have much less tooth loss and tooth decay. In the days when only natural fluoride was available, it was found that children who grew up in fluoridated communities exhibited about 50 - 60% less decay than those in non-fluoridated areas.

As people live longer and keep more of their natural teeth, the problems of decay on root surfaces are on the increase. With age, roots of teeth are often exposed and vulnerable to decay. The decay-protective effect of fluorides confer a measure of protection against root decay in the elderly. Thus life-long use of fluoride has a greater effect on tooth decay prevention than the approximate 50 - 60% reduction reported for water fluoridation. Because fluoride in water was so successful in preventing decay, ways and mean were studied to incorporate it into many other oral health products such as toothpaste and mouthrinses. Many people even in non-fluoridated areas, receive some measure of protection by virtue of use of these oral health products, as well as the consumption of foods and drinks processed in fluoridated areas.

Why is water fluoridation ideal?

Water fluoridation is effective, safe, inexpensive and practical. When fluoridation of public water supplies was first approved in Malaysia in 1972, per capita cost was estimated at 16 sen per person per year. 25 years later estimates within the government public health services still put it at less than 50 sen per person per year. Put that in perspective to a very simple restoration of, say, RM30.00 at today's estimate. One must remember that restorations are far from perfect. Look around us, at our children in schools, at our young generation at work and play - more importantly, how does one value in dollars and cents the perfect natural teeth or the beautiful natural smile?

Water fluoridation cuts across borders. The entire community benefit from water fluoridation, regardless of a person's age, income, level of education or access to dental care services. Everyone automatically benefits when they drink and consume food and drinks processed from fluoridated water.

Is water fluoridation safe?

The safety of water fluoridation has been studied more thoroughly than any other public health measure with results of clinical, animal and laboratory studies reaffirming its safety. Ironically, one reason for the very large number of studies is because opponents have made so many inappropriate claims and unfounded assertions. Fluoridation has the unqualified approval of every major health organisation in the world. WHO recognised it as a practical and effective public health measure as far back as 1958, and has repeatedly reaffirmed its support. In litigation-conscious USA it gains support from such organisation as the American Medical and Dental Associations, the US Public Health Service, the American Cancer Society, the American Academy of Paediatrics, American Heart Association, the American Public Health Association and the International Association of Dental Research, to mention a few.

Coverage of fluoridation programme

Singapore implemented fluoridation in 1957 and because the water source was in Johor Bahru, the benefits of water fluoridation extended to the local Johor population. Since 1966, the Johor State government spearheaded its own independent fluoridation programme. Following the 1972 government approval for water fluoridation, subsequent expansion of the programme has hinged upon multi-sectoral collaboration between the Ministry of Health Malaysia. the public works department and various water authorities. An estimated 62.6% of the Malaysian population benefit from fluoridated water.

In the region, the municipal water supplies in Hong Kong has been fluoridated since the late 1950s. Globally, as on 31st December, 1989, the International Dental Federation (FDI) reported its member countries as estimating 275 million persons drank fluoridated water that was adjusted, and an additional 300 million drank water with appropriate levels of naturally occurring fluorides.

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