Oral Health: The Bigger Picture

We all know the one golden rule to abide by at a dinner party; don't discuss sex, politics or religion. 

Well, you should probably add fluoride to that list.  

Vehemently defended by both sides of the fence, the debate has been raging for over 50 years since the majority of Australia's water supply was fluoridated in the 60s and 70s.    

Similarly to the left and right of politics, arguments are delivered with heated conviction. However, among the passion, one inarguable fact is that tooth decay is still occurring at near epidemic proportions in Australia. 

Why? Because we're busy arguing about the wrong things.   

The anti-fluoride campaigners use this as an argument for why water fluoridation is unnecessary. However data shows that tooth decay occurs as close to 30 per cent higher in non-fluoridated populations.[1]  Studies are weighted towards the positive effects of water fluoridation in relation to tooth decay.   

For the pro-fluoride argument this underpins the statement that water fluoridation is one of the top 10 great public health achievements of the 20th century. This is perhaps a US centric view with only 11 countries in the world having more than 50 per cent of the population drinking fluoridated water. The water supplies of nearly all countries in the European Union remain unfluoridated.  

Reasons for the decision not to fluoridate across Europe have included that a medication needs to be applied with proper consent. This is where energy invested into the fluoride argument has been vastly overcompensated.

...medication needs to be applied with proper consent.

Fluoride is a naturally occurring element that is known to change the composition of tooth enamel when incorporated into the tooth structure. For the most part it creates a stronger and more acid resistant tooth surface.   

The dental industry has isolated this phenomenon in a range of applications, one of which is water fluoridation. As a treatment for tooth decay fluoride is effective, there's no denying it. But while arguing how and whether it should be used, we've forgotten that fluoride is a reactive intervention to the rampant presence of tooth decay in modern society.  

Even with the application of water fluoridation in Australia for over half a century, tooth decay is still considered by the Australian Dental Association as one of the country's most prevalent diseases.[2] The problem is that fluoride fails to address the core reason  of why tooth decay occurs: our diet.    

Dental decay has only existed in its contemporary form for about 200 years, or since the turn of the industrial revolution.[3] This is when you can pinpoint the introduction of large-scale delivery of refined grains into our diet.  It's also where our diets transformed from consumption of local produce to the global business that food is today.   

Before this, archeological records show that humans lived for thousands of years without the significant presence of any dental disease.  In the animal kingdom tooth decay is equally rare.  The unsettling reality is that tooth decay is a disease of human civilisation and while fluoride has applications in treatment, it's by no means the silver bullet.   

At the heart of the problem are the bacterial changes in our mouth that occur due to the consumption of simple carbohydrates. This results in the proliferation of certain microbes whose metabolites cause destruction of the tooth surface.  

Fluoride is known to have certain antibacterial actions in the mouth that seem to inhibit some bacteria. However with at least 500-700 species in the mouth,[4] it's unclear how it impacts the entire ecosystem.  Fluoride is a not a cure for tooth decay.     

Yes, we're talking about sugar, which is so insidiously inserted into our day-to-day life, it's near impossible to avoid. Today children grow up inundated with food companies pushing sweetened, processed, nutrient-less food in their faces.  They're available on every corner and many of the foods we consider healthy are laced with added sugar.   

This is only part of the problem. Refined flour finds its way into a large proportion of the Western diet and has the same effect on the bacterial populations of the mouth.  Between added sugar and staples like bread, pastas and cereals, we're flooding our mouths and bodies with substances that we know cause disease. You only need to look at skyrocketing rates of obesity and type-2 diabetes for the systemic results of what may all begin with a hole in our tooth.

Tooth decay as a problem represents a large and complex iceberg.  We can argue all we like about chipping away at the surface with fluoride.  But unless we address the deep seeded and endemic dietary issues that reside in our society, the efforts will continue in vain.  

If there's any common ground to be found in the fluoride argument it's that both sides care immensely about our health.  For the sake of future generations it's time to agree to disagree on fluoride and join to fight the real cause of tooth decay.    

References

1. Armfield JM. Commmunity effectiveness of public water fluoridation in reducing children's risk of dental disease. Public Helath Rep 2010;125(5):655-664. [Full text]
    
2. Tooth decay - Australia's most prevalent health condition. Australian Dental Association 2012. Viewed 1 September 2015. [Website] 
    
3. Adler C, Dobney K, Weyrich LS, et al. Sequencing ancient calcified dental plaque shows changes in oral microbiota with dietary shifts of the Neolithic and Industrial revolutions. Nature Genetics 2013;45(4):450-455. [Full text]
    
4. Dewhirst FE, Chen T, Izard J, et al. The human oral microbiome. J Bacteriol 2010;192(19):1002-5017. [Full text]

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