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The Centers for Disease Control and Prevention (CDC) ranks Kentucky as the state with the second highest missing teeth rate, falling only a few percentage points behind West Virginia.
In an effort to promote better dental health, in July 2007 the Kentucky Cabinet for Health and Family Services began encouraging physicians to administer topical fluoride varnish to the teeth of Medicaid-eligible children through age 4. Studies show the fluoride varnish helps prevent early childhood caries (tooth decay) in young children. The application of fluoride varnish at a child’s first birthday or first tooth eruption will help reduce future disease and lessen the occurrence of decay.
Often referred to as baby bottle tooth decay, decay in infants and children can destroy the teeth. It occurs when sweetened liquids such as milk, formula and fruit juice are left on an infant’s teeth for long periods of time. The sugar becomes food for bacteria in the mouth, producing acids that attack the teeth.
The American Dental Association recommends the following to prevent tooth decay in infants.
Fluoride is a naturally occurring mineral found as a constituent of minerals in rocks and soil. When rainwater flows over and through the rocks and soil containing fluoride, it dissolves the compounds, resulting in small amounts of soluble fluoride in water sources. In most areas, this small amount of fluoride is not enough to provide dental benefits, so communities add more fluoride to public water supplies in a process referred to as fluoridation.
“Most of the water that Americans drink contains the recommended amount of fluoride.”
“Most of the water that Americans drink contains the recommended amount of fluoride.”
According to the CDC, fluoride from many sources prevents tooth decay. Fluoride can be applied directly to teeth through toothpaste, mouth rinses, professionally applied fluoride treatments (such as the fluoride varnish mentioned above) and dietary supplements prescribed by a dentist, physician or other health professional. The widespread availability of fluoride via water fluoridation, toothpaste and other sources has resulted in the steady decline of dental caries throughout the United States.
Although some people oppose fluoridation of drinking water, it is endorsed by the American Dental Association, the American Medical Association and the World Health Organization, as well as numerous other prestigious medical organizations.
Despite its benefits, fluoridation can be harmful if overdone. A March 2006 report from the National Research Council found that the U.S. Environmental Protection Agency’s standard for the maximum amount of fluoride allowed in drinking water, 4 milligrams of fluoride per liter of water, is too high. At concentrations of 4 mg/L, children are prone to develop severe tooth enamel fluorosis, a condition that causes loss of enamel, discoloration and pitting of the teeth.
In 1962, the Public Heath Service recommended that public water supplies contain between 0.7 and 1.2 milligrams of fluoride per liter in an effort to help prevent tooth decay. Most of the water that Americans drink contains the recommended amount of fluoride (0.7 to 1.2 mg/L).
According to the CDC, Kentucky ranks number one among U.S. states with 99.8 percent of its population receiving fluoridated water. A few rural areas do not have community water fluoridation, but fluoride dietary supplements can provide fluoride to those who do not have adequate levels in their drinking water.
To find out whether one’s drinking water is fluoridated and at what levels, check with the local water supplier.
For more information, or to make an appointment with a UK HealthCare physician, please call UK Health Connection at 800-333-8874.
Fluoride works primarily after teeth have erupted into the mouth. It is most critical for infants and children between the ages of 6 months and 16 years to be exposed to the proper levels of fluoride. In children, when teeth are still forming, fluoride helps to make tooth enamel harder and more resistant to acid and thus decay.
“Fluoride . . . is most critical for infants and children between the ages of 6 months and 16 years.”
In an effort to ensure that children get the proper levels of fluoride, primary care pediatricians at UK under the leadership of Dr. Kimberly Northrip and with the support and assistance of the UK Division of Pediatric Dentistry have begun applying topical fluoride varnish as part of well-child visits to help deal with the issue of so many Kentucky children with early childhood caries.
Adults benefit from fluoride, too. Topical fluoride from toothpaste, mouthwash or fluoride treatments from the dentist not only helps strengthen teeth as they develop but also helps repair tooth decay in early stages before it becomes visible.
As the research on fluoride in the water indicates, fluoride can be hazardous at high doses. However, fluoride is very safe and effective when used as directed. The optimal level of fluoride in the water is 0.7 to 1.2 parts per million.
The report also recommends drinking water contain no more than 2 mg/L of fluoride to protect against cosmetic dental effects linked to excess fluoride consumption. However, even at this level, less than 10 percent of the population experiences cosmetic effects. The cosmetic effects of excess fluoride range from slightly noticeable white streaks or spots to more noticeable brown discoloration. Known as fluorosis, these defects are most often associated with high levels of naturally occurring fluoride found in well water.
Fluoride is a mineral that occurs naturally in foods and water. It is also often applied directly to the teeth in the form of toothpaste or mouthwash that contains fluoride. When you visit the dentist, you may get a fluoride treatment in the form of a gel, foam or varnish. Fluoride helps to prevent the development of cavities.
Throughout the day, an acid is formed in your mouth from sugars and plaque bacteria. That acid can cause tooth decay by breaking down the enamel layer on the teeth, a process called demineralization. Our mouth fights tooth decay with minerals such as fluoride and calcium in our saliva. These minerals are deposited, in a process called remineralization, on the teeth, making them more resistant to acid attacks by interfering with the bacteria’s ability to adhere to teeth. The fluoride from saliva is incorporated into the enamel and makes a stronger crystallite.
Proper fluoridation of community water supplies increases the amount of fluoride in our saliva and in turn the fluoride interferes with bacteria sticking to teeth resulting in stronger enamel and teeth that are more resistant to bacteria. If your community water does not contain fluoride and if your children have a history of tooth decay, I recommend parents buy water with fluoride in it. If children do not have a history of dental decay, then with proper dental health (dental checkups, proper dental hygiene and limited sticky sugary snacks) purchasing water with fluoride is not necessary.
For children under the age of 1, we recommend breast milk as the number one choice for feeding. If a child is formula fed, you should not use tap water, but rather bottled water with no fluoride added.
Similar to a well-baby visit, a child should come for their first dental visit at age 1. The dentist will help teach parents what they should know to help their child prevent cavities. We may also recommend a fluoride varnish at that time to help prevent tooth decay.
At the UK Division of Pediatric Dentistry we have children age 2 to 4 that we have to take to the operating room to have multiple teeth crowned. Typically, it is for a combination of reasons including inappropriate feeding, poor oral hygiene and little or no access to preventive dental care.
To prevent tooth decay, parents should begin flossing their children’s teeth as soon as the child has back teeth that touch. This could be as early as age 3. In children, the most significant action you can take to prevent tooth decay is to brush at least 2 minutes twice a day. Children over the age of two should use fluoride toothpaste while children under 2 years of age should use non-fluoride toothpaste. Always choose a toothbrush with soft bristles, as the hard bristles can be very damaging. As long as the plaque is removed, both manual and electric toothbrushes are good. I recommend replacing your toothbrush every three to four months.
Food intake also becomes very important to prevent tooth decay in children. Try to limit sugary snacks to mealtime only. The most damaging kind of snack is sticky and sugary, such as gummy bears, raisins and dried fruit. If your child eats these types of snacks, bite-size is best. It is also important to limit juice to four to six ounces per day.
Dr. Mathu-Muju is a pediatric dentist and an assistant professor of dentistry at the UK College of Dentistry. Her interests include public health dentistry.
Each issue of Advances & Insights summarizes an important piece of medical news, accompanied by commentary from a UK expert.
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