My View: Modern-day myth-busting

Goiter is a funny word and a funny name for a not-so-funny disease. In the 1920s, goiter was a lethal disease that plagued 30%-60% of the population, with the Midwestern states being affected at a higher percentage rate. It was such a concern, the U.S. military considered it a national health crisis, accounting for a 30% loss of draftees preceding World War I. So why is goiter a funny name now but a national health crisis 100 years ago? A public health initiative was set into motion and continues to work to this day to prevent goiters from plaguing our society.

A public health approach curtailed a public health crisis with a simple, cheap adjustment to people’s daily diet: ionized salt. A goiter is a swelling in the thyroid gland caused by hypothyroidism due to a lack of iodine in people’s diet. The Midwestern areas like Michigan had the highest rates due to a lack of iodine in the ground water and plants. Thus, when iodine was added to the dietary salt in Michigan alone, it reduced the rate from 30% to 2% in 10 years.

So why am I discussing the history of goiters in a dental journal? Addressing widespread diseases with minimal intervention from a community health perspective is beneficial to all communities. Today, the benefit of a government agency adding supplements to food or water is negated with one viral take on the internet allowing disinformation to overwhelm the scientific knowledge and facts that support the intervention. We all remember the Netflix show about root canals causing breast cancer from a few years ago, and we are all still seeing those effects today. And while water fluoridation is not a new fight to the dental community, it is one that is building steam in our Oklahoma communities.

My least favorite discussion in dentistry is with a patient who has a terminal dentition due to decay. Yes, we could save the teeth with a complete remake in your oral health regimen, or we can remove all the teeth. My patient a few weeks ago was pondering this scenario when she asked what she needed to do to keep her teeth. I recommended a fluoride regimen, in which she at once declined treatment and went on to explain how toxic fluoride was. I am not going to lie — it was hard to keep a straight face as she declined fluoride with her mouth clearly showing the outcome of a zero-fluoride mentality.

The introduction of fluoridated water in 1945 was not the start of water fluoridation in the U.S. Water fluoridation is quite common naturally or organically, and it is also gluten free! It is the 13th most abundant element on Earth available in water and air. We cannot escape it. And when added to water that is lacking it naturally, fluoridation has shown to reduce caries risk by 50% in the general population. Fluoride not only strengthens teeth but also reduces the pH of the oral cavity, limiting bacterial growth. It is shown to benefit children and adults throughout their lifetime, saving financial costs to the patient and improving quality of life.

I know I am preaching to the choir when spouting the benefits of fluoride to an audience of dentists, but the time is now to back up what we know to be beneficial to our patients in our communities. We need to have hard discussions with our neighbors and community leaders about the benefits of fluoride in the water and put at ease the unfounded fears of toxicity. Patients will ignore the talking head on their phones when the dentist who took care of them as a child explains why fluoride is important and why you are an advocate for it. And it is not because we get a big check from the fluoride industry.

It’s because we want to minimize the number of children needing dental care and adults who are going without teeth. Both improve the financial and socioeconomic status of our communities.
 
Community health initiatives have vastly improved the lives of the public with limited cost. In 1998, folic acid was added to the fortified grains in the U.S./Canada after it was noted that women and children did not have enough in their diet. The main concern was neural tube defects in children, causing diseases like spina bifida. Since the introduction of folic acid in 1998, there was a 20%-50% reduction in children born with the disease. Another advantage of additional folate in the diet with B6 and B12 is that it can reduce heart disease, stroke, dementia and Alzheimer’s by checking the production of homocysteine, reducing health care costs for pennies on the dollar.

For a public intervention to work, we need to make sure the public understands why the intervention is necessary. Not to say there are not pros and cons, but when the benefits vastly outweigh the consequences, then it is up to the medical and dental communities to speak up in support for the good of our communities. Water fluoridation is a valuable and necessary benefit to our communities, providing financial and economic gains to Oklahoma.

This editorial, reprinted with permission, originally appeared in the June issue of the Oklahoma Dental Association Journal. Dr. Hamburg is the editor of the journal.