(CNN)- President-elect Donald Trump appointed Robert F. Kennedy Jr. as Secretary of Health and Human Services and promised to “do a bigger job on health”, making health care a priority on his second term agenda.
Although we don’t know what his policies will be, one of the things Kennedy has indicated is that he will study water fluoridation throughout the United States. He will not be able to take any action until he is appointed and confirmed by the Senate in 2025. But Social Network , “Fluoride is an industrial waste that is linked to arthritis, bone fractures, bone cancer, loss of IQ, neurodevelopmental disorders and thyroid diseases,” he said.
Fluoride is a natural mineral present in small amounts in soil, plants, water and food and helps prevent cavities by keeping teeth strong at optimal levels. Countries take different approaches to ensuring children get fluoride, with some adding it to water, such as the United States, and other countries adding fluoride to milk or salt to maintain recommended levels. Other countries opt for varnishes and mouthwashes provided in schools.
Community water fluoridation was introduced in the United States in 1945 to help improve oral health in a cost-effective and equitable manner. The US Centers for Disease Control and Prevention (CDC) has ranked drinking water fluoridation as one of the 10 most important health interventions of the 20th century in this country, along with vaccination, family planning, and safety in the workplace.
According to CDC data, 72% of the US population will have access to fluoridated drinking water in 2022. This figure varies by state, ranging from 8.5% of Hawaii’s population to 100% of Washington’s population.
Water fluoridation is not mandatory, and although there is a recommended concentration of fluoride in drinking water by the CDC (0.7 milligrams per liter), that level is not a mandatory standard. The decision to fluoridate water is made at the local level and depends on the amount of fluoride naturally present.
There are 36,767 water supply systems in 36 states with public information available on the CDC website, which is a small fraction of the projected number of drinking water systems in the US in 2023, comprising just over a third (37%) of the water systems in the data. Is fluoridated.
It also varies according to the state. In Kentucky, 93.8% of these declared water systems are fluoridated, and at a lower level, only 3.7% of declared water systems in Alaska are fluoridated.
There is also wide variation in the levels of fluoride found in these water systems. Of the 36 states that report fluoride access, not all report concentration levels, limiting opportunities for comprehensive analysis. Of those, 24 states report fluoride levels in 1,774 public water systems.
About 53% of these water systems have fluoride concentrations within recommended levels: between 0.7 and 1.2 milligrams per liter. Less than half of them (47%) have fluoride concentrations below the level recommended by the CDC.
In publicly available data on fluoride levels from water systems, two water systems located in South Carolina reported fluoride concentration levels above WHO guidelines. WHO says long-term exposure to fluoride levels above 1.5 milligrams per liter (mg/L) in drinking water can cause health problems.
Fluoride has long been known to help strengthen teeth and bones; That’s why it has been added to food and tap water for many decades. The CDC believes that community fluoridation is responsible for a 25% reduction in cavities in children. Cavities can cause pain and tenderness, which can affect speaking and eating. These can cause tooth loss or infection that can spread throughout the body, causing serious illness or death.
But at certain concentration levels, fluoride can cause harm. The World Health Organization states that although fluoride reduces the incidence of dental caries, at high levels it has negative effects, such as “prolonged exposure to high concentrations causing dental and skeletal enamel fluorosis ” Skeletal fluorosis is a serious disease that causes weakness in the bones and stiffness and pain in the joints.
Several studies have shown that fluoridated water can help prevent cavities and improve oral health. A 2010 study in Nevada found that living in a community with fluoridated drinking water had a lower incidence of decay or missing teeth. In 2011, the Canadian city of Calgary removed fluoride from its water due to doubts about its benefits and to reduce costs. A later study comparing the city’s children with those in Edmonton, where the water was still fluoridated, found that over three years, Calgary children had more cavities in their baby teeth. This suggests that fluoridated water, without other interventions, was an important source of fluoride for that community.
However, other studies have shown that improvements in oral hygiene awareness and dental practices in general have diminished the benefits of fluoridated water. A recent report concluded that water fluoridation helps prevent cavities, but not as much as originally thought; The authors believe that recent improvements in cavity prevention are due to the popularity of fluoride in toothpastes and mouthwashes.
International figures also confirm this. Worldwide, tooth decay has declined since the 1970s, even in countries where fluoride is not added to water.
Some countries where the water is not fluoridated take a different approach to oral health, with others opting for fluoride-based interventions.
For example, Manchester and Blackpool in the United Kingdom have programs to provide fluoridated milk to local schoolchildren. In the rest of the country, it is estimated that 10% of the population has access to fluoridated water either naturally or through local fluoridation programs.
In Iceland, the water is not fluoridated, but there are fluoride flushing programs in schools across the country. Fluoride rinses are given to school children twice a month.
Japan started a similar fluoride mouthwash program in schools in the 1970s, which has since spread to daycare centers across the country. Research has shown that these fluoride mouthwash programs are most effective in reducing cavities when started at an early age.
In Italy, the Society of Pediatric Dentistry recommends a series of interventions for children, such as brushing their teeth with fluoride-containing toothpaste twice a day and reducing their intake of sugary foods and beverages. People at high risk are recommended fluoride tablets, varnishes, gels or sealants, depending on their age.
However, excessive exposure to fluoride can have adverse effects. A study published in May this year found that high exposure to fluoride during pregnancy was linked to an increase in neurobehavioral problems. And in August, a federal review of existing research found that high estimated fluoride exposure (above the WHO guideline of 1.5 mg/L) was associated with lower IQ in children. These levels are rarely found in the United States.
“Water fluoridation is thought to be particularly beneficial for disadvantaged communities and families who are unable or culturally unwilling to access dental hygiene and dental services,” water researcher and professor John Fawell told CNN in an email.
Fawell, who has advised the World Health Organization on water quality standards, said: “Fluoride below the concentrations that cause dental fluorosis has been associated with a slight reduction in IQ in children in some studies”.
“However, in the absence of a clear mechanism, this does not necessarily remain a causal association.”