Fluoride. Friend or Foe?

One of our patients came in the office just the other day and asked me whether or not I was in favor of fluoridated water. The patient happened to be a millennial and she was very concerned about her children and the potential complications with the use of any prescription level medication. This is an interesting question and is not without political intrigue so therefore I thought it might be the good subject of a blog.

When I was at UCLA School of Dentistry in the early 70s my epidemiologist instructor Dr. Serene (a great name for a dentist) was very much involved in the fluoridation of public waters.  In fact he was the lead researcher involved with the first fluoridated water project ever in the United States on the east coast in the 50's and 60's.  Because he was my instructor at a very formative age I obviously took his opinion very seriously.  However, my clinical group director Dr. Janette had what I consider the best answer to any question regarding the use of prescription level fluorides.  He was a clinical dentist and his comment whenever asked was something along the lines of, "when you get a cold, you take cold medicine.  You don’t take cold medicine if you don't have a cold.  If you have cavities, you take cavity medicine.  Cavity medicine are fluorides."  I believe to this day even with all the ups and downs of the use of publicly fluoridated water Dr. Janette's comment is the most accurate.  Children and older adults that have cavity issues should be on prescription level fluorides and we prescribe those for them on a routine basis.  We have applied fluoride here to children topically as well as older adults for sensitivity and many other reasons.  However, the use of systemic fluorides can certainly be made complex by the use of publicly fluoridated water.  How much fluoride do you ingest when you cook with it?  If you bathe in it and wash with it, exactly how much of it are you ingesting? These are complex questions that are difficult to quantify and make prescribing personal systemic fluorides difficult to answer.  So my question back to the patient was are you most interested in my opinion regarding Elk Grove or National issues?  She indicated that she was most interested in our and her family's area. And in my opinion that is once again is fraught with politics and complications that involve the Elk Grove area that was I will discuss in my next blog.