Fluoridation From Trenton Family Dentistry’s Perspective
By LYDIA BERGLAR
News Editor
Given the ongoing debate about fluoridation of public water systems, the Sentinel asked our local dentists to share their expertise on this issue. True Dental did not respond, but Dr. Harrison Filler of Trenton Family Dentistry offered his thoughtful, balanced, professional opinion.
Filler recalled hearing about the controversy when he was growing up before he entered the dental field. “It’s been on people’s minds since fluoride was implemented,” he said, but the debate has certainly ramped up in the current socio-political climate.
Filler has noticed two distinct areas of concern within the broader debate. The first question has two sides: Does fluoride (whether in toothpaste or in water) help teeth, and does fluoride cause harm in other ways? The second question is whether or not it is ethical for the government to put it in everyone’s water supply, i.e. mass medicating the American public.
Of current factors impacting people’s concerns, Filler said, “I think there’s an overlap between the concern with this issue and a larger distrust of the establishment, healthcare, and government mandated healthcare. People are having questions about the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). It’s not surprising that at a time when both of those are seeing major funding cuts, people are asking if we can trust the information they’ve produced in the past.”
Filler and the Sentinel discussed how the government’s response to COVID-19 raised red flags for many people. We also discussed how the internet allows information and misinformation alike to spread easily while also fatiguing people with the seemingly endless amounts of scientific studies, opinions, and ever-changing recommendations.
As Filler said, “We’ve never been in an age of greater skepticism about scientific research. It’s become, ‘I heard one thing last year. Hearing it differently this year makes me doubt the veracity of the statement.’ Also, an AI generated Facebook post holds just as much validity to some people as a $10 million NIH study by people who have spent 40 years of their lives researching a topic and working in a lab every day.”
All in all, this set the scene for the debate about fluoride to ramp up in recent years.
As to whether or not fluoride helps teeth and is safe, Filler is emphatic that yes, it does work and it is safe in certain amounts. Like most things, too much is toxic, but the amounts in public water are very low. (Currently, most of the public water systems in Georgia are fluoridated at 0.7 milligrams per liter.)
Studies on the matter are easily accessible (thanks to the internet and the Information Age), but again, many people do not trust these studies and have concerns due to other studies that found potential links between too much fluoride and various serious issues.
While applying fluoride with toothpaste helps prevent cavities in adult teeth, Filler explained that taking in some fluoride systemically (rather than topically) is especially important for children. This helps the adult teeth harden as they form. Since adults already have fully formed teeth, systemic fluoridation doesn’t help them.
Filler highlighted that fluoride is a mineral that occurs naturally in some rocks through which it enters water and gave a brief history lesson: Scientists realized that people living in some regions had fewer cavities than people in other regions. They eventually found that this was due to the naturally occurring fluoride that hardens teeth and makes them resistant to cavities.
However, too much fluoride causes spots on teeth called “fluorosis.” Filler said fluorosis is not harmful, but it is also not aesthetic. Scientists eventually found the right amount of fluoride needed to strengthen teeth without causing fluorosis.
Fluoridation of America’s water began in 1945. Filler noted that the decades that followed were centered around exciting scientific discoveries, the Space Race, and television shows like “The Jetsons.” In this cultural climate, fluoridation may have been seen as a scientific success.
However, “Today we live in a climate where we doubt the future and wonder about the government,” Filler said. “People aren’t thinking about flying cars; they’re thinking about ‘The Walking Dead,’ an apocalyptic vision of the future.”
Filler compared fluoridation of public water to iodized salt. Much like the benefits of fluoride, iodine’s benefits were discovered when scientists noticed that people living in regions with low levels of naturally occurring iodine had enlarged thyroids (called goiters) caused by iodine deficiency. Adding iodine to table salt became common in the United States because it is an easily accessible, often used item.
However, Filler pointed out one key difference between iodized salt and fluoridated water: It’s fairly easy to buy sea salt and other salts without added iodine, but it’s not easy to take fluoride out of public water. In his words, “I’m not saying you’re consenting to medical treatment when you buy Morton’s Iodized Salt, but there is an alternative. However, if you live here in Dade County and you’re using the tap water, there’s not really an alternative unless you buy a reverse osmosis filter or expensive bottled water.”
This leads to the second big question. As Filler asked, “Should we put something in the water to medicate a community without their specific consent individually?”
He gave a made-up example to illustrate the importance of informed consent. Say a patient comes to him with a severely infected tooth. After x-rays and a discussion with Filler, the patient consents to a dental extraction. “That’s treatment,” said Filler, “but what if that same patient came in and we put them in a headlock and pulled the tooth? It’s the same treatment and result, but we would call that assault.”
So, when it comes to fluoride, Filler respects patients’ desire to be careful about what they put in their bodies, but he asks them to consider how they will treat the immediate problem of tooth decay. “For my patients with rampant tooth decay, it’s not that they had two cavities last year; it’s that they have 25 cavities every year. The question for them would be, ‘It’s cool that you’re careful about what you put in your body, but what are you going to do about the cavities?’”
Filler believes that people with good dental hygiene routines do not need fluoridated water, but he also doesn’t think they’ll see any health benefits if it’s removed. “If you take good care of your teeth, if you brush your teeth twice a day with fluoridated toothpaste, you don’t need fluoride in your water, but you will not be the person who is affected by the decision to remove it.”
However, there are people whom he believes do need fluoridated water and will see negative impacts if it is removed. “Maybe it’s a four-year-old kid whose parents are really busy, the kid doesn’t want to brush his teeth, and it’s hard to keep him motivated. Maybe they don’t own a toothbrush. We see kids come in here who haven’t had a toothbrush in years.”
“No man is an island,” he reminded everyone. “I think that some of us come from a position of privilege, getting a gleam of excitement in our eye to choose to not do something when really other people are going to feel the negative effects the most. If fluoride is removed from the water, a lot of people will not see a change in their lives at all, but indirectly, they’re going to see the absence of coworkers due to dental visits. They’re going to have more neighbors suffering in pain, more people going to Erlanger on Saturday night with a dental infection.”
Naturally, Trenton Family Dentistry encourages everyone to practice good dental hygiene regardless of fluoridation. Relying on fluoride in the water alone is clearly not enough to prevent cavities. As Filler said, “I hope we can find a way to empower the community as a whole.”
There is recent research supporting alternatives to fluoride. First, Filler explained that xylitol, a sugar alcohol like erythritol and sorbitol, surprisingly works to prevent cavities. The bacteria in our mouths that cause cavities can’t digest xylitol. “The bacteria kind of gets plugged up. They eat this xylitol and get stalled out, so xylitol is actually an anti-cavity agent. The bacteria can’t reproduce, and they can’t metabolize other sugars.”
However, Filler explained that xylitol doesn’t harden teeth the way fluoride does, nor does it work as efficiently as fluoride.
Next, he said the cutting edge alternative is currently hydroxyapatite. “It sounds so good that I had some questions about it, but actually it works.”
Teeth are made from hydroxyapatite, so someone came up with the idea of brushing it into the teeth as a way to harden them. Filler was skeptical at first, but he said that the science supports the claim. Scientific studies have shown that hydroxyapatite remineralizes teeth, but it doesn’t make them harder or more resistant to cavities.
The Sentinel asked why our area has poor dental hygiene when it’s widely known that brushing and flossing is important. “A big thing is expectations,” explained Filler. “Young people expect to have dental issues. They expect for their teeth to fail. Mom and dad were in dentures at 40, so they’re not upset because things are happening just like they thought they would.”
He said that running a dental practice in Trenton is very different from his experience practicing in Birmingham, Ala., due to societal expectations, norms, and beliefs. He is motivated to reduce suffering in our area by improving dental health.
“People think I’m hypervigilant, looking for cavities or any excuse to drill on teeth and that finding fillings to do is going to make me extremely rich. That’s really not the case. I’m motivated for people to have as healthy teeth as possible. I’d love for them to never have a cavity, and I think that involves some fluoride—whether it’s in their toothpaste or also in the water.”
