Afterthoughts: We Know the Drill

Why have fear-mongers won an important public-health debate?

Photo: Linny Morris

Would you trust a drill-wielding dentist who suggests, “Want to try this without the Novocain?”

I did; that’s how much I like my dentist. He said it was a tiny cavity and I probably wouldn’t need the painkiller.

“Can I stop if it hurts?” I asked him.

“Of course,” he said. “Just lift your arm up as a signal.”

“Has anyone ever slapped you?”

My dentist assured me he’d never been smacked by a signaling client. And he was right about not needing the Novocain.

Unlike many people, I love going to the dentist. I think it’s because I adored my childhood one. As soon as Dr. Mains was done with my checkup, I got to dig through a cardboard treasure chest, brimming with toys.

Illustration: Jing Jing Tsong

But I know it’s more common for people to fear their dentists, maybe especially so in Hawaii. We have higher rates of tooth decay than on the Mainland and less than 10 percent of the population has access to fluoridated tap water.

Fluoride is a naturally occurring element found in water and air. If there’s too much of it in the water supply, people wind up with strong, but discolored, teeth. If there’s too little of it, people have soft, cavity-prone teeth. But when you get the level just right—1 part per million, according to the American Dental Hygienists Association—it lowers the risk of dental decay. Since communities started adjusting their fluoride levels in the mid-1940s, Americans have gotten 50 percent to 60 percent fewer cavities.

But despite 60 years of research, despite constant monitoring by groups such as the Centers for Disease Control and the World Health Organization (WHO), there are still fluoride fear-mongers. In Hawaii, they have the upper hand: We are one of only two states that don’t adjust fluoride levels.

Anti-fluoride activists claim that fluoride leads to everything from lowered IQs and dementia to cancer and chronic fatigue. Yet these groups misunderstand or misrepresent the studies they rely on. Take, for example, a 2006 WHO study, which lists horrible disorders stemming from fluoride. But that study looked at excess levels of fluoride, such as those found in people exposed to fluoride from indoor coal burning. They were getting 9.63 milligrams of fluoride per day. Compare that to the daily .07 to 1.2 milligrams for the average American child.

In 2004, the Honolulu City Council voted against adding fluoride to the water, despite protestations from the Hawaii Dental Association, the Academy of Pediatrics and the state Department of Health. 

Because we don’t use this inexpensive and effective public-health method, the state Department of Health’s Dental Health Division has to perform triage. According to its 2008 report, it screened more than 6,890 public-school children in grades K-12 statewide for dental problems, referring nearly a quarter of them for treatment of acute problems. And it uses topical fluoride treatments for schoolchildren. 

Topical treatments are far more expensive and time-consuming than fluoridating the water. And this is not just about our children’s teeth. Hawaii also has disproportionally high rates of tooth decay in people who can’t afford medical care, and in other vulnerable populations, such as patients in long-term-healthcare facilities.

Tooth decay, the Dental Health Division notes, is “an insidious and progressive disease” which can put people at risk for potentially life-threatening infection.

In Hawaii we have let a vocal minority—well intentioned as they may be—scare lawmakers into making an important health decision that ignores current science.

It’s time for a checkup.                             

For more of Wagner’s writing, see her “Guilty Pleasures” blog.