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Hawaii’s Water Remains Un-Fluoridated

“No” is still Hawaii’s answer to the recommendations of adding fluoride to its community water system. Yet, an alarming prevalence of tooth decay continues to plague its young population.

The oral health report sponsored by the State Health Department has shown 71 percent of tooth decay prevalence among children. This is higher by 19 percent than the national average of 52 percent. Even worse, it is the highest among all 50 states. The report screened 3,184 third graders in 67 public schools and found that seven in every ten children have tooth decay.

In 2012, Hawaii had more than 3,000 emergency room visits due to preventable dental problems. Unfortunately, this is a 67 percent increase from 2006. The number is also 22 percent higher than the rest of the country from 2006 to 2009.

The alarming figures suggest the need for more primary prevention programs in Hawaii. This may include dental education, the use of dental sealants, and topical fluoride applications. Dr. Steve Wilhite, former president of Hawaii Dental Association, said the incidents of tooth decay and other avertible dental diseases could have been prevented by 50 percent within about 10 years if the only fluoride was part of the water system.

The use of fluoride for teeth protection and as a means to combat decay has been extensively endorsed by health agencies. This includes the World Health Organization, the Centers for Disease Control and Prevention, and the American Dental Association.

As nature’s cavity fighter, fluoride provides the teeth necessary protection against plaque bacteria and sugars. The naturally-occurring compound is vital in the remineralization of the enamel. Fluoride helps strengthen the teeth from the wear caused by acid attacks from the sugar we consume. Still, Hawaii has resisted fluoridating its community water. Yet, this is a practice that is common across the United States since Grand Rapids, Michigan started it in 1945.

Only 11 percent of the state’s community water system is fluoridated. This means that only 159,935 residents out of 1,419,516 people served by the water system receive fluoridated water. The percentage is considerably lower to the national figure of 75 percent.

Aside from military properties, no single Hawaii county fluoridates its drinking water. Honolulu City Council even passed an ordinance in 2004 to ban the fluoridation of Oahu public system. Before that, Lanai Water Co. has decided against fluoridating the island’s water supply in 2002.

Health reports sponsored by the State Health Department promote the benefits of water fluoridation and other fluorides for the reduction of dental diseases. But some residents, including Honolulu City Council member Ann Kobayashi who favored the banning of fluoridated water from Oahu’s public system in 2004, are against fluoridation. According to them, the compound has killed houseplants and koi and causes serious health ailments. However, these are claims with scant evidence.

American Dental Association President Dr. Maxine Feinberg contested these claims. He says that water fluoridation is effective and safe. In fact, it has been validated by tens of millions of people since 1945 in Grand Rapids.

Drinking fluoridated water reduces the prevalence of dental caries by 20 to 40 percent. Additionally, it can prevent tooth loss and infection, improve oral health, and help reduce costs of dental treatments due to tooth decay.

The National Cancer Institute has also rejected claims that water fluoridation can lead to cancer, citing that there’s lack of evidence. Still, despite the benefits of fluoride, the Aloha State remains unyielding in its stance to funnel the cavity-fighting compound into its community water systems. For Kobayashi, she believes people the state should not force people to consume fluoridated water. “You can always add it by getting fluoride drops and adding it your drinking water,” she says. 12 years ago, she voted against water fluoridation.

On the other hand, State Senator Karl Rhoads believes it should be the other way around. Rhoads believes those against it should go and buy un-fluoridated water — adding that scientific evidence supporting the cost-effectiveness and safety of fluoridated water is overwhelming.

Another concern of critics of water fluoridation is the costs. Honolulu’s Board of Water Supply in 2015 estimated the initial capital investment of fluoridating Honolulu’s water system at 15 million US dollars. Additionally, it would have a 2.7 million US dollar annual operating cost.

To fluoridate the community water system, the Board must install equipment at more than 190 facilities across the state. Continuous monitoring will also be implanted as an inadvertent over-dosage of fluoride could mottle the teeth. And for Senator Rosalyn Baker, the chair of the Commerce Consumer Protection and Health Committee, water fluoridation is not going to happen unless there is convincing evidence that it is the sole way to attain good oral health.

History of Fluoridated Water

In the 1940s, scientists found out that people living in areas where drinking water had naturally-occurring fluoride had lower incidents of dental caries. By 1945, water fluoridation in the US began with Grand Rapids, Michigan adjusting the fluoride content of its water supply to 1.0 ppm. The city became the first place in the country to implement community water fluoridation. By 2014, over 66 percent of the country’s total population were receiving fluoridated water.

Benefits of Fluoridated Water

Drinking fluoridated water is beneficial. In fact, it reduces dental costs caused by tooth decays, lessens the percentage of dental caries by 20 to 40 percent, and prevents tooth loss and infection. That said, water with fluoride can generally improve overall oral health. Among the 66 percent who receive fluoridated water, 74 percent benefit from community water fluoridation.

Community water fluoridation is valuable because it promotes health for its members. It is also cost-effective and equitable. ADA urges communities to continue fluoridating water at recommended levels. After all, this is one of the most effective and least-costly ways to boost the public’s oral health.

Where can I get fluoride?

Fluoride treatments are available and come in various types.

Toothpaste usually contains fluoride. Yet, toothpaste has a lower amount of fluoride than the level prescribed by dentists.

Fluoride gels are also accessible over-the-counter. A higher dose of the gels may be acquired with a dentist’s prescription. This type of fluoride treatment uses a tray and is applied with a mouth guard. Another type of treatment available is fluoride varnish. Varnish can be applied manually, brushed onto teeth. After application, eating and drinking must be avoided for 30 minutes. You can always inquire with your dentist for the treatment most suitable for your needs.

But fortunately, you might be able to avoid the cost of fluoride treatments. Since fluoride is a naturally-occurring compound, it is present just about anywhere, especially in food and water.

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