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The Questionable Tooth

The purpose of this article is to provide a review of the small but loud debate that has surrounded fluoride over the past 50 years. The benefits of fluoridation and its effect on public health are well known throughout the dental community. What is far less well known are the objections from people— in the tradition of the old amalgam and radiograph radiation debates—who feel that fluoride has adverse effects serious enough to warrant a cessation of its use. This article will present both sides of the issue, not to influence the reader, but to allow the reader to realize that this issue exists and to understand what the key arguments are. TODAY’S DENTAL SCHOOL GRADUATES are not only familiar with and well trained in caring for common, everyday dental problems, they also know how to handle many of the uncommon ones. A typical oral surgery program might teach dental considerations in patients with a cleft lip or palate. Pathology courses cover oral manifestations of systemic diseases and how to treat them. Other courses teach oral manifestations and considerations in patients with various genetic diseases, such as Down’s or Turner’s syndrome. Yet few dental schools teach students about another large (and growing) group of people who may well bring legal action against a general practitioner who uses glass ionomer cement to place a crown. These are patients who will not accept cast partial dentures under any circumstances; patients who may equate amalgam with arsenic; patients who, in extreme cases, may even opt for extraction over root canal therapy because they object to the gutta-percha sealer cement. In short, these are people who do not accept the placing of perceived foreign substances into their bodies. The amalgam debate, which has raged for over a century, is discussed in all dental schools. Facts and scientific studies are cited to show the effectiveness and safety of amalgam fillings. Students are taught that there are patients who will not accept these mercury fillings and they are instructed in how to provide alternate treatment modalities. But almost no one is taught that a debate over fluoride is growing to proportions that might come to rival the old amalgam issue. The purpose of this paper is to give the reader a small insight into the minds of these patients. Since one would need a textbook to cover all facets of dentistry to which objections exist, this article will present in detail only the debate raging today over fluoride. It will attempt to set forth the arguments raised by critics; and it will present counter-arguments put forth by the ADA based on standing research. It is important to note, therefore, that the facts presented in this article may not be absolute, but they are, nonetheless, regarded as “fact” by this community of patients. And whether one agrees with them or not, one must respect the opinions of the patients sitting in the chair. Where the Debate Started Early in the 20th century, Frederick McKay opened a dental practice in Colorado Springs, Colorado. He noticed an abundance of residents who had brown-stained teeth and irregularly shaped enamel surfaces—a condition known as mottling. Dr. McKay enlisted the aid of G.V. Black to help determine the cause of this staining, but as the condition was studied, they realized that these teeth also Fluoride A CONTROVERSY REVISITED