HJAR Jul/Aug 2025

HEALTHCARE JOURNAL OF ARKANSAS I  JUL / AUG 2025 67 Niki Carter, DMD, MPH Dental Director Delta Dental of Arkansas study to prove that fluoride is harmful when ingested at the recommended level. Many elements, medicines, or chemicals are harm- ful when taken above recommended levels. When higher concentrations of fluoridated water are ingested, fluorosis can poten- tially occur. Dental fluorosis is a condition that can change the appearance of dental enamel. These changes range from a white lacey pattern to pitting of teeth in the rare and harshest form. When optimal levels are observed and regulated, fluoridated water has proven safe. Existing research has not shown that wa- ter fluoridation leads to neurotoxicity is- sues, arthritis, cancer, or other unconfirmed health concerns. 15 The National Toxicology Program released a report in 2024 assess- ing higher concentrated levels of fluoride in other countries, and the report has led to great controversary. 16 To date, Florida and Utah have banned fluoride from their com- munity water systems. Fluoride is crucial during the formative years because it becomes incorporated into the developing tooth enamel, making it stronger andmore resistant to decay while the teeth are still forming. 17 This process primarily happens during childhood. Once teeth are fully mature around age 12, the systemic benefit of fluoride is significantly reduced, as it can't actively integrate into the enamel structure anymore. The topical effects of fluoride continue to provide pro- tection to children and adults, as it provides a cleansing effect to teeth topically. From a public health standpoint, water fluoridation remains the best strategy to combat tooth decay, as it distributes equally among population health into entire com- munities. The challenge we already own is being ranked last in the nation in oral health. Removing fluoride from water would have a negative impact for Arkansans’ oral and overall health. n REFERENCES 1. Centers for Disease Control and Prevention. “2022 Water Fluoridation Statistics.” Accessed June 2025. https://www.cdc.gov/fluoridation/php/statistics/2022- water-fluoridation-statistics.html 2. Campaign for Dental Health. “Is Fluoride Toothpaste Enough?” Accessed June 2025. https://ilikemyteeth.org/ debate-fluoridation/fluoride-toothpaste-fluoridated- water/ 3. McLaren, L.; Patterson, S.K.; Faris, P.; et al. “Fluoridation cessation and children's dental caries: A 7-year follow- up evaluation of Grade 2 schoolchildren in Calgary and Edmonton, Canada.” Community Dentistry and Oral Epidemiology vol. 50, no. 5 (October 2022): 391-403. DOI: 10.1111/cdoe.12685 4. Neidell, M.; Herzog, K.; Glied, S. “The Association Between Community Water Fluoridation and Adult Tooth Loss.” American Journal of Public Health vol. 100, issue 10 (October 2010): 1980-1985. https://ajph.aphapublications.org/doi/full/10.2105/ AJPH.2009.189555 5. Centers for Disease Control and Prevention. “Fluoridation of Drinking Water to Prevent Dental Caries.” Morbidity and Mortality Weekly Report vol. 48, no. 41 (Oct. 22, 1999): 933-940. https://www.cdc.gov/mmwr/ PDF/wk/mm4841.pdf 6. Arkansas Department of Health. “Medical & Dental Professionals.” Accessed June 2025. https:// healthy.arkansas.gov/programs-services/prevention- healthy-living/office-of-oral-health/medical-dental- professionals/ 7. America’s Health Rankings. “Dental Care Providers in United States.” Accessed June 2025. https://www. americashealthrankings.org/explore/measures/dental_ provider 8. American Dental Association. “10 Reasons to Fluoridate Public Water.” Last updated Sept. 2016. https://www.ada.org/-/media/project/ada-organization/ ada/ada-org/files/community-initiatives/fluoridation- ten-reasons-to-fluoridate.pdf 9. O’Connell, J.M.; Brunson, D.; Anselmo, T.; et al. “Costs and Savings Associated With Community Water Fluoridation Programs in Colorado.” Preventing Chronic Disease vol. 2, special issue (November 2025): 6. https:// www.cdc.gov/pcd/issues/2005/nov/05_0082.htm 10. CareQuest Institute for Oral Health. “The Hour of Need: Productivity Time Lost Due to Urgent Oral Health Needs.” Feb. 2, 2024. https://www.carequest.org/ resource-library/hour-need-productivity-time-lost-due- urgent-oral-health-needs 11. James, C.; Cipich, B. “LEND - The Most Common Chronic Disease of Childhood in the US.” Indiana University School of Medicine, Pediatrics (Feb. 16, 2022). https://medicine.iu.edu/blogs/pediatrics/lend---the- most-common-chronic-disease-of-childhood-in-the-us 12. Centers for Disease Control and Prevention. “CDC Scientific Statement on Community Water Fluoridation.” May 15, 2024. https://www.cdc.gov/fluoridation/about/ statement-on-the-evidence-supporting-the-safety-and- effectiveness-of-community-water-fluoridation.html 13. Junior League of Little Rock. “Poverty in Arkansas.” Accessed June 2025. https://www.jllr.org/poverty-in- arkansas/ 14. Department of Health and Human Services, Office of the Secretary. “Public Health Service Recommendation for Fluoride Concentration in Drinking Water for Prevention of Dental Caries.” Federal Register, May 1, 2015. https://www.federalregister.gov/ documents/2015/05/01/2015-10201/public-health- service-recommendation-for-fluoride-concentration-in- drinking-water-for-prevention-of 15. Putterman, S.; PolitiFact. “Does fluoride cause cancer, IQ loss, and more: Fact-checking Robert F. Kennedy Jr.’s claims.” KFF Health News, Nov. 18, 2024. https:// kffhealthnews.org/news/article/fluoride-drinking-water- rfk-jr-fact-check-cancer-iq/ 16. Environmental Protection Agency. “EPA Will Expeditiously Review New Science on Fluoride in Drinking Water.” News release, April 7, 2025. https:// www.epa.gov/newsreleases/epa-will-expeditiously- review-new-science-fluoride-drinking-water 17. Big Tooth Boca. “Fluoride For Kids: Why It’s Essential For Strong and Healthy Teeth.” August 18, 2023. https:// pediatricdentistbocaraton.com/fluoride-for-kids-why- its-essential-for-strong-and-healthy-teeth/ costly than having to treat a larger oral health issue later that accompanies other troubling characteristics, such as missed school or work hours. Dental disease can be significant, which is associated with general overall health. Tooth decay remains the most common chronic disease both globally and in the U.S., with one in four children below federal poverty level experiencing untreated tooth decay. 11,12 In Arkansas, one in three families with children live below the family income threshold. 13 Pain fromuntreated tooth decay results in school absences, difficulty learn- ing, missed workdays, and unfavorable ap- pearance. These all contribute to decreased quality of life and ability to succeed or retain work. Water fluoridation aids in promoting better dental outcomes, which translates to better overall health outcomes. The association of poor oral health to several illnesses results in worse overall health outcomes. Poor oral health has been linked to diabetes, cardiovascular disease, pneumonia, arthritis, stroke, and numerous other conditions. Especially in individuals who have few resources for their oral health, fluoridated water aids in cleansing teeth and is available with no added costs. Fluoridat- ed water has been a major player in public health during the last several decades and has improved American lives. The safe andmandated level was adjusted from 1.5 ppm to 0.7 ppm in 2015, as scien- tists concluded this was the lowest effective level to fight tooth decay and have no harm- ful effects. 14 Fluoridation in water occurs naturally, however the levels range from minimally perceptible to 10 ppm. The level of fluoride in water is recommended by the U.S. Public Health Service; however, there are some communities inArkansas that do not abide by this regulation and are being fined as a result. To date, there has not been one credible