WATER FLOURIDATION-THE SAFETY ISSUE

Dental decay is a common phenomenon to day amongst the population in some of the industrialized countries, probably due to the dietary changes which have taken place during the last 5 decades with sugar based products increasingly dominating the portfolio of processed food industry. It is estimated that practically the entire population in a country like the US suffer from some degree of tooth decay while this phenomenon is not that predominant in Europe. Dental decay is caused by bacterial plaques that develop between the teeth because of infection of the gum by microorganisms like Streptococcus mutans and some strains of Lactobacillus which thrive when the diet is rich carbohydrates mainly sugar, causing a drop in pH to about 5. At such an acidic environment the enamel material that coat the teeth are dissolved and lost damaging the tooth progressively. The legendary saying that "brush the teeth after each meal" is based on the effectiveness of removing the "food" for the bacteria left over by the meal promptly giving no cause for plaque formation. Besides almost all brands of tooth paste products contain fluorides that can help remineralization of the affected teeth.

Fluorides are known to inhibit dental decay and water used every day generally contains sufficient fluorides to afford protection to the teeth. But modern day water purification process removes practically all fluorides along with other undesirable inorganic salts to ensure its potability. After all fluoride is not proven to be an essential nutrient and there are no water standards which stipulate minimum or maximum levels permitted or mandatory. Mounting evidence about the role of fluorides in reducing tooth decay has persuaded many countries to take up "fluoridation" of water as a public health measure. Such a practice combined with use of fluoride containing tooth pastes is presumed to have halted the onslaught of dental decay in many parts of the world, benefiting over 400 million population. When water is not a convenient medium for fluoridation, others like salt, sugar, milk etc also can be candidates for mass fluoridation. Fluoride compounds Sodium Fluoride, Fluorosilicic acid and Sodium Fluorosilicate are commonly used as sources of fluoride.

As halogens are increasingly being shunned because of their carcinogenicity, fluoridation also is a suspect process in the eyes of many critics. However there is little evidence implicating this mineral in any serious health disorders. Defluoridation is still recommended when the fluoride content in water is abnormally high, especially in industrial areas, coal belts and deep under ground water. It is more or less agreed now that fluoridation of water @1 mg per liter is absolutely safe and adult human beings can tolerate a level of 0.1 mg per kg body weight. There are some organized groups still agitating for stopping compulsory water fluoridation, raising ethical and societal issues. However, if iodization of salt is accepted as a public health program to prevent mental retardation and development of goiter, there should not be any reservation about the fluoridation program too.

Fluoride absorbed by the body is circulated in the blood and when adequate fluoride intake is ensured, the saliva contains about 0.04 mg per ml of this chemical that can prevent dental decay. Under such a situation the fluoride in saliva reacts with the bacterial plaques dissolving the enamel substances and subsequently the affected teeth gets recoated with a thin layer of this solution as a part of the process of demineralization. Decay becomes a serious problem when demineralization rate exceeds remineralization pace over a period of few years. There are suggestions that Calcium present in water and Xylitol chewing gum can also retard dental decay but they can at best be complimentary to fluoridated water.

Traditional Indian practices of using neem sticks, mango leaves, charcoal powder mixed with camphor etc are known to maintain dental and gum health but very scant scientific supporting evidence is available regarding their mode of action. Most probably neem and mango may be acting as antibacterial while charcoal powder has the capacity to adsorb gases and very small particulate materials including bacteria, thus preventing the very process of plaque formation. Regular gargling with warm water after each meal has the salutary effect of flushing out residual food particles struck between the teeth and also forced removal of adhering bacteria without giving them any chance for colonization. Use of dental floss by many people serves the limited purpose of removing food particles which provide the source of food for the infectious bacteria.

V.H.POTTY

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BEVERAGE CONSUMPTION AND DENTAL DECAY

One of the major issues regarding the safety of soft drinks is their adverse effect on teeth due to the acids present as well as the sugar content in them. While frequent mouth washing can remove most of the sugar adhering to the gums and the teeth, acids are supposed to be corrosive causing tooth erosion and hyper sensitivity. Many campaigns of the past against Cola giants Coke and Pepsi were based on the presence of the mineral acid phosphoric acid in the formula which is considered one of the most corrosive chemicals. In other synthetic flavored drinks, organic acids like citric, malic etc are used and many feel comfortable because of their belief that these acids are mild and non-corrosive. But this may be a misplaced hope if the findings by some researchers are taken at their face value.

Carbonated non-alcoholic beverages are generally sweetened, flavored, acidified, colored, artificially, carbonated and some times chemically preserved. In such beverages sugar concentration can be between 8-14% while acid levels may vary from 0.1% to 0.2%, the pH range being 2.6-4.0. In aerated drinks CO2 itself lowers the pH by dissolving in the syrup at the low temperature used in processing while addition of acids like phosphoric, citric,fumaric, tartaric and malic acids, is common. Sports drinks are specialty products targeted at athletes and other personnel engaged in heavy exercises regularly for more than an hour each day. They are mostly isotonic solutions containing 5-7% glucose and optimal levels of electrolytes designed to recoup water and nutrients lost through sweating during the work out. Some drinks are hypotonic while few hypertonic drinks are also available for use under certain conditions. Sweating is a natural phenomenon that is intended to maintain the body temperature constantly at 37 C and significant amounts of water and nutrients are lost during sweating. 2% loss in body weight during sweating can cause impaired performance, 4% loss reduces work capacity, 5% loss results in heat exhaustion, 7% loss can create hallucination and 10% loss leads to circulatory collapse and heat stroke.

A typical male athlete has 90 gm of glycogen stored in the liver while the muscle stores another 400 gm of glycogen. During vigorous exercise body loses 3-4 gm of glucose per minute and prolonged exercise an deplete the glycogen level severely which may take 24-48 hours to replenish. Normally 300-400 ml of sports drink is consumed in a day with 5-6 sips every 15 minutes, creating a situation where the teeth are in constant contact with the beverage for prolonged time and their consequent erosion over a period. Erosive Tooth Wear (ETW) is a common dental disease condition, different from caries as the former affects only the enameled surface of the teeth. Appearing as a yellow patch at first ETW can dissolve the minerals in the dendrite underneath and cause considerable damage, eventually leading to loss of the tooth, unless treated properly. The reported finding that citric acid present in the sports drink can cause ETW is based on studies conducted on Cow teeth which was immersed in sports drink for 75-90 minutes and evaluating its impact. Whether these results can be applied to human beings and how far they will be realistic require deeper consideration. It is debatable whether any athlete will keep the drinks in the mouth for such a long time to have ETW and validation is necessary through actual human studies to subscribe to such a conclusion.

It is rather scary when one hears that 45.9% of American children have ETW of varying severity and such tooth ailments in early phase of growing, can have serious health consequences at later stages in life. As a precaution drinking soft drinks or juices with a straw and not swirling the drink in the mouth before swallowing will reduce the chances of prolonged contact with the teeth significantly. Brushing immediately after drinking a beverage can cause further damage as most tooth pastes are abrasive in nature. Frequent consumers of soft drinks, who cannot chuck this undesirable practice, are better advised to use neutralizing/remineralizing tooth paste to help re-hardening of the soft enamel.

V.H.POTTY
http://vhpotty.blogspot.com/