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A Tennessee Perspective on Community Water Fluoridation. David E. Brumley, DDS, MPH South Central Region November 16, 2006. Community Water Fluoridation. Centers for Disease Control and Prevention Community water fluoridation is one of ten great public health achievements

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a tennessee perspective on community water fluoridation

A Tennessee Perspective on Community Water Fluoridation

David E. Brumley, DDS, MPH

South Central Region

November 16, 2006

community water fluoridation
Community Water Fluoridation

Centers for Disease Control and Prevention

Community water fluoridation is one of

ten great public health achievements

of the 20th century.

MMWR April 2, 1999, Vol. 48 (12)

community water fluoridation what is water fluoridation
Community Water FluoridationWhat is water fluoridation?
  • Small amounts of fluoride are present naturally in all water sources.
  • Water fluoridation is the precise adjustment of the natural fluoride concentration in a public water supply up to the level recommended for preventing tooth decay.
  • The USPHS has established the optimal concentration for fluoride in water supplies in a range of 0.7 to 1.2 parts per million.
historical perspective
Historical Perspective
  • At the turn of the 20th century, Dr. Fredrick S. McKay moved from Philadelphia to Colorado Springs, Colorado and opened a dental practice.
  • He noticed that many of his patients exhibited a peculiar condition referred to along the Continental Divide as ‘Colorado Brown Stain.’
  • In 1908, he initiated a study and found that this condition was prevalent among long-term residents who were born in the area. It was also endemic to other communities along the Continental Divide.
  • Dr. McKay and Dr. G.V. Black wrote the first detailed clinical description of mottled enamel which is now termed fluorosis.
historical perspective8
Historical Perspective
  • In 1928, Dr. McKay discovered the agent in the drinking water that caused mottled enamel also inhibited dental caries.
  • In 1931, Dr. McKay sent samples of this water to an Alcoa chemist named H.V. Churchill who identified the causative agent as fluoride.
  • In the 1930s, Dr. McKay and Dr. H. Trendley Dean of the USPHS collaborated to explore the possibility of adjusting the level of fluoride in drinking water to reduce dental caries.
  • In the 1940s, four classic studies were begun which proved the benefits of adding fluoride to community water supplies.
      • Grand Rapids, MI – Muskegon, MI
      • Newburgh, NY – Kingston, NY
      • Evanston, IL – Oak Park, IL
      • Brantford, Ontario – Sarnia, Ontario
slide11

Bristol

Crossville

Cookeville

Cleveland

Chattanooga

Cowan

Lawrenceburg

Nashville

Paris

milan tennessee
Milan, Tennessee
  • In March 1951, Milan became the first city in Tennessee and the second city in the Southeast to adjust the level of fluoride in its community water supply for the prevention of dental caries.
  • As a result, five years later in 1956, the six-year-old Milan children had a 57 percent reduction in dental caries in their permanent teeth compared to the 1951 same-age cohort.
  • In addition, when compared to their counterparts in Humboldt and Trenton – two neighboring nonfluoridated cities – the 1956 Milan six-year-olds had a 62 percent and 70 percent reduction in dental caries, respectively.
slide14

Systemic Effect of Drinking Fluoridated Water

  • 97 percent of tooth enamel is composed of hydroxyapatite.
  • When fluoridated water is ingested, the fluoride ion (F-) readily replaces the hydroxyl ion (OH-) during enamel formation of the tooth.
  • Hydroxyapatite Ca5(PO4)5OH then becomes a compound called fluorapatite Ca5(PO4)3F.
  • Fluorapatite at the enamel surface is less soluble and more resistant to acids produced by cariogenic bacteria.
slide16
Disinfection

Absorption

Dechlorination

Algae control

Oxidation

Metal coagulation

Water softening

Filtration

pH control

Iron control

Coagulation

Corrosion control

Decolorization

Fluoridation

Community Water Systems

>50 water treatment chemicals used for:

water fluoridation chemicals
Water Fluoridation Chemicals
  • Sodium Fluoride (NaF)
    • Crystalline powder
    • Relatively constant (low) solubility
    • pH 7.6
    • Saturator Systems
  • Sodium Fluorosilicate (Na2SiF6)
    • Crystalline powder
    • Solubility varies with water temperature
    • pH 3.5
    • Dry-feed Systems
  • Fluorosilicic Acid (H2SiF6)
    • Liquid
    • Infinite solubility
    • pH 1.2
    • Venturi Systems
community water fluoridation is it safe
Community Water FluoridationIs it safe?
  • Acute fatal poisoning (CLD) in adults requires the ingestion of 2.5 - 5.0 grams of fluoride in a 2 - 4 hour time frame.
  • In drinking fluoridated water at 1.0 ppm, an adult would have to drink 660 gallons in 2 - 4 hours to reach the lower limit of a fatal dose.
  • A 10kg child (12 - 18 months of age) would have to drink 85 gallons of fluoridated water (1.0 ppm) in 2 - 4 hours to reach the lower limit of a fatal dose.
community water fluoridation what are the costs
Community Water FluoridationWhat are the costs?

$0.50 per person

Average annual cost of water fluoridation in the U.S.

Systems serving 2,000 or less =

$0.77 - $1.16 per person per year

Systems serving 2,000 - 20,000 =

$0.21 - $0.95 per person per year

Systems serving  100,000 =

$0.12 - $0.21 per person per year

In most communities, every$1 invested in fluoridation saves $38 to $80 in dental treatment costs.

slide20

Community Water FluoridationStatus

Healthy People 2010 Goal

75%

States Currently Meeting Goal = 24

States range from:

2.3% (Utah) to 100% (Kentucky, Rhode Island, South Dakota, & the District of Columbia)

CDC Fluoridation Status, 2002

slide21

Community Water FluoridationStatus

  • 10 states, Puerto Rico, and the District of Columbia mandate statewide fluoridation through legislation.
    • California, Connecticut, Delaware, Georgia, Illinois,

Minnesota, Nebraska, Nevada, Ohio, South Dakota

  • Kentucky mandates statewide fluoridation through administrative regulation.
  • Tennessee has a voluntary process with an emphasis on education rather than legislative mandate.
slide22

Community Water FluoridationStatus

Healthy People 2010 Goal75.0%

public water system
Public Water System

Source: http://apps.nccd.cdc.gov/gisdoh/waterfluor.aspx

total population
Total Population

Source: http://apps.nccd.cdc.gov/gisdoh/waterfluor.aspx

slide26

Tennessee’s Water Systems

532

Approved Systems

214

Fluoridating Systems

118

Consecutive Systems

332

Fluoridated Systems

slide31

1996-97 East Tennessee Dental Health Survey

15 ETR counties

62 communities

65 schools

17,256 children