I was pleased to note that the most recent meeting of the East Brunswick Water Policy Advisory Committee concluded that East Brunswick’s policy of fluoridating its drinking water is beneficial and should be continued. The use of fluorination is one of the most important public health victories. Originally designed to protect us from cavities (by itself a laudable goal), data strongly support the concept that fluorination saves tens of thousands of lives. In this budget sensitive time, fluorination also saves billions of dollars.
Drinking water fluorination, in use for almost 70 years, reduces dental decay by more than 40%. $40 is saved on dental costs for every $1 dollar spent on fluorination. This does not count the indirect savings on medical costs. Extensive experience in fluorination (70% of public water systems in the United States) has shown it to be highly effective and safe.
Fluorination has benefits far beyond dental caries. The systemic complications of poor dental care can be morbid or fatal. Bacteria invade the bone of the jaw, causing osteomyelitis. This can require complex surgery and extended antibiotics. These bacteria can spread to other parts of the body. Healthy heart valves, blood vessels, joints and bone are often destroyed. Any patient who has an artificial device placed in their body (hip, pacemaker, stent) has real risk of bacterial contamination, if they have poor dentition. Usually, doctors must remove infected medical devices. These can be hard to replace in contaminated tissue.
Any patient with a weakened immune system, such as a cancer patient on chemotherapy or patient on steroids, has a significant risk of a deadly blood infection (sepsis and shock) in the setting of gum disease. Finally, for reasons we do not yet understand, we now know that dental problems double the risk of major cardiac events, such as heart attacks. It appears that the presence of chronically inflamed gums may cause chronic inflammation of arteries leading to blockage.
Perhaps the critical lesson here is the ability of public health measures to increase the quality of life of a society, the health of the individual, and save money at the same time.
America has a history of public health achievement such as immunizations, motor vehicle safety, workplace safety, an increasingly safe food supply, family planning education, mammograms, PAP smears and tobacco education. We are seeing a continuing drop in heart disease because of education regarding high blood pressure, salt and cholesterol.
We have a long way to go in other public health areas. Obesity is a major problem with diabetic complications our newest “plague.” While we have the finest children’s hospitals in the world, we have one of the highest rates of infant mortality rate in the West. We have failed to control illegal narcotics and have an expanding problem with the diversion of “legal” drugs. With 30,000 gun deaths a year, we have not achieved any measure of adequate gun safety. Fortunately, we are getting better about colonoscopies, sunscreen and active exercise lifestyles (buying a gym membership does not count). However, many challenges still confront us.
One of the greatest benefits of living in a society where we take our responsibility to our fellow man seriously is that we ourselves benefit. The organized, comprehensive and altruistic efforts of our public health services is something about which we can be proud. It is of note that these measures, when applied at a societal level, are cheap. In return, they save in dollars and suffering.