Study predicts national fluoride ban would substantially increase children’s tooth decay and dental costs

 

• Mass General Brigham researchers developed a model to estimate the impact on children’s dental health and its cost if fluoride were no longer added to U.S. public drinking water.
• The model estimated that a fluoride ban would result in a 7.5 percentage point increase in tooth decay and cost an additional $9.8 billion over 5 years.
• This translates to tooth decay in 25.4 million more teeth, the equivalent of a decayed tooth for one out of every three children.

Fluoride has been added to public water systems in the United States since 1945 to strengthen tooth enamel and fight off bacteria, ultimately reducing tooth decay. Mass General Brigham researchers developed a model to estimate dental health outcomes for children if the United States were to ban fluoridation of public water. The new study, published in JAMA Health Forum, found that banning fluoride would substantially increase dental decay and costs particularly for publicly insured and uninsured children.

“Fluoride replaces weaker ions within tooth enamel, making it stronger and less susceptible to tooth decay caused by bacteria,” said senior author Lisa Simon MD, DMD, Division of General Internal Medicine at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system. “There’s strong evidence from other countries and cities, such as Calgary in Canada, showing that when fluoride is eliminated, dental disease increases. Our study offers a window into what would happen in the United States if water fluoridation ceased.”

Simon and the research team focused on children for the study, because fluoride strengthens teeth during development, and more robust data links fluoridated water to oral health in this age group.

The study used detailed oral health and water fluoridation data collected from 8,484 children (ages 0-19, 49% girls) in the nationally representative National Health and Nutrition Examination Survey (NHANES). Using this dataset, the researchers developed a microsimulation model to see how banning fluoride from drinking water would impact oral health, quality of life and dental care costs.

The researchers simulated two scenarios over 5- and 10-year periods, which align with policy planning horizons. First, maintaining current fluoride levels, and second, eliminating the addition of fluoride to public water.

"Using a simulation model to track the progression of diseases in current populations, we estimated the impact of removing fluoride on the risk of tooth decay and the related dental care costs, including treatment for decay and complications from delayed treatment. We ran the simulation 1,000 times to see how different factors could affect the results. This approach helps ensure that our predictions are more reliable and reflective of real-world variability,” said first author Sung Eun Choi, PhD, assistant professor of Oral Health Policy & Epidemiology at Harvard School of Dental Medicine.

The researchers found that eliminating fluoride increased the total number of decayed teeth by 7.5 percentage points, or 25.4 million more teeth with tooth decay over five years (equivalent to a tooth for one out of every three American children). The number of fluorosis cases—a discoloring of tooth enamel due to excessive fluoride intake—decreased by 0.2 million. They also estimated a cost of $9.8 billion in additional dental care costs over five years, which rose to $19.4 billion after 10 years.

“Most of the increased cost could be attributed to publicly insured children, meaning it would be a direct public health cost,” said Simon.

The study did not model cognitive effects from fluoride exposure as current levels of fluoride in public water are not associated with worse neurobehavioral outcomes. The researchers note that their model demonstrates meaningful, ongoing benefit from fluoride at safe levels currently recommended by the Environmental Protection Agency, the National Toxicity Program, and the Centers for Disease Control and Prevention.

“We know fluoride works. We’re able to show just how much it works for most communities and how much people stand to lose if we get rid of it,” said Simon.

 

Dental flosser for at-home stress monitoring

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This dental floss pick has a sensor that can assess your stress level.

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Credit: Atul Sharma

Over time, stress and anxiety can build to a point where life’s challenges become overwhelming and cause physical effects. Now, in ACS Applied Materials & Interfaces, researchers report a dental floss pick with a built-in sensor that could monitor stress as part of a daily routine. The device, which accurately senses levels of the stress hormone cortisol in minutes, could help users recognize when it’s time to get help.

Unchecked chronic stress can lead to health conditions such as heart disease and mental disorders. Catching rising stress levels early is important, but daily blood tests at a doctor’s office aren’t feasible for most people, and self-reported questionnaires are subjective. That’s why researchers are developing point-of-care tests that measure cortisol levels in saliva, which mirror the hormone’s concentrations in blood. Although the saliva tests are promising, many of them require people to remember to perform the complicated analyses or use a bulky mouthguard. In addition, the anxiety of performing a test can cause stress levels to spike. So, Sameer Sonkusale and colleagues took a completely different approach by integrating a cortisol sensor into a dental floss pick — something many people use every day.

The team’s dental pick features floss that collects saliva. The floss is connected to a microfluidic thread that transports saliva to a flexible electrochemical sensor embedded in the handle of the pick. The sensor is made of an electrode with an electropolymerized molecularly imprinted polymer (eMIP) on it. The researchers made the eMIP by embossing cortisol molecules into an electrically conductive film and then removing them — similar to a shoe leaving an impression in wet cement. During tests, salivary cortisol binds in the impressions, decreasing the electrical current flowing through the sensor, which produces a signal that is wirelessly transmitted to a mobile device. The strength of the signal corresponds to the amount of cortisol in the saliva. Finally, the analyzed saliva moves to an adsorbent waste pad next to the sensor and the pick can be discarded.

The device takes around 10 minutes to report a result. In tests with cortisol-spiked artificial saliva, the dental pick was sensitive enough to detect small increases in cortisol that could be early indicators of stress. In tests with real human saliva samples, the dental flosser performed just as well as the commonly used ELISA saliva test for measuring levels of cortisol.

Overall, the researchers say that this device is one of the best-performing cortisol sensors reported so far, and it could someday be modified to detect other clinically important salivary molecules.