The benefits of fluoridated water for infants outweigh the disadvantages, doctors say
Fluoridated water is good for dental health, no? Not in the opinion of Ms Joy Warren, coordinator at British non-government organisation West Midlands Against Fluoridation, who recently wrote to LifeStyle about the effects of taking fluoridated water. West Midlands is a county in England. Ms Warren said that fluoride in water drunk by expecting mothers is passed to the foetus via the placenta, and to the baby when baby formula is dissolved in fluoridated water. She claimed that this results in a delay in the development of milk teeth by up to 14 months.
Milk teeth usually emerge between the ages of six months and 33 months. These so-called temporary teeth are replaced by permanent ones that normally erupt around ages six to 12. Dentists here tell LifeStyle that there is little evidence to support Ms Warren’s assertions, adding that infants who are fed water without fluoride are put at a disadvantage.
As Dr Joyce Boudeville, a dental surgeon with Raffles Dental, says: “Scientific research shows that water fluoridation is one of the 10 greatest public health achievements of the 20th century.” Among the benefits of fluoride are stronger teeth, hindering bacterial growth and inhibiting the formation of plaque, a colourless film that is formed on the teeth by bacteria and can lead to tooth decay.
Associate Professor Stephen Hsu, a paediatric dentist with the National University Hospital, notes that a variety of factors can affect the development of milk teeth. These include nutrition, genetics and whether the expecting mother has developmental diseases. Conditions such as Down syndrome, a developmental disorder, can delay the eruption of milk teeth.
Prof Hsu says it is “extremely unlikely” for fluoridated water to have an extensive effect. When asked if the slower onset of milk teeth is detrimental to a baby’s growth, Dr Boudeville debunks the thought. She notes: “Infants are normally fed milk. And as they grow, their diet is normally supplemented with semi-solid foods, for example, mashed potato and squash, porridge and mashed bananas. “This is gradually done and as more milk teeth emerge, parents would introduce more solid foods.”
In Singapore, fluoride has been added to the water supply since 1954. In response to a parliamentary query in April about fluoride in the drinking supply, a Health Ministry spokesman cited the findings of the Cochrane Collaboration Oral Health Group, an international expert group based in Britain. “It has studied allegations of health risk due to water fluoridation. They found no evidence of such an allegation, so long as the water fluoridation is kept within a certain concentration,” said the ministry spokesman.
The latest WHO guideline prescribes it at 1.5mg per litre. The fluoridation level in Singapore’s tap water is 0.6mg per litre. Dr Boudeville says one possible side effect of excessive fluoride ingestion is dental fluorosis, or faint white markings on the front of the teeth. “This is mostly mild and not normally a cosmetic issue,” she says.
The ministry spokesman added that fluoridated water has been effective in reducing tooth decay. One measure of dental health is the DMFT (Decayed, Missing and Filled Teeth) Index. The index for 12-year-old children here has fallen from 2.97 in 1970 to 0.54 in 2003. This figure is among the lowest in the world.
For expecting mothers concerned about the future development of their children’s teeth, Dr Boudeville has this advice: “Eat a well-balanced diet. Avoid excessive sugar, high carbohydrate and acidic foods. “Practise good oral hygiene and ensure there is no periodontal disease during pregnancy.” While a diet of excessive sugar and high carbohydrates has no direct effect on the foetus’ developing teeth, it will have a more significant effect on the mother herself and therefore affect the general well-being of the developing foetus. She adds that parents should take their children to the dentist as early as possible to detect any possible development problems.