QMUL Article Flashcards
(12 cards)
Can you summarise the article?
1) so from my understanding, studies by the national toxicology program have requested an updated risk-benefit anaylsis of fluoride.
2) fluoride has been added to drinking water since the mid 20th century and is in the majority of US water supplies.
3) there is established research demonstrating fluoride helps prevent tooth decay, some people including Robert F Kennedy jr, who is US’s health secretary have raises concerns that it has potential neurodevelopmental effects, especially in children.
4) For example, the national toxicology program found a link between higher fluoride exposure and lower IQ in children and a Cochran review found that the effects of fluoride are less beneficial because of fluoride in toothpaste.
5) There’s a strong need for oral health care solutions in the US due to limited access to dental care and it being too expensive for many Americans to afford.
6) there are ongoing studies investigating potential effects of fluoride on sleep and other non-dental issues with funding from the NIH, as they need to balance the benefits of fluoride against the possible risks.
What is your stance on water fluoridation and why?
1) water fluoridation has been a highly effective public measure being put into place. It has very robust evidence to prove that it helps prevent decay, for example fluoridating water to 0.7mg per litre led to nearly a 26% reduction in tooth decay. This is due to fluoride interacting with the enamel to strengthen it and make it more resistant to acid.
2) I also feel that especially in the US where dental access is limited and many people struggle to afford dental care or insurance, this is an effortless way to provide some healthcare benefits to underserved communities, and it almost acts as an equaliser to ensure as many people as possible have good oral health. This does link to the medical ethics pillar justice as it allows individuals to improve oral health without additional costs. US also has high obesity levels due to a diet high in sugars so water fluoridation is more beneficial there.
3) however it is important to acknowledge the ongoing debate about potential risks with fluoride and keep up with new research findings. For example, the NIH is funding research to look for the potential negative affects of fluoride and studies have gone on looking at the association between fluoride and low iq in children done by the national toxicology programme. Another issue not directly mentioned in the article is that not everyone can have the choice in the water they choose, as it is impossible to get consent from everyone.
4) Right now a lot of the research is correlational, so cause and effect cannot be established and there could be an unknown third factor affecting both variables so a lot of the evidence is inconclusive. It is also difficult to get everyone’s consent on water fluoridation as everyone has different opinions.
5) If future studies show conclusive evidence of harm, they should adjust the public health recommendations accordingly but for now, I support water fluoridation as a preventative tool for dental health.
Can you explain the history and purpose of adding fluoride to water?
1) it was added to drinking water in the mid-20th century as studies were done in the grand rapids in Michigan which had naturally high fluoride levels, and these regions were more resistant to tooth decay.
2) the primary purpose of fluoride is to reduce tooth decay as it interacts and strengthens the tooth enamel, making it more resistant to acids.
What are the potential health risks associated with fluoride mentioned in the article?
1) recent studies including one done by the national toxicology program have raised concerns that fluoride may cause neurodevelopmental effects especially for children.
2) they suggest that if children are exposed to levels double that in fluoridated water, it can lead to lower IQ levels.
3) the Cochrane review also mentioned that fluoride’s beneficial effects have decreased due to fluoride in toothpaste
4) However organisations like the CDC continue to support water fluoridation saying there’s a lack of convincing evidence . It’s important to keep up with dental research to see if this research becomes proven.
How has the availability of fluoride in toothpaste affected this debate?
1) the cochrane review suggests that the effects of fluoride are not as beneficial as they seem to be, because all toothpaste contains fluoride.
2) However you do have to take into account those without regular dental access, especially in america where there are dental deserts and dental care is expensive, water fluoridation is crucial so that as many people as possible have access to dental care.
How would you approach the issue of fluoride as a future dentist for patients?
1) if a patient expressed their concerns about the effects of fluoride, I would first listen to their concerns carefully and acknowledge new research going on.
2) I would explain that many major health organisations like the CDC show the benefits of fluoride in helping to prevent tooth decay and that the benefits far outweigh the potential risks, especially at recommended levels.
3) I would also reassure them that fluoride levels are carefully regulated based on up to date research and recent studies have yet to show conclusive evidence of harm.
4) it’s important to approach this situation with empathy because the patient is just worried about their health. Make sure to be non-judgmental the entire time . One of the medical ethics pillars being non-maleficence, it’s important to treat the patients with respect and ensure that they do not feel embarrassed or uncomfortable.
Do you think this source is credible?
1) the article was published by the guardian which is a reputable news source. there are a lot of respected public health institutions mentioned in this article. For example the CDC is a leading authority on health and safety and the American dental association are very important in the fields of dentistry and their support for water fluoridation are grounded in decades of research.
2) even some of the researchers and experts mentioned specifically such as Bruce lanphear who works for the NTP, are credible in their field of work and their work is often peer reviewed, so mistakes would’ve been caught before publishing.
3) I would say almost all the sources mentioned in the article are credible. It also provides a balanced argument where it mentions the potential risks and the proven benefits so it’s seems like it’s not a biased article, and it’s purpose is just to educate the public on the debate with fluoride in drinking water. Though this article was published around 2 months ago, there hasn’t been an updated risk-benefit analysis produced yet, however some researchers are arguing that we are taking the effects of fluoride for granted, and that we should find other ways to reduce fluoride exposure to the public.
Who are the individuals for fluoride?
Dr Koka- strongly supports water fluoridation. He emphasises the effectiveness of fluoride in preventing tooth decay especially in “dental deserts” where access is limited. He describes it as a “perfect example” of helping people passively.
CDC- supports water fluoridation. They believe there is no convincing scientific evidence linking water fluoridation to any adverse health effects like cancer and low IQ. Believe it is a key public health measure to prevent tooth decay.
ADA/AAP- support water fluoridation due to the extensive research supporting its effectiveness in reducing tooth decay. The AAP advises caution in the use of fluoride in very young children to avoid excessive exposure.
Dr Rottnek- advocates for public health measures like fluoride especially in communities with limited access because there is a lack of dnegal care in young people in juvenile detention centres.
Who are the critics of fluoride?
Robert F Kennedy- vocal critic of water fluoridation. He describes fluoride as “industrial waste” and wants to limit its use in public water supplies. His stance represents the views of those concerned about the potential health risks of fluoride.
NTP + Dr lanphear- have moderate confidence that children exposed to fluoride levels above the recommended concentration may experience reduced IQ. Lanphear wants Pause in water fluoridation until scientific reviews are conducted.
There are researchers like Ashley Malin and Christine Till still researching effects of fluoride on neurodevelopmental and sleep patterns.
Cochrane review- they believe that while fluoride was effective prior to 1975, the widespread use of fluoride toothpaste since then has likely reduced the magnitude of its effect today. Dana Goin is looking at effects of fluoride on reproductive health.
What is the EPA?
The environmental protection agency protects people and the environment from significant health risks, sponsors and conducts research and enforces some regulations. They have conducted a lot of research to do with fluoride and have a fact sheet educating the public on current limits, their actions and potential adverse health effects.
What do you find interesting about this article?
1) what I find most interesting about this article is the difficulty in balancing the public health benefits with potential concerns with fluoride. Fluoride has been recognised for a long time for its positive effects on oral health and preventing tooth decay, which is especially beneficial for underserved areas.
However the article also highlights the idea that constant new discoveries and how there is now an association between fluoride’s potential negative effects like lower IQ in children. It shows that science is always progressing and new findings can challenge ideas that have been accepted for a long time. There’s also contrasting views from the CDC and ADA supporting fluoridation.
3) I also appreciate the article mentioning the ethical components of water fluoridation, and how it’s not just about scientific discoveries but also to the best thing for the public. There are many links between this article and the medical ethics pillars like justice and having good oral health to underserved areas, and it’s important to take all of these into account when making a decision on water fluoridation .
What would you bring to queen Mary’s?
1) firstly being someone who is Sikh and Punjabi, and takes a lot of pride in my religion, I would definitely join these societies at queen Mary’s. Not only would it let me meet new people who also appreciate their culture but also allow me to organise events within the society like Bhangra night or something similar. I do love planning events and it’s a really good way to bond with other people. Queen Mary’s also have baking society, with baking being one of my hobbies, I would definitely be an asset to that.
2) I also saw that queen Mary’s has a RAG week, where the university does fundraising for a lot of different charities. This is something I’d definitely like to be apart of if I had the opportunity to study there. I have organised a charity bake sale at my school, which raised a bit of money for children in need, and I would love to host more of these events on a larger scale alongside other people.
3) I am also interested in doing research while studying, and I know that queen Mary’s is very research orientated, and even has the opportunity to intercalate while doing a dental degree. I would love to take part in research projects for the university and discover and learn new things.
