It is most unfortunate that Dr. Glenn resorts to emotional attacks on various scientists and their colleagues, including myself. Her attack on the "Scandinavian cult" is unsubstantiated and unjust. Those countries have some of the lowest levels of caries in the world right now and lead the world in innovative detection and prevention measures.
I believe our intention is to report the findings of well-conducted scientific studies with the aim of improving the oral health of the nation, and indeed the world. At least that is my intent. My article is a review of the current state of our knowledge, but obviously, within the constraints of space in The Journal, it cannot be all-encompassing.
With reference to the topical vs. systemic action of fluoride against caries, I listed only a few of the numerous references that support this with facts. The point is to understand the mechanism so that we can better deliver fluoride as an anti-caries tool to adults as well as children, and so that we can better direct our efforts to individuals as well as public health measures.
This is but a part of the overall message of the article, which is aimed at the practicing clinician. Caries is a bacterially generated disease and we continually omit this critical fact, as has Dr. Glenn in her letter.
My and others’ laboratory studies are merely substantiation of mechanism. The clinical data speak for themselves. For example, the study in England by Hardwick and colleagues, which looked at caries reductions over four years in 12-year-olds who lived in a newly fluoridated area, is clear (
Hardwick JL, Teasdale J, Bloodworth G. Caries increments over 4 years in children aged 12 at the start of water fluoridation. Br Dent J 1982;53[6]:217–22
). Since 12-year-olds do not have developing teeth (except for unerupted third molars) that benefit systemically, this study dramatically showed the topical effect of fluoride.
If you want to refer to well-conducted animal studies, the work of Meyerowitz and colleagues demonstrated no systemic effect in rats, whereas there was a dramatic topical effect (
Meyerowitz C, Spector PC, Curzon ME. Pre- or post-eruptive effects of strontium alone or in combination with fluoride on dental caries in the rat. Caries Res 1979;13[4]:203–10[Medline]
).
Why should we care? Because we want to know the best way to protect the teeth of adults and children to prevent the necessity of invasion of the structure of the teeth by our so-called restorative procedures in future years.
Not only does fluoride in the water reduce dental decay in children, it works for adults too, because it works effectively on the surface of the tooth. Consequently, in communities where the drinking water is fluoridated, the benefit is there for all ages and all socioeconomic levels. In particular, help is given to the underprivileged families who are unable or unwilling to take advantage of more costly measures.
As clearly laid out in my article, fluoride in the drinking water or in fluoride products adds to the protective side of the equation, especially when it is present in the mouth several times a day. A little fluoride applied often is effective.
I do hope that we can keep emotions out of our desire to better prevent caries and intervene for the health of the nation.
