Community Water Fluoridation and Good Oral Health for Spokane Residents

ORAL HEALTH IN SPOKANEAsk anyone why they love living in Spokane and they might say we enjoy good jobs, beautiful recreational opportunities, our kids go to good schools and we have access to health care. These are the things that nurture healthy community and make Spokane such a great place to live, learn, work and play. But not everyone in Spokane has equal access to these opportunities for healthy living. The City of Spokane actually houses one of the poorest legislative districts in the state1, and someone born in North East Spokane has a life expectancy 18 years shorter than someone born on the South Hill.

The Empire Health Foundation’s vision is to transform our region into the healthiest region in the state for everyone. This must start with eliminating those health disparities for our community members. Let’s look at oral health as an example. Our region has some of the state’s worst health outcomes related to oral health2:

of Spokane adults have lost at least one of their natural teeth due to dental cavities

third-graders has rampant tooth decay—meaning at least seven teeth are decayed or filled because of cavities

When children and adults have toothaches or other dental problems, they are more likely to miss school, work and other activities that make their lives productive and meaningful. Untreated oral disease and tooth decay can increase chronic health conditions like diabetes and heart disease. Yet tooth decay is a preventable disease for a community armed with the right resources.

1. U.S. Census Bureau (2012). Table of Poverty Status (of individuals) in the Past 12 Months, 3rd Legislative District in the State of Washington, 2006-2010 American Community Survey 5-Year Estimates. American Fact Finder. http://factfinder2.census.gov.

2. Spokane Regional Health District. (Oct 2010). Healthy Smile, Healthy Life: Improving Oral Health in Spokane County.

Spokane third-graders have experienced tooth decay

EMPIRE HEALTH FOUNDATION AND ORAL HEALTH

Programmatic Investments

Over the past three years, Empire Health Foundation has co-funded with Washington Dental Service Foundation (WDSF) and Providence Health Care to develop and support the Better Health Together Dental Emergencies Needing Treatment (DENT) program.

DENT Community Health Workers are reducing the number of individuals accessing the Emergency Room (ER) unnecessarily for dental care by connecting patients to dental appointments and providing behavioral coaching to prepare patients to receive care. DENT is also improving access to dental services for Apple Health individuals by expanding the network of Medicaid accepting dental providers.

1Assumptions:• Onaverage,thehospitalbilled$650perERvisit• Pastdatashowsthatadentalpatient,whodoesnotgetadequatedentalcare,willreturntotheEmergencyRoom

four times• AmajorityofDENTclientsdonotreturntotheERfordentalissues,resultinginatleast$650insavingsper

enrolled client.

DENT successes:

• $2 million in estimated savings from avoidable ER readmissionscostsinthefirst18months

• Doubled Medicaid accepting dental provider network from 22 to 65 providers

• Increased emergency dental appointments available monthly from 51 to 269

• Through behavioral coaching, DENT patients retain a low no-show rate of under 10%

Empire Health Foundation is moving the dial to improve oral health for everyone.

Community Engagement and Awareness

Ongoing co-funding and partnership with the Washington Dental Service Foundation, including:

• Annual execution of October’s “Teeth Week” to raise awareness of Oral health via earned and social media as well as community events.

• Executive leadership in Smile Spokane, formed out of the Symposium and Teeth Week efforts focused on implementing strategies that improve oral health for all people.

• Co-sponsorship of the April 2015 Oral Health Symposium. 70 cross-sector community leaders gathered to discuss action steps to advance oral health.

» Event was highlighted in a Spokesman Review article (www.spokesman.com/stories/2015/may/01/dental-care-gap-problem-for-adults/) with quotes from Antony Chiang

» BHT’s Executive Director Alison Carl White penned an Op-Ed following the symposium (www.spokesman.com/stories/2015/jun/06/alison-carl-white-lets-maintain-areas-innovation/)

Responsive Grants

Since 2010, EHF has awarded $73,000 in responsive grants for oral health related programs to the following organizations:

• Communities in Schools

• Spokane District Dental Society Foundation (three separate grants)

• Big Table

• Operation Healthy Family

COMMUNITY WATER FLUORIDATION IS A PROVEN, SAFE AND COST-EFFECTIVE STRATEGY TO IMPROVE ORAL HEALTH

Here in Washington, we can see evidence that fluoridation works:

The percentage of third-graders in Pierce County (the county seat, Tacoma, fluoridates) who are cavity-free is 14% higher than the same percentage in Spokane County.

Adjusting the amount of fluoride already naturally in the water to the level needed to prevent tooth decay—like using seatbelts, adding vitamin D to milk or iodine to salt—is a simple step that greatly improves the health of the entire community.

When communities make the choice to update their water systems and fluoridate, they see improved oral health for themselves and their neighbors.

Learn More About Community Water Fluoridation

We want to make sure you are able to get answers to any questions you may have about fluoridation. To findaccurateinformation,youshouldvisittheCDC’swebsite and another website operated by the American Academy of Pediatrics. The web address for the CDC is www.cdc.gov/fluoridation and the other web address is www.iLikeMyTeeth.org.

2. J.V.Kumar,O.AdekugbeandT.A.Melnik,“GeographicVariationinMedicaidClaimsforDentalProceduresinNewYorkState: Role of Fluoridation Under Contemporary Conditions,” Public Health Reports, (September-October2010)Vol.125,No.5,647-54.

3. “Preventing Dental Caries: Community Water Fluoridation,” U.S. Task Force on Community Preventive Services, (2013),http://www.thecommunityguide.org/oral/fluoridation.html.

4. McLaren,L.,et.al.”Measuringtheshort-termimpactoffluoridationcessationondentalcariesinGrade2 children using tooth surface indices”. Community Dentistry and Oral Epidemiology. (2016) 10.1111/cdoe.12215.

5. S.O.Griffin,E.Regnier,P.M.GriffinandV.Huntley,“EffectivenessofFluorideinPreventingCariesinAdults,”TheJournalofDentalResearch,(2007),Vol.86,No.5,410-415,http://www.ncbi.nlm.nih.gov/pubmed/17452559.

Community water fluoridation means adding

a little more fluoride to reach the level that has

been shown to significantly reduce cavities2,3,4

The Centers for Disease Control and Prevention

(CDC) reports that drinking fluoridated water reduces

tooth decay by 25% over a person’s lifetime. This

is especially important for low income and vulnerable

communities who may lack access to quality oral

health care.5

Individual actions, like regular brushing and flossing, limiting your sugary food and drinks, and seeing the dentist, are all important ways to protect your health. But while these habits are very important, they alone won’t provide maximum protection against cavities. That’s where community water fluoridation comes in.

Fluoride is a mineral that already exists naturally in rivers, lakes, groundwater and the oceans, and is used to prevent tooth decay or a more serious infection. Most communities that are Spokane’s size have chosen to add fluoride to their water as an inexpensive way to prevent tooth decay. Yakima, Tacoma, Cheney and many other Washington cities fluoridate.

Community water fluoridation is safe and effective. Fluoridation is backed by more than 70 years of research and experience showing it prevents dental cavities for both children and adults. All of the leading health and medical organizations recommend that communities fluoridate their drinking water. This includes the American Academy of Pediatrics, the American Dental Association and the Washington State Medical Association.

Q & AQUESTION: How does Spokane compare to other communities when it comes to tooth decay?

ANSWER: Consider these statistics:

• A kindergarten student in Spokane is more likely to have rampant decay (at least 7 decayedorfilledteeth)thanthesamechildinotherareasofourstate.

• The percentage of third-graders in Pierce County (Tacoma) who are cavity-free is 14% higher than the same percentage in Spokane County.

QUESTION: Do other areas of Washington State add fluoride to their drinking water? What about the nation as a whole?

ANSWER: Nearly 3 out of 4 Americans whose homes are served by a public water system have access to fluoridated water. In Washington State, more than 3.5 million people receive fluoridated water where they live. Most of the larger cities in our state add fluoride. This includes Tacoma, Yakima, Seattle, and Cheney.

QUESTION: What makes you think that water fluoridation will improve dental health?

ANSWER: One of the many reason we support fluoridation is that it is backed by more than 70 years of research and experience showing it prevents dental cavities for both children and adults.

In fact, the Centers for Disease Control and Prevention (CDC) reports that drinking fluoridated water reduces tooth decay by 25% over a person’s lifetime. All of the leading health and medical organizations recommend that communities fluoridate their drinking water. This includes the American Academy of Pediatrics, the American Dental Association and the Washington State Medical Association.

QUESTION: Some people might object to adding fluoride to the water supply. What about individual choice?

ANSWER: A public water system isn’t owned by an individual; it’s owned by the community. That’s why fluoridation is a community choice. Most communities that are Spokane’s size have chosen to add fluoride to their water as an inexpensive way to prevent tooth decay.

Our nation has a long tradition of adding vitamins and minerals to foods and beverages because they protect human health. For example, Vitamin D is added to milk, iodine is added to salt, and folic acid is added to many breads and cereals. Fluoride is one more example of this.

Q & A CONTINUED

QUESTION: My family and I eat fairly healthy, and we regularly brush our teeth with fluoride. Why do I need fluoride in the water too?

ANSWER: Brushing at least twice a day with fluoride toothpaste is a very good habit. However, toothpaste alone won’t provide maximum protection against cavities. Leading health experts do not view fluoride toothpaste as a substitute for fluoridated water6—and neither should Spokane residents. In fact, the CDC explains that fluoride toothpasteandfluoridatedwater“provideimportantandcomplementarybenefits”7.

QUESTION: Is it safe to add fluoride to water? If so, how do we know?

ANSWER: Fluoride is a mineral that already exists naturally in rivers, lakes, groundwater and the oceans. The process of fluoridation means adding a little more fluoridetoreachthelevelthathasbeenshowntosignificantlyreducecavities.Weknow this is safe because we have many decades of research.

Five committees of the National Research Council have studied fluoride or fluoridationandissuedreports.Noneofthesereportshaveidentifiedanysafetyconcerns about the level of fluoride used for the water fluoridation process. In 2015, the Water Research Foundation issued a report to examine nine common concerns that critics raise about fluoridation. It concluded that “none of these issues poses a risk to public health at [fluoridation] levels.” The research on the safety of fluoridation is well-established.

It’s important to remember that almost anything—even Vitamin D—can have negative effects if consumed in unusually high quantities. Yet we wouldn’t suggest that people avoid consuming Vitamin D.

QUESTION: With all of the problems that Spokane faces, what makes tooth decay so important?

ANSWER:Lastyear,anationaleducationgroupidentifieddentalproblemsasoneofthe seven leading reasons why children miss school. When that happens, children aren’t the only ones who suffer. Spokane’s economic future is undermined when students are absent from school, unable to concentrate in class or performing poorly on tests. Young people who enter adulthood with unhealthy or missing teeth are at a disadvantage when they compete for jobs.

Tooth decay is a preventable disease. This means we can make real progress by improving our eating habits, brushing more regularly with fluoride toothpaste and adding fluoride to our drinking water. More than 18,000 public water systems add fluoride.

6. “U.S. Public Health Service Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries”. U.S. Department of Health and Human Services Federal Panel on Community Water Fluoridation. Public Health Reports. (July-Aug 2015) Vol. 130.

7. DivisionofOralHealth,NationalCenterforChronicDiseasePreventionandHealthPromotion.(April2015).“CommunityWaterFluoridation”RetrievedMarch21,2016fromhttp://www.cdc.gov/fluoridation/faqs/index.htm.