Fluoridation still vital in the age of COVID-19

Article: 'To protect the integrity of equitable public health infrastructure, community water fluoridation is imperative'

COVID-19 has reaffirmed the importance of disease prevention and the value of public health infrastructure, according to an article published in the Journal of Public Health Dentistry.

The pandemic also helps illustrate the barriers standing in the way of — as well as the continued need for — another vital preventative program: community water fluoridation.“ Community water fluoridation is a population health program that is in a unique position to equitably prevent dental caries across all socioeconomic groups,” wrote the authors. “As vaccinations for COVID-19 are rolled out to communities, offering new opportunities for disease prevention, we recognize another milestone across the United States: the 76th anniversary of community water fluoridation.” The article, published Oct. 14, was co-authored by Howard Pollick, B.D.S., a fluoridation consultant for the California Department of Public Health, a health sciences professor at the University of California, San Francisco School of Dentistry and a member of the ADA’s National Fluoridation Advisory Committee. The other author was Tooka Zokaie, manager of fluoridation and preventive health activities for the ADA Council on Advocacy for Access and Prevention.>In an interview with ADA News, Dr. Pollick said that the COVID-19 pandemic exposed weaknesses in the country’s public health infrastructure due to political naiveté, and that it requires much effort to overcome.

"While access to dental care is rebounding from the restrictions during the early phase of the pandemic, it may have been that community water fluoridation provided many with the main source of protection against tooth decay," Dr. Pollick said. “Much effort will be required going forward to expand the benefits of community water fluoridation.”

In the article, the authors noted that barriers to an expansion of community water fluoridation are rooted in public perception, despite research continuing to show the safety and efficacy of this public health program.

“COVID-19 has added an additional challenge and exposed the lack of adequate and equitable funding for public health budgets,” according to the article. “As health budgets are given a closer look, one of the most equitable and impactful public health programs is at risk in countless communities. To overcome the challenges facing this preventive measure, health professionals at the national, state and local levels will need to enhance their promotion of fluoridation and commit the necessary resources for equipment, personnel and training.”

COVID-19 interrupted many community services and public health initiatives, such as access to routine dental care in community health centers and school-based programs, the authors wrote.

“These interruptions disproportionally affected communities of color and lower socioeconomic communities,” the authors wrote. “Studies have shown that populations from lower socioeconomic groups within fluoridated communities have less tooth decay when compared to peers in nonfluoridated communities. To protect the integrity of equitable public health infrastructure, community water fluoridation is imperative.”

The authors concluded by saying that dental professionals promoting community water fluoridation are key factors in sustaining and expanding this health program. Mask mandates and social distancing have been encouraged by public health leaders to reduce the rate of infectious disease spread, and the same advocacy can be done for fluoridation.

“Interprofessional collaboration at the local, state and federal level with trusted community partners could address health literacy, the culture of doubt and the spectrum of hesitancy,” according to the article. “It is imperative that dental public health advocates obtain the best evidence on community water fluoridation and continue to share the science of this important decay-preventing practice.”

Evidence-based resources are available for community water fluoridation advocacy, such as the 2018 edition of “Fluoridation Facts” available at no cost at ada.org/fluoride.