ADA Council, ASTDD: Maintaining optimal fluoride levels important in face of additive shortage

'Innovative strategies must be utilized as current supply chain issues continue to impact all sectors of our economy'

The ADA, through its Council on Advocacy for Access and Prevention, and the Association of State and Territorial Dental Directors are working together to provide information and guidance to the dental community and public related to the potential shortage of sodium fluoride, which some communities use to fluoridate public drinking water.

According to the CDC, there are three types of fluoride that can be added to public water systems to achieve fluoridation — fluorosilicic acid, sodium fluoride or sodium fluorosilicate. Most communities use fluorosilicic acid.

Among the number of goods and services that have been affected recently by supply chain issues is sodium fluoride.

“Current supply challenges that limit product availability and cost increases have been reported by various states and water systems to the Environmental Protection Agency, Centers for Disease Control and Prevention and the Association of State and Territorial Dental Directors,” according to CAAP and ASTDD. “These shortages are expected to be temporary. Although they may result in a relatively short-term suspension of community water fluoridation, they should not be used as a justification for ending community water fluoridation. The long-term costs of discontinuing fluoridation are much higher.”

CAAP and ASTDD agree that “innovative strategies must be utilized as current supply chain issues continue to impact all sectors of our economy … It is imperative to support the health of the public and continue community water fluoridation.”

Additionally, according to CAAP and ASTDD, “States and communities will differ in their response to this public health challenge, but collaboration between dental associations, health departments, oral health advocates and community members is essential to ensure that oral health remains a priority. Maintaining optimal fluoride levels for safe drinking water will improve oral health and quality of life and help take a significant step toward achieving health equity.”

Members of the ADA’s National Fluoridation Advisory Committee weighed in on the fluoride shortage faced by some communities.

“Although unfortunate, it’s not a crisis,” said Howard Pollick, B.D.S., a fluoridation consultant for the California Department of Public Health and health sciences professor at the University of California, San Francisco School of Dentistry.

He added that he heard of the shortage being reported for “quite some time … Everything is backlogged.”

Steven M. Levy, D.D.S, the Wright-Bush-Shreves Professor of Research and graduate program associate director of dental public health in the University of Iowa’s College of Public Health, said that studies have shown that cessation of community water fluoridation leads to more tooth decay in those communities.

Dr. Levy had heard that the situation is more of a transportation issue than an actual product shortage issue, with sodium fluoride — like many other products — being a casualty of COVID-19 supply chain issues.

CAAP and ASTDD recommends several ways to cope with current fluoride product shortages:

• “Contact your state health department/oral health program, the ADA, or state dental association to receive help finding additional educational resources for your situation. Many of these organizations have been in communication with organizations in other states that have been experiencing similar supply-chain issues and they may have identified additional resources.
• Engage in community-based advocacy. Other communities have also experienced shortages and may have information on finding alternate suppliers.
• Reference the ADA’s Fluoridation Facts or All About Fluoride on how you can take action and how to advocate for and protect your community’s dental health.
• Forge partnerships with your local oral health champions to continue existing efforts, expand new opportunities, and engage in community-driven grassroots efforts to promote optimal oral health and community water fluoridation.
• Reinforce the power of prevention through good oral health habits, especially when drinking optimally fluoridated water is not readily available.”

Since 1950, the ADA has continuously endorsed optimal fluoridation of community water supplies as a safe and effective public health measure for the prevention of tooth decay. The ADA’s policy is based on the best available scientific evidence on the safety and effectiveness of fluoridation.

For more information on community water fluoridation and ADA advocacy, visit the ADA.org resources on fluoride in water.