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Abstract

Community water fluoridation (CWF) has both benefits and challenges to the health of communities. It is implemented by relevant authorities such as the municipality and other government agencies. The consumption of fluoride in water results in the mineralization of both bone and enamel of the tooth. Its impact on the teeth causes hardening, which makes teeth resistant to acidic dissolution from bacterial pathogens, thus preventing dental caries. Increased dental health, in turn, improves personal image and nutrition. However, fluoridation violates ethical values because people consume water with this chemical without consent to have it. Moreover, excessive fluoride in the body increases the likelihood of suffering from dental and skeletal fluorosis, which causes bone pain and yellowing of teeth. Its accumulation in bones can also cause osteosarcoma. Research has further associated the consumption of this element with poor growth and development of the brain, resulting in low intelligence quotient among children. Furthermore, fluoride impacts the environment since chlorofluorocarbons contribute to ozone layer depletion, predisposing individuals to skin cancer. Additionally, fluoridation affects the entire food chain because of fluoride accumulation in the food system.

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Water Fluoridation

Community water fluoridation (CWF) creates an immense controversy over the perceived benefits or risks incidental to the consumption of fluorine. It is the manipulation of the naturally occurring levels of fluoride by adding the mineral to the water for human consumption. According to Gopal and Ghosh (2014), fluoride is an element that occurs naturally in most foods and portable water sources. Although fluorine is considered non-essential for the growth and development of the human body, moderate intake of this mineral is beneficial. Conversely, some studies have proposed that a prolonged exposure to the mineral is associated with adverse health effects, something that results in the opposition to the fluoridation of community water (Choubisa, 2012). Therefore, as the fluoridation of community water is based on conflicting evidence, it is essential to carefully scrutinize the relevant research to achieve a clear understanding of this burning issue.

Community Water Fluoridation

CWF is decided by administrative authorities such as municipalities and government agencies. In Canada, the territorial and provincial governments are the ones with the responsibilities of regulating the quality of drinking water within their jurisdictions (McLaren et al., 2016). CWF is decided by the respective municipalities in collaboration with territorial or provincial governments after consulting with their residents. Connett (2012) explains that only Ireland, Serbia, Spain, the United Kingdom, and Poland fluoridate their water for community consumption in the entire European continent. At the same time, the majority of developed nations such as Japan and most western European countries do not fluoridate their water (Connett, 2012). In the United States, most public water supplies are fluoridated, with more than 185 million people consuming fluoridated water (Connett, 2012). In some nations, the natural levels of fluoride in the water are high, eliminating the need to add the mineral to this natural resource artificially. Some of these countries include China, India, and some African states. In fact, some nations have high levels of this element in their water, something that compels them to remove it because of the adverse health effects it can cause.

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Positive Impact of CWF on Dental Health

Having healthy teeth has substantial benefits to people and societies. A better understanding of various factors that relate to the loss of teeth is crucial because healthy teeth are not only a vital but also a visible component of the general well-being of a person. Neidell, Herzog, and Glied (2010) explain that teeth are necessary for the maintenance of the general body health through nutrition, and they contribute to the general physical appearance of individuals, which significantly impacts one’s employment opportunities and earnings. Through such benefits, unhealthy teeth can affect a quality of life of many people in the society because it directly influences self-esteem and personal body satisfaction (de Paula, Santos, da Silva, Nunes, & Leles, 2009). Furthermore, poor oral health impacts the productivity of employees and subsequently results in adverse economic effects to any nation. In a research survey carried out by the British Dental Health Foundation, over 415,000 workers took time off their work because of dental problems while 1.1 million people were admitted or took off work time to look after their children suffering from oral health conditions (Oral Health Foundation, 2013). Such a figure shows that dental health affects the United Kingdom because a substantial number of its employees miss work because of the health issue.

Fluoride is added to water because of its health effects on the teeth as it prevents dental caries. Connett (2012) asserts that this mineral is added to drinking water because of its purpose of medical treatment. The renowned U.S. Food and Drug Administration considers this chemical as a drug if it is used to either mitigate or prevent diseases (Connett, 2012). In fact, adding fluoride to consumable water with the primary purpose of preventing tooth decay, which is a non-waterborne disease, is a particular form of medical treatment. Dhar and Bhatnagar (2009) reiterate that fluoride is an essential element that promotes healthy growth and development in both animals and human beings because it increases bone and tooth mineralization, contributing to their hardness. Its impact on mineralization of the enamel makes teeth resistant to dental caries and subsequent tooth loss. Thus, the importance and effectiveness of maintaining and promoting dental health should be encouraged through the fluoridation of community water supplies (Armfield, 2010). From these assertions, it is clear that this mineral proves useful in the dental health of individuals, justifying why some countries and states have adopted water fluoridation for human consumption.

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The United States has also seen the benefits of CWF; therefore, most states of this developed nation provide it to the locals. Studies have found that fluoride plays a critical role in the maintenance of dental health through combating demineralization of the enamel, which is initiated by the caries process (Nanci, 2012; Kumar & Puri, 2012). Neidell et al. (2010) explain three ways in which fluoridation of public water supplies can positively impact tooth loss among populations of different ages. First, water fluoridation reduces childhood dental caries incidences. The reduction happens because this mineral reduces the probability of developing unchecked caries in which bacterial pathogens penetrate tooth tissues, including the enamel, the dentin and the pulp, which subsequently leads to the necrosis of the pulp, hence tooth loss. Second, the exposure to this mineral element before tooth eruption is known to alter the composition of enamel, which is the mineralized part of the tooth composed of hydroxyapatite crystals (Berg & Slayton, 2009). The incorporation of fluoride into these crystals from fluoridated water makes the enamel much more resistant to acidic dissolution. In their study, Neidell et al. (2010) found that CWF levels at the time of one’s birth were related to tooth loss within the U.S. population. Their results showed that out of every four people who lived in countries with fluoridated water at their time of their birth, one person had at least one more tooth compared to those who had not lived in such countries. It shows that water fluoridation has a lasting effect that can protect individuals from tooth loss even in their adulthood. Finally, the exposure to mineralized water in adulthood can improve oral health through the provision of continued protection of teeth throughout the life of an individual (Neidell et al., 2010). Therefore, mineralization of community water with this element is essential not only to the health of an individual but also to the entire society.

Reason for Opposition to CWF

Many scholars have complained of CWF because of its unintended side effects on the health of communities. Furthermore, the mineralization of community water is a violation of the rights of people to make a choice on whether to utilize a drug. Connett (2012) asserts that informed consent is the standard of practice in ethics for all medication, which has made most Western European nations rule against fluoridation. As fluoridation aims at the prevention of diseases, it is mandatory to acquire informed consent from the people before mineralizing their drinking water. It means that countries and states that fluoridate community water supplies violate the moral right of individuals to give informed consent.

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CWF has negative consequences that impact the community. It accumulates in bone and tooth enamel, causing mineralization. However, excessive fluoride in the human body causes both skeletal and dental fluorosis (Dey & Giri, 2016). Skeletal fluorosis results in bone structural and functional challenges that include osteomalacia, osteosclerosis, exostosis formation, and osteoporosis (Dhar & Bhatnagar, 2009). These problems cause chronic joint pain and dose-related ligament calcification, which may be misdiagnosed as osteoarthritis. Research further indicates that other than escalating arthritic symptoms, fluorine toxicity causes softening of bones and, fertility problems, negatively impacts brain development, and increases the probability of developing cancers (Villanueva et al., 2014). Moreover, research has linked excesses fluorine in the body to osteosarcoma, a common type of bone cancer, due to its accumulation in bone growth plates (American Cancer Society, 2015). The American Cancer Society (2015) also asserts that osteosarcoma starts to develop in this part of the bone. Therefore, this element has negative impacts on the health of the population.

Finally, CWF negatively affects the environments, as well as the intelligence among children. Excessive fluoride interferes with the normal growth and development of the brain, which contributes to low intelligence quotient among children (Eswar, Nagesh, & Devaraj, 2011; Kundu et al., 2015). According to Connett (2012), the purported association between intelligence quotient and CWF has been reported to be the main reason Portland is against it. On the other hand, CWF poses ecological risks. As it is chemically inert, its effects on the environment are sustainable, meaning that it affects the entire food chain (Darchen, Sivasankar, Prabhakaran, & Bharathi, 2016). Furthermore, it is part of chlorofluorocarbons that enhance the depletion of the ozone layer, which results in an increased risk and incidence of skin cancer.

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Conclusion

Fluoride contributes to skeletal and dental health through increased mineralization. It is necessary for the prevention of tooth decay because it makes teeth much more resistant to acidic dissolution. Improved dental health further enhances general body health and personal image, hence self-esteem. Consequently, it results in better employment opportunities and income, which contributes to economic development. Conversely, CWF violates the right of people to give informed consent before using medication. Additionally, excessive fluoride in the body causes skeletal and dental fluorosis, which has been associated with low intelligence quotient, osteosarcoma, osteoporosis, and osteosclerosis, among many other health problems. It also impacts the ecology since it contributes to the depletion of the ozone layer and affects the food chain. As such, CWF has both benefits and limitations, and there is a need to have definitive studies to justify this practice.