Some things don’t need a click-baity title to make you sit up and pay attention – such as an argument against fluoride from what appears to be an overall pro-fluoride position.
As a treatment for tooth decay fluoride is effective, there’s no denying it. But while arguing how and whether it should be used, we’ve forgotten that fluoride is a reactive intervention to the rampant presence of tooth decay in modern society.
Even with the application of water fluoridation in Australia for over half a century, tooth decay is still considered by the Australian Dental Association as one of the country’s most prevalent diseases. The problem is that fluoride fails to address the core reason of why tooth decay occurs: our diet.
Specifically, that means refined sugar and other simple, processed carbohydrates. Once eaten sparingly, such carbs have come to dominate the Western industrial diet.
Dental decay has only existed in its contemporary form for about 200 years, or since the turn of the industrial revolution. This is when you can pinpoint the introduction of large-scale delivery of refined grains into our diet. It’s also where our diets transformed from consumption of local produce to the global business that food is today.
Before this, archeological records show that humans lived for thousands of years without the significant presence of any dental disease. In the animal kingdom tooth decay is equally rare. The unsettling reality is that tooth decay is a disease of human civilisation….
As the author notes, obsessing over fluoride or other non-dietary intervention is necessarily reactive, an after-the-effect attempt to mitigate the damage caused by poor or thoughtless dietary choices. And as a paper in PLOS Medicine  showed earlier this year, that’s just how the sugar biz wanted it.
The sugar industry could not deny the role of sucrose in dental caries given the scientific evidence. They therefore adopted a strategy to deflect attention to public health interventions that would reduce the harms of sugar consumption rather than restricting intake… Seventy-eight percent of the sugar industry submission was incorporated into the NIDR’s [National Institute of Dental Research’s] call for research applications. Research that could have been harmful to sugar industry interests was omitted from priorities identified at the launch of the NCP [National Caries Program].
It was simply declared “unrealistic” to go after the primary cause of caries. So the emphasis went to interventions such as fluoride and sealants – as if these were the only weapons available to combat decay. Touting fluoride became a real distraction from the more critical task of lowering sugar intake.
Happily, more voices are sounding out in the mainstream, urging the dental profession to finally zero in on the number one risk factor – some would even argue the only real risk factor – for caries. As recently reported by Dr. Bicuspid , a paper in the October issue of the Journal of Dentistry, in fact, makes this very point.
“…it is clear that sugars start the process and set off a causal chain; the only crucial factor that determines the caries process in practice is sugars,” the authors wrote. “Thus, to stress the multifactorial effects on the sugars-induced causal process muddies our understanding and misdirects policy.”
To back up their claim, they drew evidence from research, including a study on people with a hereditary fructose intolerance, population studies before and after average sugars intake spiked, and systematic reviews. Such evidence showed that despite interventions, caries steadily progresses with age, its effects are lifelong, and there is a causal relationship between free sugars and dental caries.
“So why call caries an infectious transmissible disease when the presence of these microorganisms in the mouth is ubiquitous,” he asked, “and it is only the addition of sugars that then stimulates their proliferation and adhesive qualities and allows them to produce the acids required for dental caries?”
“Because it’s easier to fall back on fluoride and sealants?” That would seem to be the most honest answer for many. But as ever-high rates of dental disease continue to tell, it’s clearly far from the right one.