Saturday, March 21, 2015

Dental Waterline Asepsis

Potable water in the United States and Canada has a health standard of less than 500cfu (colony forming units)/ml to be considered safe for drinking. Believe it or not the water that is expelled from non-treated dental lines can be upwards of 1 MILLION cfu/ml!

Why is that dental units can have such a high incidence of bacteria that they would surpass the bacterial load in your toilet? The water lines in your house have large diameters of ½ inch to 1 inch. Dental water lines on the other hand have lumens that are measured in the millimeters. These small diameters are exceptionally great breeding grounds for all sorts of bacteria.

In 1995 the American Dental association put out a release encouraging the industry and researchers to improve water unit output to less than 200 cfu/ml. This is a similar standard in Dialyslate, one of the fluids used in dialysis.

Subsequent to this one of the major changes with newer dental offices units has been the introduction of a bottled water system. Prior to this dental offices received their water from city water lines and the only way to “sterilize” the water was to introduce an iodine filter into the line prior to it entering the dental unit.  The problem with this method is that it often has the undesirable side effect of making the water taste like diluted iodine…. mmmm…. not so great.

Some offices have no protocols in place to sterilize the water and up until recently their was no direct causal evidence that these extremely high bacterial loads posed a tangible health risk. But in 2012, a report in the Lancet, chronicled an 82 year old woman who passed away after developing Legionaires disease – a respiratory illness associated with exposure to L. pneumophilia. The inception of the disease was linked back to her dental office because she had only left her house twice in over a month and both times was to visit her dental office. The report drew worldwide attention and was picked by ABC news and other agencies. Despite immediate treatment with antibiotics the woman developed immediate and irreversible septic shock and died within two days.

This story should have been a shock to all dental offices and forced nationwide change in waterline maintenance. Unfortunately; change takes time and as a profession we are still waiting on mandated changes to infection control with respect to water treatment.

In an effort to be proactive at our clinic we have chosen to protect our patients the best way possible by introducing a daily and monthly waterline treatment developed by the German company Hu-Friedy.  Ultimately this was a win-win for us as we get to make sure our water is as pure as it can be and it tastes great too!

Thursday, March 5, 2015

Drinking Water and the Role of Fluoride and Fluorosis

What is Fluoride?

Fluoride is a natural occurring element in the earth’s crust that is found in soil, fresh water, sea water, plants, foods and many professional dental products. Fluoride is helpful in preventing tooth decay by recrystallizing demineralized tooth enamel.

What is Fluorosis?

Your permanent teeth start forming in your upper and lower jaws starting from the age of 2 to 3 years old. Outside of your wisdom teeth the rest of the crowns of your teeth (the white part that you can see) are done forming by the ages of 8 to 9.

If during this developmental time period you consume too much fluoride the extra fluoride can disrupt the formation of the enamel.  If someone has too much fluoride the changes can range some white spots that are barely noticeable to staining and pitting in more severe cases. Dental fluorosis occurs in children consume too much fluoride from any source.

Only children up to the age of 8-9 are succeptible to the effects of fluorosis. The duration, dosage and frequency with which the fluoride is ingested all play a role in fluorosis. 

Fluoride actually works BOTH while the teeth are developing and every day after the teeth have emerged from the gums. 

What are the common sources of fluoride?
  • Toothpaste if it’s swallowed by young children
  • Fluoridated drinking water
  • Beverages and food processed with fluoridated water
  • Dietary prescription supplements
  • Professional products (mouthrinses, gels, etc.)
Fluorosis is the reason we advise that adults supervise young children under the age of 6 while they brush so they don’t inadvertently swallow fluoride.

If the fluoride in the water is above 0.7mg/ml it is not recommended that fluoride drops or tablets be used.

What are the benefits of Flouride that is added to the drinking water?

Extensive research over the last 50 years by the World Health Organization shows that Fluoride is a low cost, effective way to decrease the rate of tooth decay in children up to 35% ultimately reducing the number of potentially missing teeth in adults. Adding too much can cause fluorosis but having the right amount can be of tremendous benefit.

Within British Columbia how much of the water is fluoridated?

Over 96% of the communities in BC, including the lower mainland, are NOT fluoridated.

The only communities that still DO fluoridate their water are:
  • Cranbrook
  • Fort St John
  • Prince George
  • Price Rupert
  • Sparwood
  • Terrace

So despite the Canadian Dental Association, Canadian Medical Association, Canadian Public Health Association, Canadian Pediatric Society and the World Health Organization all recommending fluoridating water, BC is overwhelmingly against this practice. Why?

Unfounded reports of birth defects, cancer and other syndomes have unfortunately skewed public opinion in much the same way that erroneous reports of vaccinations causing Downs syndrome or ethylmercury in Thimerosal have caused people to elect not to vaccinate their children with potentially life saving medicines.

The likelihood that communities will change back to fluoridation is slim because of anti-Fluoride groups that have been fanatical about it’s eradication from the water supply.  Unfortunately; fear can sometimes win over scientific truths.

Even though the bacterial flora in your mouth play a key role in determining susceptibility to cavities I would suggest at the minimum you have a Fluoride toothpaste, rather than an all natural variety, and of course maintain a low sugar diet as much as possible. Otherwise you might need to see the dentist more often than you like!