General Articles

TEETH WITHOUT TOOTHACHES

Scientists wondered why kids around Ripley, Ont., had good teeth. Here’s what they found

GEORGE H. WALTZ September 15 1947
General Articles

TEETH WITHOUT TOOTHACHES

Scientists wondered why kids around Ripley, Ont., had good teeth. Here’s what they found

GEORGE H. WALTZ September 15 1947

TEETH WITHOUT TOOTHACHES

GEORGE H. WALTZ

THE LITTLE Ontario village of Ripley, a half dozen miles back from Lake Huron’s eastern shore, has been referred to as Canada’s “town without a toothache.” Its nickname is an exaggeration—but it has considerable basis in fact. Of some 400 inhabitants, few of the born-and-raised-there townspeople have had any of the tooth troubles that plague most of us. For many of them, cavities and fillings are the exception, not the rule. In a recent mouth-tomouth survey Ripley lived up to its “believe it or not” name with a dental showing of nine sets of perfect teeth out of every 10!

About a hundred miles to the south and east of Ripley is the city of Brantford. It too may someday in the not-too-distant future join Ripley’s ranks, if its health officers and dental experts have their way.

For almost two years now, one thing—a fluorine-fortified water supply— has been common to both towns. Fluorine, in the form of a fluorine

salt or fluoride, has long been a natural ingredient of Ripley’s artesian-well water source and has been cited as the main reason for the town’s amazing dental record. In the case of Brantford, sodium fluoride is now being added to the city’s water as part of a long-term controlled experiment to test the ability of fluorinated drinking water to protect teeth against decay.

The Brantford fluorination test is just one of a series now being carried on jointly by Canada and the United Stales. Across the border similar mass experiments are now in progress in Grand Rapids and Midland, Mich., Sheboygan, Wis.,and Newburgh, N.Y. In each case the individual water supply is being fortified with minute quantities of fluorine in the form of sodium fluoride, and careful periodic checks are being made of all children’s teeth to determine whether or not the number of dental cavities is reduced.

While these long-range fluorinated water tests are going ahead, dentists and technicians working in clinics and large children’s institutions are checking the possibilities of applying a weak solution of sodium fluoride directly to the teeth to obtain the same decay prevention. Many private dentists already are using and recommending the treatment.

If these varied tests prove successful, the use of sodium fluoride either as a tooth swab or as part of our drinking water would become widespread. At the moment the prospects look promising. So far, the combined Continued on page 64

Continued on page 64

Scientists wondered why kids around Ripley, Ont., had good teeth. Here’s what they found

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early results tend to indicate that sodium fluoride used early enough in a tooth’s life can reduce eventual decay j by at least 45%. Quite an item when you consider that the average dental bill for each of us during a lifetime is about $650 and that few of us have all the tooth repairs made that should be I made.

For us oldsters, however, there appears to be just one unfortunate hitch. Many scientists believe that to get in its beneficial work the sodium fluoride i must be available to the adult or second teeth before and during their calcifying or hardening stage, which means during the school years. Once our teeth are fully formed and enamelized, they say, the fluoride treatment seems to have little or no effect. Others contend that fluorine solution can be of some benefit to adult teeth.

This apparent ability of fluorine to help build better teeth and arm them against decay was first discovered in 1931, but the actual beginning of the trail of research and medical detective work goes back more than 30 years.

Water on the Tooth

It all began in 1916 when parents in the small rural community of Oakley, Idaho, noticed that something strange was happening to their youngsters’ teeth. Second teeth that had come in white and smooth were becoming discolored and mottled or pitted. Whatever it was, it was not affecting the teeth of the grownups or of the older boys and girls. They called in Dr. Frederick McKay, a Colorado dentist who had had some previous experience with tooth discoloration among his own patients in Colorado Springs.

After talking to the town fathers Dr. McKay discovered that the tooth disfigurement had appeared shortly after Oakley had tapped a new source of water. He also found that the teeth of children living on Yiearby ranches with independent water supplies were unaffected. It was evident that something in the new water supply was causing the trouble, so, on Dr. McKay’s recommendation, the townspeople raised the necessary funds and tapped still another source, drawing the water from an area where there was no evidence of tooth discoloration or mottling.

About eight years later Dr. McKay decided it was about time to check up on Oakley. He figured that by that time a new generation of children would have grown enough permanent teeth to reflect any change. What he found proved his original recommendation to be sound. The teeth of the new crop of youngsters, who had never been exposed to the old water, were entirely normal without the slightest trace of mottling. But even more startling was the fact that the teeth of those children who had been exposed to both types of water showed a definite demarcation ! line between those that had calcified or ¡ hardened under the influence of the old water and those that had calcified j under the new. In the older children ! the mottled enamel caused by drinking the old water had in no way been eliminated by the new.

It was not until a few years later that fluorine was identified definitely j as the active agent in the water that had caused the “trouble”—a trouble that now is proving to be a blessing. In 1928 Dr. McKay was called into action again. This time to survey a J similar condition that existed at Bau1 xite, Ark. The story was somewhat

the same. Again the enamel of children’s teeth had become pitted and mottled shortly after the installation ot a new water supply. Again teeth that had calcified before the change to the new water had not been affected. And again Dr. McKay recommended that water be piped into the town from another nearby community that was free of the tooth troubles.

As with Oakley, Dr. McKay returned to Bauxite some few years later to check up, and it was then that he made his most important discovery. As he had suspected the new water had completely eliminated the mottling ot the younger children’s teeth, but the average number of cavities per child had increased. Teeth which had calcified after the change to the new water showed a higher rate of cavities than those that had calcified under the influence of the old water. There was just one answer: something in the old water not only had pitted and disfigured the enamel but also had permanently reduced the tendency to decay.

Chemical tests of the old water and the new showed just one main difference—the old water contained 14 parts of fluoride in every million, the new contained none. Analyses of other water supplies where mottled teeth were prevalent showed they too were distinguished by a high fluorine content. The old well at Oakley was found to contain eight parts of fluoride per million as against practically none for the new. The natural conclusion was that fluorine in some way or another was a first-class decay inhibitor. Toothaches and cavities had always been considered a necessary evil about which little in a preventive way could be done. Now, Dr. McKay hoped, perhaps something could be done.

The Government Moves In

At this point the U. S. Public Health Service began to take a more active interest in the proceedings, under the able guidance of Dr. H. Trendley Dean. The next step was to evaluate the effectiveness of fluorine as a toothdecay preventive and to determine the minimum concentration of fluorine in drinking water that would help prevent decay and still not mottle or disfigure the teeth.

First a small, but detailed, study was made. Two comparable towns were chosen. One, Galesburg, 111., had a water supply that showed about two parts of fluorine per million. The other, Quincy, 111., used a practically fluorinefree water. Careful checkups of the school children’s teeth in the two communities showed a third more cavities in the mouths of the children who had been drinking Quincy’s fluorinefree water than in the mouths or Galesburg’s children who had been drinking naturally-fluorina ted tap water.

The next step was a broader study in 21 cities scattered through four states. In these cities, with water supplies containing varying amounts of fluorine,more than 7,000 school children between the ages of 12 and 14, who had been exposed to their iocal water for most of their lives, were given extensive dental examinations. The final results supported the fluorine theory. Children using water containing between 1 and 1.4 parts per million of fluorine averaged about 2.9 decayed, missing, or filled teeth per child. In cities using water containing less than one half part per million of fluorine, the average per child jumped to 7.4. Where water supplies showed only slight traces of fluorine, or none at all, the cavity rate was about 20 times that

in localities using water with one or more parts of fluorine per million.

As for the minimum fluorine concentration, about one part in a million seems to be just about the ideal. In this strength it has no effect on the appearance of the teeth and still tends to reduce tooth decay. It is this concentration that is being used in the mass fluorination experiments in Canada and the United States.

Experts say it will be five or ten years before the results of these mass fluorination tests can be properly evaluated. A generation of children, whose second teeth have just erupted, must be exposed to the fluorinated water before its decay-preventing properties can be carefully measured.

In the clinical tests, where a solution of sodium fluoride is applied directly to the teeth, the results are showing up sooner. This treatment, called “topical application,” consists of swabbing the teeth with a one to two per cent solution of sodium fluoride at intervals over the course of a year. The research department of the University of Toronto’s faculty of dentistry found that a one per cent concentration of sodium fluoride protected the enamel surface of teeth to a remarkable degree from acid attack. Amazingly enough, a one-year series of treatments seems to do the trick for a lifetime if the teeth have not already calcified. In a recent test, in which 563 school children’s teeth were painted with sodium fluoride solution as prescribed, the group showed a 40.1% reduction in cavities over a similar group whose teeth had not been treated. An interesting, but at the same time discouraging, fact is that similar tests carried out on adults showed no reduction in cavities.

Why fluorine appears to strengthen teeth against decay is still not thoroughly understood. Researchers are not even entirely sure whether the fluorine is absorbed by the teeth on contact or taken up through the intestines, although tests so far indicate the former. One thing, however, has been fairly well established — a minute amount of fluoride incorporated into the tooth structure before calcification does help the tooth to remain healthy and resist decay. The enamel of a perfect tooth invariably contains more

than one and a half times more fluoride than a tooth with cavities.

No broad serious scientific investigation such as this is ever without its lighter and humorous side. Not long ago the newspapers, with a certain amount of naive amazement, discovered that the people of Hereford in Deaf Smith County, Texas, had remarkably good teeth. The guesses as to the cause ran the gamut from climate to drinking water to something special in the soil in which they grew their food and cattle feed. Immediately wheat from Deaf Smith County skyrocketed crazily in price and producers of foods for health faddists eagerly bought it. One enterprising Californian even bought Hereford water in tank-car lots so it could be put up in fancy bottles and sold at fancier prices. Later checks of Hereford’s water showed just what McKay had discovered under similar circumstances years before—a fairly high fluorine concentration.

Because of the necessity of making annual dental checkups of school children during the present tests, the cost of the research is fairly high—averaging about $25,000 a year for a city the size of Brantford. However, once the plan proves practical, the average medium-size city having a modern water-treatment plant will be able to fluorinate its water for an average annual outlay of about $1,500 or about five cents for each person. That’s cheap protection, no matter how you figure it.

Another interesting possibility about the medical properties of fluorine deserves mention, but this aspect, too, will require many more years of research. Recent studies, conducted by Dr. Hans Reese and Dr. John Frisch of the University of Wisconsin, tend to show that the virus of poliomyelitis may enter the body through decayed teeth. The same team conducted geographical surveys of water supplies which show further that communities having fair concentrations of fluorine in the water also have about 30% fewer cases of infantile paralysis.

If the hopes of health officers in Canada and the U. S. are fulfilled, every town may, like Ripley, Ont., cut down on its citizens’ dental bills, if