The four risk factors of dental decay and effects of water fluoridation

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By John Rothchild DDS

There has been a lot of conflicting information about the benefits versus the risks of fluoridating our
local water supply. To make the most informed decision possible on this issue, one must consider the

There are four risk factors that influence the development of dental decay: diet, bacteria, genetics and
saliva flow.(7) Any one of these risk factors can affect tooth decay, but if you combine the factors you
will get a significant increase of the decay pattern.

Dental decay is the most prevalent disease in childhood today. (4) So why hasn’t water fluoridation
completely eradicated dental disease? Studies in water fluoridated communities versus non fluoridated
communities do not show that water fluoridation decreases tooth decay at all (6,8,10). In fact tooth
decay is decreasing worldwide in fluoridated communities as well as non fluoridated communities at the
same rate.

If you study the risk rate of these factors, you will understand why so many people suffer from tooth

1.Diet: 55 percent of people admit to consuming high levels of sugar (including beverages). (7)
Simply put, the higher the sugar consumption the higher the decay rate. Even children with low levels of
sugar had decay, regardless of water fluoridation or non-water fluoridation. A Brazil study in 2016
showed that children consumed greater than 10 percent of their caloric energy from sugar. (5) The
World Health Organization recommends less than 10 percent caloric consumption per day. Ideally they
recommend 5 percent, the best case scenario would be 3 percent. the average American consumes 23
teaspoons a day of sugar. 3 percent consumption per day would be two-thirds of one teaspoon.
How do we decrease this risk factor? Decrease sugar consumption.

2.Bacteria: 45-51percent increase risk of dental decay (7)
The mouth is colonized by 200-300 bacteria but only a few are associated with tooth decay. So how do
we decrease this risk? Infographics show that people own more mobile devices (4.8 billion) than they
do toothbrushes (4.2 billion). Brushing two to three times a day and flossing once a day will decrease
bacteria. Twenty three percent of Americans have gone two days or more without brushing their teeth
in the past year. Nearly 37 percent of adults ages 18 to 24 have gone that long without brushing. Four
out of 10 Americans floss at least once a day and two out of 10 never floss. A recent national survey
conducted for the Ad Council showed three out of four parents admit their children don’t brush
regularly or frequently skip brushing altogether. A survey of 600 parents with children ages six to 12
showed that brushing negligence affected a full 75 percent of the respondents. The researchers
concluded that dental care is simply a lower priority to parents today. Children’s safety is a much larger
concern and parents are too busy. (2)

3.GENETICS: 30 to 60 percent influence on dental decay. (7)
There are 34 different genes on our DNA that influence decay. Genes may express themselves
differently in different environments. A famous nutritionist said ” genetics loads the gun, the
environment pulls the trigger.” This is true with many health concerns, including decay.

4.SALIVA: Up to 63 percent influence on decay. (7)
As we age our salivary flow decreases. In addition, there are over 1,800 medications that can cause dry
mouth. (3) This does not factor much in children unless they are taking a drug for asthma.
Research has proven that these are the greatest influencing risk factors. Further, fluoridated water
supply shows no difference in the rate of decay compared to areas with non-fluoridated water.

John A. Rothchild, DDS has been practicing general and holistic dentistry for over 30 years. After building
a successful practice in Chicago for almost 3 three decades. Dr. Rothchild moved to Durango to enjoy the
mountains and opened his local practice shortly thereafter. You can contact Dr. Rothchild’s office at (970)
382-7780 or online at
1) Microbiology 4th edition Chapter 99 Microbiology of Dental Decay and Periodontal disease Walter L.
of dental tooth decay and does water fluoridation really
prevent decay
4)American Dental Association
5) Perez MA. Sugar consumptions and changes in dental caries from childhood to adult. J of Dental
research. April 2016
6) Fluoride: Journal of the International Society for Fluoride Research
April 1990 (Volume 23, Issue 2, Pages 55-67)
10) Water Fluoridation & Tooth Decay: Results from the 1986-1987 National Survey of US Schoolchildren
by John A. Yiamouyiannis, Ph.D.

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