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CNN
6 days ago
- Health
- CNN
Prescription fluoride faces FDA scrutiny despite widespread support from providers and the public
The US Food and Drug Administration appears poised to continue with a plan to ban prescription fluoride supplements at a time when many experts say that access to the products has become especially important. Most US residents live in a community where fluoride is added to the public drinking water, according to federal data from 2022. But this year, Utah and Florida became the first states to ban the practice, and similar legislation has been introduced in several other states. Fluoride is a mineral that can be found naturally in some foods and groundwater. It can help prevent tooth decay by strengthening the protective outer layer of enamel that can be worn away by acids formed by bacteria, plaque and sugars in the mouth. Adding fluoride to public water systems started in the US in 1945, and is considered by many public health experts – including the US Centers for Disease Control and Prevention – to be one of the top public health success stories of the last century. In places where fluoride is not in the drinking water, fluoride tablets or drops may be prescribed for babies and children to reduce the risk of tooth decay. Fluoride prescriptions spiked in Utah this spring amid changes to the public drinking water. An analysis of electronic health records conducted for CNN by Epic Research showed that the share of the population with a prescription for fluoride supplements jumped 30% in a matter of months, from about 1% at the start of the year to 1.3% by May. However, the FDA announced in May that it plans to remove ingestible fluoride prescription drug products for children from the market by the end of October – marking clear intentions before conducting the necessary safety review or public comment period. On Wednesday, the Regan-Udall Foundation, an independent nonprofit organization created by Congress to advance the FDA's mission, hosted a public meeting to discuss the risks and benefits of the prescription fluoride supplements. Dozens of dentists, researchers, public health experts and other members of the public spoke at the meeting, and thousands of others shared their thoughts in the federal register ahead of time. Among those expressing support for prescription fluoride were the American Dental Association, the American Academy of Pediatrics, the American Academy of Pediatric Dentistry and the American Association of Public Health Dentistry. Dr. George Tidmarsh, who was announced as the new director of the FDA's Center for Drug Evaluation and Research on Monday, was present at the meeting and shared his thoughts early on. 'Our job at FDA is to balance risk and benefit, and every day we have to make that balance,' Tidmarsh said. 'It's frequently a challenge, not always, but nothing is without risk, and you have to make sure that if there is risk, there's a clear benefit. And that analysis needs to be done with data.' He critiqued the first two presenters who were in favor of fluoride supplements largely for their lack of data. However, one presenter was tasked with sharing a 'lived patient experience.' The other, Dr. James Bekker, a pediatric dentist from Utah, agreed on the importance of data but said that his goal was not to overwhelm the audience with numbers-heavy slides using information that is 'readily available all across the country.' Just 30 minutes into an hours-long meeting that was meant to offer robust discussion on a much broader set of research on the topic of fluoride supplements, Tidmarsh also chose to single out two studies that highlight risks. One was a lengthy federal review published in August by the National Institutes of Health's toxicology program, which concluded that higher levels of fluoride exposure are linked to lowered IQ in children. This has become a key argument for proponents of banning fluoride, but others have said the work lacks key context. Fluoridated water is the most common exposure noted in this analysis and the focus of most research on the topic, and the potential risks are identified with exposure at much higher levels than what is used in the US. Prescription fluoride supplements that are available to children in the US in tablet and drop form are not formally FDA-approved, but are also well below recommended levels. Experts on both sides of the issue on Wednesday agreed in large part that more research is needed to better understand the risks and benefits of fluoride supplements in general. Dr. Susan Fisher-Owens, a pediatrician and clinical professor at the University of California San Francisco, shared a presentation on Wednesday about the links between fluoride and neurocognitive development. 'In general, I am an optimist, who believes good science can change people's minds and lives for the better. It would be easy to believe this is a foregone conclusion, given the announcement of removing supplements from market came before the science was presented, and Tidmarsh stated his opinion after only the first round,' she said. 'Still, I hope, for my patients' sake, that the presentations emphasizing safety at levels as seen in the US will convince the FDA.' As the national conversation around fluoride has ramped up in recent months, dentists and doctors say that they're getting more questions about fluoride from patients and parents who want to better understand the risks and benefits – but evidence suggests that most still remain largely in favor of fluoride. 'There's a changing political conversation, but it's not necessarily changing where the average American perception of fluoride is yet,' said Melissa Burroughs, senior director of public policy at CareQuest Institute for Oral Health, a nonprofit focused on equitable access to dental care. A poll conducted by the organization in July found that most US adults support community water fluoridation. 'Removing fluoride without a plan to try to support those communities will only keep it an already serious oral health crisis,' Burroughs said. An analysis of electronic health records conducted for CNN by Truveta found that fluoride prescription rates among children in the US have been declining for the past few years – but rates are consistently about 20 times higher in states where community fluoridation is least common compared to rates in states where it is most common. As in Florida and Utah, decisions to add – or remove – fluoride to public water are determined at the local level. The question is sometimes put to public vote, and community members almost always vote in favor of adding fluoride. Similar data showing a decline in fluoride prescription rates among children was presented at the meeting on Wednesday. Dr. David Krol, a pediatrician representing the American Academy of Pediatrics, said that the trend was 'really hypothesis-generating.' He theorized that it could be evidence of more thorough conversations between providers and their patients about all of the different ways they might already be getting fluoride and their individual risk assessments for cavities and tooth decay. 'After that conversation, there's still a need for the provision of supplementation for some patients,' Krol said. Others have suggested that there may be a link to more widespread hesitancy around government intervention on individual health that ramped up during the Covid-19 pandemic. But as community water fluoridation starts to roll back, experts say that protecting the option to use prescription fluoride supplements is key. In fact, the legislation in Utah that banned the addition of fluoride to the public drinking water included provisions to expand access to prescription fluoride – emphasizing the desire for choice. 'We're talking about supplements here today, and we're talking about a choice, and giving people a choice if they want to have that benefit of fluoride. In a non-fluoridated area or where it doesn't occur naturally, supplement is the only tool they have,' Bekker said at the meeting Wednesday. 'So as we consider supplements, the opportunity to have them available is a matter of people's choice. We're not forcing anyone to take them, we're allowing them to have an option and to have a choice.'
CNN
6 days ago
- Health
- CNN
Prescription fluoride faces FDA scrutiny despite widespread support from providers and the public
Water availability Federal agencies Children's healthFacebookTweetLink Follow The US Food and Drug Administration appears poised to continue with a plan to ban prescription fluoride supplements at a time when many experts say that access to the products has become especially important. Most US residents live in a community where fluoride is added to the public drinking water, according to federal data from 2022. But this year, Utah and Florida became the first states to ban the practice, and similar legislation has been introduced in several other states. Fluoride is a mineral that can be found naturally in some foods and groundwater. It can help prevent tooth decay by strengthening the protective outer layer of enamel that can be worn away by acids formed by bacteria, plaque and sugars in the mouth. Adding fluoride to public water systems started in the US in 1945, and is considered by many public health experts – including the US Centers for Disease Control and Prevention – to be one of the top public health success stories of the last century. In places where fluoride is not in the drinking water, fluoride tablets or drops may be prescribed for babies and children to reduce the risk of tooth decay. Fluoride prescriptions spiked in Utah this spring amid changes to the public drinking water. An analysis of electronic health records conducted for CNN by Epic Research showed that the share of the population with a prescription for fluoride supplements jumped 30% in a matter of months, from about 1% at the start of the year to 1.3% by May. However, the FDA announced in May that it plans to remove ingestible fluoride prescription drug products for children from the market by the end of October – marking clear intentions before conducting the necessary safety review or public comment period. On Wednesday, the Regan-Udall Foundation, an independent nonprofit organization created by Congress to advance the FDA's mission, hosted a public meeting to discuss the risks and benefits of the prescription fluoride supplements. Dozens of dentists, researchers, public health experts and other members of the public spoke at the meeting, and thousands of others shared their thoughts in the federal register ahead of time. Among those expressing support for prescription fluoride were the American Dental Association, the American Academy of Pediatrics, the American Academy of Pediatric Dentistry and the American Association of Public Health Dentistry. Dr. George Tidmarsh, who was announced as the new director of the FDA's Center for Drug Evaluation and Research on Monday, was present at the meeting and shared his thoughts early on. 'Our job at FDA is to balance risk and benefit, and every day we have to make that balance,' Tidmarsh said. 'It's frequently a challenge, not always, but nothing is without risk, and you have to make sure that if there is risk, there's a clear benefit. And that analysis needs to be done with data.' He critiqued the first two presenters who were in favor of fluoride supplements largely for their lack of data. However, one presenter was tasked with sharing a 'lived patient experience.' The other, Dr. James Bekker, a pediatric dentist from Utah, agreed on the importance of data but said that his goal was not to overwhelm the audience with numbers-heavy slides using information that is 'readily available all across the country.' Just 30 minutes into an hours-long meeting that was meant to offer robust discussion on a much broader set of research on the topic of fluoride supplements, Tidmarsh also chose to single out two studies that highlight risks. One was a lengthy federal review published in August by the National Institutes of Health's toxicology program, which concluded that higher levels of fluoride exposure are linked to lowered IQ in children. This has become a key argument for proponents of banning fluoride, but others have said the work lacks key context. Fluoridated water is the most common exposure noted in this analysis and the focus of most research on the topic, and the potential risks are identified with exposure at much higher levels than what is used in the US. Prescription fluoride supplements that are available to children in the US in tablet and drop form are not formally FDA-approved, but are also well below recommended levels. Experts on both sides of the issue on Wednesday agreed in large part that more research is needed to better understand the risks and benefits of fluoride supplements in general. Dr. Susan Fisher-Owens, a pediatrician and clinical professor at the University of California San Francisco, shared a presentation on Wednesday about the links between fluoride and neurocognitive development. 'In general, I am an optimist, who believes good science can change people's minds and lives for the better. It would be easy to believe this is a foregone conclusion, given the announcement of removing supplements from market came before the science was presented, and Tidmarsh stated his opinion after only the first round,' she said. 'Still, I hope, for my patients' sake, that the presentations emphasizing safety at levels as seen in the US will convince the FDA.' As the national conversation around fluoride has ramped up in recent months, dentists and doctors say that they're getting more questions about fluoride from patients and parents who want to better understand the risks and benefits – but evidence suggests that most still remain largely in favor of fluoride. 'There's a changing political conversation, but it's not necessarily changing where the average American perception of fluoride is yet,' said Melissa Burroughs, senior director of public policy at CareQuest Institute for Oral Health, a nonprofit focused on equitable access to dental care. A poll conducted by the organization in July found that most US adults support community water fluoridation. 'Removing fluoride without a plan to try to support those communities will only keep it an already serious oral health crisis,' Burroughs said. An analysis of electronic health records conducted for CNN by Truveta found that fluoride prescription rates among children in the US have been declining for the past few years – but rates are consistently about 20 times higher in states where community fluoridation is least common compared to rates in states where it is most common. As in Florida and Utah, decisions to add – or remove – fluoride to public water are determined at the local level. The question is sometimes put to public vote, and community members almost always vote in favor of adding fluoride. Similar data showing a decline in fluoride prescription rates among children was presented at the meeting on Wednesday. Dr. David Krol, a pediatrician representing the American Academy of Pediatrics, said that the trend was 'really hypothesis-generating.' He theorized that it could be evidence of more thorough conversations between providers and their patients about all of the different ways they might already be getting fluoride and their individual risk assessments for cavities and tooth decay. 'After that conversation, there's still a need for the provision of supplementation for some patients,' Krol said. Others have suggested that there may be a link to more widespread hesitancy around government intervention on individual health that ramped up during the Covid-19 pandemic. But as community water fluoridation starts to roll back, experts say that protecting the option to use prescription fluoride supplements is key. In fact, the legislation in Utah that banned the addition of fluoride to the public drinking water included provisions to expand access to prescription fluoride – emphasizing the desire for choice. 'We're talking about supplements here today, and we're talking about a choice, and giving people a choice if they want to have that benefit of fluoride. In a non-fluoridated area or where it doesn't occur naturally, supplement is the only tool they have,' Bekker said at the meeting Wednesday. 'So as we consider supplements, the opportunity to have them available is a matter of people's choice. We're not forcing anyone to take them, we're allowing them to have an option and to have a choice.'
Yahoo
7 days ago
- Health
- Yahoo
Do fluoride supplements harm children? FDA panel discussion turns into heated debate
A meeting Wednesday at the Food and Drug Administration about fluoride supplements became, at one point, a contentious back-and-forth over whether the ingestible tablets harm children's microbiomes or play a vital role in helping protect them from tooth decay. Pediatric dentists consider the chewable tablets, available only by prescription, as particularly important for families who live in areas without fluoride in drinking water, who don't have dental insurance or who can't afford regular visits to dentists. Under Commissioner Marty Makary, however, the FDA has been taking steps to remove fluoride supplements from the market. A final decision isn't expected until October, although advocates and critics at the meeting didn't agree on basic scientific methods or even responsible dental practices. During the public meeting held in Silver Spring, Maryland, dental experts outlined the careful balance of getting the right amount of fluoride to their patients. Too little can result in weakened tooth enamel, said Dr. James Bekker, a member of the Utah Dental Association. Too much can lead to fluorosis, a condition that leaves white or brown spots on the teeth. 'There are areas where we have community water fluoridation. We don't need supplements in those areas,' said Bekker, who was invited to speak at Wednesday's meeting. 'But there are many areas of our country where we either don't have community water fluoridation or we don't have naturally occurring fluoride. In those places, supplements are the key to achieving that balance.' A panelist, Dr. Bill Osmunson, a retired dentist who now works for the Fluoride Action Network, an anti-fluoride group, peppered Bekker about how he determines whether a child needs fluoride supplements. 'You ask where they live?' Osmunson asked. 'You ask where they go to school?' Bekker explained how he does comprehensive assessments of his young patients, including reviewing dietary issues and whether they use other supplements, before he prescribes the fluoride tablets or drops. 'Really, you ask all those questions?' Osmunson said. 'You bet,' Bekker said. Osmunson's 'inquisition of Dr. Bekker was a tactic to attempt to make him look incompetent,' said Dr. Johnny Johnson, president of the American Fluoridation Society. 'That type of exchange is meant as a popularity contest.' Johnson spoke in favor of the supplement during a public comment session. Osmunson and other critics relied on data that didn't necessarily prove their criticism of the products. For example, Makary, the FDA commissioner, has said ingested fluoride alters the gut microbiome. His assertion appears to hinge on a 2023 review of research by scientists in Ireland. That analysis noted that animal studies suggested that ingesting fluoride affected the microbiome but that none of the studies examined fluoride and the human microbiome. The researchers concluded that any possible effect of fluoride on the microbiome is 'still in its early days, and studies investigating the impact of fluoride on the human microbiome have only begun to appear in the literature.' One of the authors of that study also spoke at Wednesday's meeting. 'Fluoride consumption at levels which we consider good for maintaining good oral health probably have limited impact on the oral and gut microbiomes,' said Gary Moran of Trinity College Dublin in Ireland. But, he added, 'we certainly need more studies.' There was no vote for or against fluoride supplements. Dr. David Krol, a representative of the American Academy of Pediatrics, spoke in favor of fluoride supplements as one of many tools physicians need to ensure their patients' teeth are as strong as possible. 'Fluoride supplementation, as well as conversations about diet and conversations about hygiene, are the kinds of things that take place between pediatricians and patients,' Krol said. 'We have to have that opportunity to continue those conversations and have those multifactorial tools to address this disease.' Even though Medicaid covers oral health for children, fewer than half went to the dentist at least once a year. Cavities that erupt in those kids' mouths get worse if they're left untreated, and they can cause widespread damage. The decay 'eats away at the bone' around the tooth and sometimes gets into the bloodstream, said Dr. Steven Levy, a professor of preventive and community dentistry at the University of Iowa. 'This is more than just a garden-variety, middle-class person's experience with a cavity,' he said. Major public health groups, including the American Academy of Pediatrics and the U.S. Preventive Services Task Force, recommend prescribing supplements for children starting at 6 months if the water supply isn't fluoridated. Fluoride supplements are often given to kids from age 5 until they have their permanent teeth, around age 13 or 14, Bekker said in an interview before the meeting. Babies get drops until they're old enough to chew tablets. They're generally inexpensive. Over-the-counter vitamins and supplements don't contain fluoride. Fluoride is available over the counter only in toothpaste and mouthwashes. Makary also objects to the fluoride supplements because they aren't approved by the FDA. Because the supplements had been in use for decades before Congress mandated that drug manufacturers show that their products were not only safe but also effective, they were never required to go through the approval process. For almost as long as the supplements have been prescribed, critics have been concerned about the lack of rigorous data showing their potential health effects and how they protect kids' teeth. 'I think we really need to understand the benefits,' said Linda Birnbaum, a toxicologist and former director of the National Institute of Environmental Health Sciences and the National Toxicology Program. Birnbaum also spoke during the FDA meeting. Dr. Brett Kessler of the American Dental Association acknowledged that prescription fluoride supplements should be administered only after a 'thoughtful decision' based on conversations between physicians and families. 'I'm hoping we can all take a breath, filter out all the noise and not give in to the anti-fluoride hysteria,' he said during the meeting. This article was originally published on Solve the daily Crossword
BBC News
21-07-2025
- Health
- BBC News
Schools in Gloucestershire join toothbrushing scheme to battle decay
More than 6,000 children from 113 schools across Gloucestershire are participating in a toothbrushing club. In March, the Government announced that children in the most deprived areas of England will get access to a programme to help protect them from tooth decay. The NHS has been funding At Home Dental's Big Brush Club, since it was launched in 2024. They help provide schools with free toothbrushes, toothpaste and kits for the children to take home. Jermaine Badman, Big Brush Club Project Facilitator, said the club was a "preventative programme" to stop early cases of tooth decay. In the South West, more than 3,300 teachers and staff have been trained as Oral Health Champions. One of the 113 Primary Schools and Nurseries involved is Bream Church of England Primary School. Headteacher Nicky Brice said: "We all know children have to brush their teeth twice a day but there is a real technique to it, good oral hygiene is vital to introduce at an early stage."We know those challenging times are bed times and getting ready for school, this makes those daily routines a lot smoother and easier." Government statistics show that 22.4% of five year old schoolchildren in England had experience of obvious dental decay, with tooth decay the most common reason for hospital admissions in children aged between five and nine Badman and Chantelle Coles, Big Brush Club Project Facilitators, said: "We target areas of deprivation, educating children how to brush their teeth effectively."It gives them the independence of doing it themselves and it makes the children very familiar with what they need to be doing."The provide advice to parents through online webinars, advising them: "Children aged above three years old should use a pea size amount of toothpaste and below three years old, the size of a grain of rice."
CTV News
30-06-2025
- Health
- CTV News
Calgary reintroduces fluoride to its drinking water
More than a decade after it was removed, fluoride is now being reintroduced into Calgary's drinking water. Mason DePatie reports. More than a decade after it was removed, fluoride is now being reintroduced into Calgary's drinking water. Mason DePatie reports. After more than a decade without it, fluoride is now being reintroduced into Calgary's drinking water. The City of Calgary began adding fluoride at a concentration of 0.7 milligrams per litre – the optimal level recommended by Health Canada to help prevent tooth decay – on Monday. While fluoride does occur naturally in water at lower levels, the mineral was first manually added into Calgary's water in 1991. It was eventually decided by city council to discontinue the practice in 2011. The decision to reintroduce fluoride followed a 2021 plebiscite held during the municipal election, in which 62 per cent of voters supported its return. In response, the city invested $28.1 million in infrastructure upgrades to facilitate the fluoridation process. Ongoing operation and maintenance are expected to cost an additional $1 million annually. With this step, Calgary joins many other municipalities in Canada and around the world in embracing fluoridation. 'It helps to improve the strength of the enamel at the surface of our teeth,' said James Dickinson, a professor of family medicine and community health sciences at the University of Calgary. 'And it makes it more resistant to the acids caused by food in the mouth, and therefore ensures in the long term we have better dental health.' Dickinson pointed to a 2021 University of Calgary study that found Grade 2 students in Calgary had higher rates of cavities than their peers in Edmonton, a city that has continuously fluoridated its water since 1967. He said the reintroduction of fluoride will be most beneficial for people who don't get fluoride in their toothpaste. 'So young children, where it's difficult for parents to make sure they brush their teeth with fluoride, those who can't afford or don't understand the value of fluoride toothpaste, and also those who are ill or elderly who have difficulty brushing their teeth,' Dickinson said. Arash Ravanbakhsh, a Calgary dentist and owner of Inglewood Family Dental, notes that people still need to practice regular dental hygiene – even with fluoride back in the water. 'At the dentist, they can get topical fluoride in addition to having fluoride in the toothpaste, and that actually is where fluoride has its most benefits,' he said. While in favour of its reintroduction, Ravanbakhsh noted that it does make it harder to control the intake of fluoride, as different age groups and activity levels dictate how much water people drink. The impact of this health measure will also extend to neighbouring communities such as Chestermere, Airdrie and Strathmore, which rely on Calgary's water supply. Officials stress that the level of fluoride being added will not affect the taste, smell or appearance of the water.
