Have you ever discussed water consumption with your patients?
Increasing numbers of Americans are shunning common tap water in favor of bottled water. Others have installed at-home water treatment systems. The ADA is concerned that those who choose one of these options may not be getting the optimal level of fluoride in their drinking water. Some home-based systems remove significant amounts of fluoride from water, and the level of fluoride in most bottled water is less than 0.3 parts per million—well below the optimal range of 0.7 to 1.2 ppm.
In December, JADA asked readers if they have ever discussed water consumption with their patients. Sixty-five percent said they have. "If a patient shows a sudden increase in caries after ruling out dietary, medical or pharmacological etiologies, we ask about water consumption, use of filters and so on," said one respondent.
"Always," said another. "As pediatric dentists, we have always been concerned about the level of fluoride from multiple ingested resources."
"Patients need a lot of coaching on the benefits of fluoride," said yet another. "They’re really quite surprised to find out that their water filtration systems designed to remove ions also happen to remove the fluoride ions."
Some readers mentioned the availability of fluoridated bottled water. "We drink fluoridated bottled water in my office," said one reader. "We had to request it. It is too bad the default for consumers isn’t fluoridated."
"The ADA should really get behind standardization of fluoride in bottled water and filtration devices so patients really have a choice," said another.
In a report issued in August 2000, the U.S. Food and Drug Administration said that the Safe Drinking Water Act had called for a published study on the feasibility of appropriate methods, if any, of informing customers of the contents of bottled water. During the period open for public comment, the ADA sent official comments to the FDA supporting the inclusion of the fluoride content on bottled water labels. "There was, however, no language in the act requiring the FDA to issue regulations on this topic, and no further action has been taken," said Jane McGinley, manager, ADA Council on Access, Prevention and Interprofessional Relations. "Additionally, the ADA has met with representatives of the International Bottled Water Association to promote the benefits of including fluoride content on bottled water labels."
In December 2002, the PureTouch water filter (Moen, North Olmsted, Ohio) received the ADA Seal of Acceptance. This type of filter removes impurities from tap water without removing fluoride.
Thirty-five percent of the Question of the Month respondents said they do not discuss water consumption with their patents. "They drink filtered tap water anyway," said one. "But I think that’s a good point, and I think it would be best to ask patients if they take bottled or regular tap water."
Others said it was an oversight that they hadn’t considered it. "I will think about discussing it in the future," said one.
"I guess I should be concerned," said another.
ADA.org provides information for dentists about drinking water and fluoride exposure at "www.ada.org/prof/prac/issues/topics/bottledh2o.html". It includes
- – the ADA Policy on Bottled Water, Home Water Treatment Systems and Fluoride Exposure;
- – Fluoridation Facts;
- – articles;
- – links to non-ADA Web sites;
- – ADA News releases and ADA News Today stories;
- – Communication resources for members, including Facts for Communicators, ADA Media Tool Kit and Baby Boomers and Bottled Water.
A similar page for patients can be found in the public section of ADA.org at "www.ada.org/goto/bottledwater".
You also can order the ADA’s 56-page Fluoridation Facts booklet. It is a comprehensive encyclopedia of fluoridation facts with more than 200 scientific references. You can order your copy of ADA’s Fluoridation Facts (Item No. J120) from the ADA Online Catalog at "www.adacatalog.org" or by calling 1-800-947-4746.
