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Spokane, Washington  Est. May 19, 1883
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Opinion >  Guest Opinion

Lisa Bilich: Community water fluoridation decreases health inequities

By Lisa Bilich Eastern Washington University

While many do not see dental disease as a health problem, the sad fact is people are affected daily by dental decay. We have people coming into the clinic who are missing work due to pain related to decay and children unable to go to school due to pain related to cavities. Untreated dental decay can lead to brain abscesses or even death.

Dental decay is almost entirely preventable, and Spokane residents should not suffer from a preventable disease, especially because good oral health leads to better overall health. This is increasingly important as we face a public health crisis due to COVID-19.

Spokane is the largest city in Washington state that does not adjust its levels of fluoride to meet optimum levels. Fluoride is a naturally occurring mineral that protects teeth against decay. Most water naturally contains fluoride, including Spokane’s, just not at the optimum level to protect against decay.

Seventy years of science and research has shown that providing community water fluoridation prevents tooth decay – which is important to oral health and overall health. The Centers for Disease Control and Prevention considers optimum water fluoridation as one of its greatest achievements. The leading health experts, including the American Medical Association, American Dental Association and American Academy of Pediatrics, recommend fluoridation.

Water fluoridation bathes the tooth in fluoride and replaces minerals lost to acid-attacks that occur when we eat. Fluoride in developing teeth makes the tooth much more resistant to cavities and can help decrease the risk of developing decay. Over the course of a lifetime, fluoridation reduces decay by 25%. Fluoridation can reduce the burden of restorative treatments, even in adults. This would increase overall health and decrease health disparities in the Spokane community.

Cavities impact low socioeconomic populations and people of color an inordinately high amount. While this population has a higher rate of cavities, it does not visit the dentist as often as people in a higher socioeconomic level. This leads to higher rates of emergency room visits due to dental pain. These visits to the ER cost the taxpayers a lot of money – the average cost of a visit related to dental pain is $778. The decay is not taken care of at the visit, so the issue doesn’t go away, and the patient may end up in the ER again – creating a vicious circle.

These same populations are also disproportionately affected by COVID-19. In Spokane County, Pacific Islanders, Hispanics and Blacks are experiencing significantly higher rates of cases, deaths and hospitalizations associated with COVID-19 than whites. If we truly care about health equity and protecting our residents during this pandemic, water fluoridation in Spokane is well overdue. During the pandemic, it is imperative to keep all nonemergency problems out of the ER to reduce the stress on hospitals and the use of Personal Protective Equipment (PPE).

Another burden on the Spokane community is increasing rates of unemployment. People who are missing front teeth due to decay or who have discolored teeth due to cavities have a harder time finding employment. This is especially important during times of economic uncertainty. It is estimated that a person who completes dental work has twice the chance of gaining employment than a person who does not have dental work completed.

With economic burden on the mind of many, water fluoridation may be seen as unnecessary. The economic benefits are huge – every dollar invested in community water fluoridation has been shown to save an average $32 in dental treatment costs – and the cost of building the infrastructure is a relativity small investment. With health disparities in the forefront, many nonprofit entities have stepped up to pledge money toward the $4 million capital costs.

We can’t pass up this opportunity to implement a proven public health policy that will benefit our community for generations to come.

Now is the time to address the oral health inequities of Spokane. I ask Mayor Woodward and the Spokane City Council to step up and say yes to water fluoridation. It is time!

Lisa Bilich is chair of the Eastern Washington University Department of Dental Hygiene.

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