When I recently wrote about cavities being on the rise in preschool age children, I got some fantastic follow-up questions to the piece. Breezy Mama turned to Paul S. Casamassimo, DDS, MS, is Chief of Dentistry at Nationwide Children’s Hospital and a Professor of Pediatric Dentistry at The Ohio State University College of Dentistry to get some hard hitting answers about your child’s visit to the dentist, the truth about whether X-rays are safe or cancerous, whether fluoride from the tap can cause bone cancer and more.
“Are X-rays safe for children and should they really be done for baby teeth .. a recent report has brought up the controversy between dental X-rays and brain tumor in kids?”
The recent report on associations between dental x-rays and cancer was somewhat limited in its methodology and should not cause undue concern by iteself. However, the message that the report gives is an important one and that is that all medical and dental x-rays carry some risk. That risk is balanced by the benefit of improved diagnosis by the health provider. What consumers and parents should know is that there is no such thing as a routine x-ray in either medicine or dentistry. All ionizing radiation exposure in health care should be done with strong indications of its necessity and benefit. Physicians and dentists should be able and willing to explain the risk-benefit of any x-ray exposure so the patient can make an educated choice. Here is a recent article Dr. Casamassimo was quoted in re: this topic.
“I was a post doc at UCLA Medical School we looked into the benefits of fluorinated water, and there was no compelling evidence that DRINKING fluorinated water would be beneficial to prevent tooth decay. However, there was a lot of evidence pointing to the risk of systemic fluoride causing bone cancer in children.” Do you have an opinion on this?
Fluoridated water and fluoride compounds used in dentistry appropriately are safe. Fluoride has been described as one of the top ten public health advances in the last century. The reduction in pain and infection and even death as the result of fluoride will never be known. In excess amounts, fluoride can cause a condition called fluorosis which is permanent staining of the teeth, and just a cosmetic annoyance. Only a small percentage of people are affected with noticeable fluorosis. In tropical countries where manual laborers drink gallons of water with high fluoride content, bony growths have been identified in some people. The association of fluoride with bone cancer recently published was shown to be erroneous.
“[This] response is the pretty standard American Dental Association-type response, and I am still not convinced. The following website http://www.nofluoride.com/ quotes Nobel prize winners suggesting that fluordie may not be the best, even the American Medical Association’s past presidents are not convinced.
This site http://www.fluoridealert.org/ also has a lot of interesting links. Many countries in Europe where fluoridation of the water was once done, have stopped doing it and banned it even. And for people who are allergic to fluoride this is not a “cosmetic” annoyance it is a real problem.”
Any comment to this response?
Unfortunately, fluoride falls into that category of controversies or conspiracies where positive health therapies become political or the victims of poor science. We can add to that list from dentistry, amalgam, x-rays, and lately, plastic fillings with BPA. In medicine, the most obvious political football is vaccination and its supposed relationship to autism. Careful reading of anti-fluoridation literature shows most testimonials and poor science. As a scientist I look at the quality of studies, but as a lay person, I have to ask the simple question: If fluoride is a cancer-causing agent, why wouldn’t we see consistent epidemiologic hotspots for cancer occurrence in areas with high fluoride occurring naturally? I also have to ask why after so many years is the only identifiable problem fluorosis?
To a large degree we need to rely on our institutions to guide us and then add to that some common sense views of the world. I think that is the case with fluoride.
“Has anyone you know done any research on the resin children get to seal their molars to prevent tooth decay, a quick look of the literature and I found that the resin contains BPA that leaches..my question: does it leach a lot, only at first, or does it break off and leach forever?”
Authorities continue to look critically at bisphenol A or BPA, a chemical widespread today in our environment. The chemical has effects on the endocrine system and has been associated with biological changes in animals at high doses. At this time, Americans are encouraged to minimize their exposure to BPA which is found in many plastic products. In dentistry, BPA is used in sealants and fillings made from plastics. Dentists can limit BPA exposure by choosing plastics without BPA, or by eliminating excess residual BPA when fillings or sealants are done. Over time, BPA depletes and very little leaches out after a few days. The available research supports the safety of BPA at this time in the amounts used in dental treatment.
“With regard to BPA, my research on dental sealants this morning led me to find this article: http://www.usatoday.com/yourlife/health/medical/oralcare/2010-09-07-dental07_st_N.htm
Parents can ask for sealants without BPA… The bis-GMA kind instead of the bis-DMA kind.”
Do you approve of that option or have an opinion?
My opinion on BPA is a lot like x-rays and that is the least amount possible and only when indicated. If a dentist can use a BPA-free material without sacrificing efficacy, then he or she should. The common sense piece here is to weigh the daily onslaught of BPA in the environment from plastic cups, utensils, and possible other sources against a once in a lifetime exposure from dental sealants or a filling.
“I would be interested in seeing research in regards to nighttime feeding and also babies who fall asleep while nursing and the link between cavities. While I am certainly not a medical professional everything I have read about this says this simply has not been proven.” Has this been studied?
The relationship between bottle feedings and nursing children and dental cares is largely guilt by association, but has been distilled down to the simple formula that says the longer a child’s teeth are exposed to sugar, the greater the likelihood of tooth decay. It would be unethical to test the relationship, so that will never happen. The risk of dental cares will increase with the frequency of nursing, bottle use, sugar-flavored drink consumption from any source. So, while a conclusive study remains elusive, most health professionals agree with the frequency formula.
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About Paul S. Casamassimo, DDS, MS
Paul S. Casamassimo, DDS, MS, is Chief of Dentistry at Nationwide Children’s Hospital and a Professor of Pediatric Dentistry at The Ohio State University College of Dentistry. He received his dental degree from Georgetown University School of Dentistry and his specialty training in pediatric dentistry at the University of Iowa. His interests are health policy and children with special health care needs.