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Abstract #160929

Janessa M. Graves, MPH(c)¹, William E. Daniell, MD MPH¹, Frank James, MD², and Peter Milgrom, DDS³. (1) Department of Environmental and Occupational Health Sciences, School of Public Health and Community Medicine, University of Washington, Box 357234, Seattle, WA 98195, 206-616-1339, janessa@u.washington.edu, (2) San Juan County Health and Community Services, P.O Box 607, 145 Rhone Street, Friday Harbor, WA 98250, (3) Department of Dental Public Health Sciences, School of Dentistry, University of Washington, Box 357475, Seattle, WA 98195

Fluoridation of community drinking water has been deemed one of the most important public health achievements of the 20th century. However, excessive fluoride ingestion by young children can cause dental fluorosis and, rarely, skeletal fluorosis. The EPA Maximum Contaminant Level (MCL) for drinking water fluoride is 4 mg/L, and the American Dental Association recommends 0.7-1.2 mg/L for optimal caries prevention. The risk of fluorosis from drinking water may be compounded by fluoride from other sources. While dental fluorosis is common in the U.S. (prevalence of 35-60% in fluoridated areas and 20-45% in non-fluoridated areas), severe or moderately severe cases are rare.

Residents of San Juan Island (population 15,700) in Washington state obtain drinking water from community and private wells. Testing by county officials revealed naturally occurring fluoride levels up to several times the MCL (0.51-12.45 mg/L). Private wells have not been tested systematically.

The San Juan Fluorosis Project—a community-based collaboration between San Juan County Health & Community Services, Friday Harbor School District, and University of Washington—is screening for dental fluorosis and measuring fluoride in household water, focusing on children with recently erupted teeth (grades 2-3). Parents complete questionnaires about water filtration and their child's dental practices, including use of fluoride supplements, dentifrice, or mouthwash. Each child's estimated total fluoride exposure will be compared to findings of fluorosis screening (available June 2007). The results will be valuable for local water management authorities and healthcare providers and will inform the ongoing political discussion and controversy regarding fluoridation in Washington state.

Learning Objectives:

• Recognize the risk factors for and characteristics of dental fluorosis as an environmental health concern for elementary children on San Juan Island, Washington state.
• Discuss the relative contribution of fluoride supplements, dentifrice, and mouthwash to the prevalence of dental fluorosis among the San Juan Fluorosis Project study population.
• Determine the prevalence of fluorosis in the study population.

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.