Pediatricians Weigh In: Fluoride in Drinking Water


In Nevada, about 74 percent of the population has access to fluoridated water, but not in Washoe County. Local physicians and public health advocates Drs. Max Coppes and Trudy Larson share the value of fluoride to individual health and the health of the community.  

Editor’s note: This opinion piece was also published in the Reno Gazette-Journal March 8, 2017. 

Fluoridation is the controlled adjustment of the fluoride concentration of a public water supply to reduce tooth decay (also called dental cavities) caused by mouth bacteria that make acids from the sugar we consume. Those acids, in turn, eat away at our teeth. Fluoride makes our teeth more resistant to these acids, hence preventing tooth decay.

Why is the prevention of tooth decay a big deal? Because healthy teeth are part of our digestive system. Oral health is not about “pearly white” teeth; it refers to the health of our teeth, gums, palate, lips, tongue, and the lining of our mouth and throat. Severe tooth decay may lead mouth bacteria to form dental abscesses, and even lower jaw infections. It can cause debilitating pain, difficulty eating, swelling of the gums and bad breath. Cavities can lead to the loss of teeth and impact social and emotional health. Tooth decay in all its forms is very prevalent, with more than 90 percent of adults having some form of dental cavities.

Dr. Max Coppes, Physician-in-Chief, Renown Children’s Hospital; Chair and Nell J. Redfield Professor of Pediatrics, UNR Med

Prevention of tooth decay is also important because it so pervasive. It is the most common chronic disease in children: it is five times more common than asthma, four times more common than early childhood obesity, and 20 times more common than diabetes. According to the Centers for Disease Control and Prevention, about one in four children aged 3 to 5 years have experienced tooth decay, while about 50 percent of children aged 6 to 9 years and those aged 13 to 15 years have experienced decay.

Dr. Trudy Larson, Director, School of Community Health Sciences, University of Nevada, Reno; Professor of Pediatrics, UNR Med (Photo courtesy of the University of Nevada, Reno)

Between 10 and 20 percent of children, depending on age, have untreated decay. Socioeconomic factors, which have a considerable impact on the health and well-being of children in general, also have an enormous impact. Dental cavities are twice as high in children aged 3 to 15 years from low-income families compared to those from higher income households. Many low-income families cannot afford fluoride supplements or dental sealants to prevent decay.

The idea to approach tooth decay as a public health issue rather than an individual health problem goes back to the 1940s and 1950s when several studies showed that the adjustment of fluoride levels in drinking water significantly reduced the development of cavities.

Today, more than 211 million people benefit from its implementation. In Nevada about 74 percent of the population receives fluoridated water, but we in Washoe County do not. As public health advocates, parents, and providers of care to children and teenagers, we find this very problematic. Our children, our families, our community deserve better.

By Max J. Coppes, M.D., Ph.D., MBA, Chair & Nell J. Redfield Professor of Pediatrics, University of Nevada, Reno School of Medicine and  Physician-in-Chief, Renown Children’s Hospital; and Trudy Larson, M.D., Director, School of Community Health Sciences, University of Nevada, Reno and Professor of Pediatrics, University of Nevada, Reno School of Medicine.