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Giving Patients a Historical Perspective on Fluoride and Vaccines by Dr. Dawn Grimes Kulongowski, DDS

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In 13 years of private practice, most of my time has been spent treating patients. I've also spent a considerable amount of time trying to educate them. I talk to my patients about the importance of proper hygiene and maintenance, why their cracked tooth needs a crown, why an implant is better than a fixed partial denture, etc. Into these dental conversations I try to weave in a little something that may seem unusual for a dentist—history.

History gives us a new perspective and can be more intriguing than another lecture about flossing. For example, when patients comment on the noise or feel of the drill I tell them how ancient people used drills to make a space for jewels in their teeth. When a patient asks me if I practice "painless dentistry" I tell them the story of Painless Parker, who coined that phrase and turned dentistry into a sideshow act. I give patients who protest "the shot" a lesson in the history of anesthetic. They learn that it's a relatively modern practice and quite luxurious since even today most people get dental treatment without anesthesia.

I talk a lot about procedures in the past as opposed to current ones. I also discuss how certain things we do now will soon become obsolete. Since February is National Children's Dental Health Month, I thought I'd share some of the history I attempt to impart to parents when we discuss their child's health, particularly about vaccines and fluoride.

In 1952, the height of the polio epidemic in the United States, there were approximately 60,000 cases in that year alone. When my grandparents loaded their four young children in the car for a family trip that summer, they had no idea that their youngest—my aunt Peggy, 13 months old—would, three days later, become one of the 3,000 polio deaths that year. She and the other three children had contracted polio and fell ill in the car. Thankfully, the three other children lived but the disease left its mark both physically and emotionally on all of them.

Although Dr. Jonas Salk had discovered the polio vaccine that same summer, it was not released for wide public use until 1955, three years too late for my family. Since then, that vaccine has nearly eradicated polio from the planet. In 2012, there were 223 cases of polio worldwide—a very small number but worth noting that it has not disappeared completely.

I tell the story of my father's family few a times a week in my office, because I, like you, have a segment of my patient pool that doesn't want to vaccinate their children. I tell my patients that we have lost our sense of history.

We have lost the reverence for these vaccines because we believe that they're somehow no longer necessary. Thanks to a lot of misinformation, we have been led to believe that they're not necessary and that they hurt our children. I don't want to get too far into the arguments on either side of this debate—we've all heard them ad nauseum—but I will say that some of these people may not have not been educated in the history of public health. They have no idea that my family's story was all too common, or how many children are still dying from preventable diseases such as measles.

The MMR vaccine is one of the most debated for its supposed dangers. I remember hearing an interview with entertainer Jenny McCarthy in which she said that her child went white on the exam table after receiving the vaccine. My kid goes white every time the doctor goes near her with a needle and this is hardly an argument against saving a life with a vaccine. Measles is in fact still a leading cause of death of children worldwide. In 2013, almost 150,000 people in the world died of the measles. In 2014, there were three times as many cases of measles in the United States than the year before. Most of its victims were not vaccinated. This situation is real and current.

I have a strikingly similar conversation with people who don't want their child to have fluoride of any kind—not in the toothpaste, not in the prophy paste, not in the water at home, and definitely not a fluoride treatment. These parents are using the same illogical path as the anti-vaccine parents, and the same sensational type of online sites as references, so I run with that correlation and compare it to the success of vaccines. Less vaccination is resulting in more disease, and likewise, with less fluoride we see a rise in decay rates. Most of these parents have heard (probably online) that fluoride is a poison.

What they might not know is that tooth decay, even now, is the most common chronic childhood disease. We owe it to our kids to continue the fight. Decay in our children results in pain, tooth loss, functional problems, absences from school, and an embarrassing appearance. It's also a costly problem—our nation spends more than $30 billion dollars a year for children's dental care. The Western world has known about the relation of fluoride to preventing tooth decay since the mid-19th century when it was discovered that fluoride in the diet fortified teeth. In 1930 the magic number of 1ppm in the water was established—enough to strengthen the enamel without causing ill effects. I tell parents this and explain the importance of dosing. I compare it to aspirin—one is good, the whole bottle is very bad.

In 1945, Grand Rapids, Michigan, became the first city to introduce the proper amount of fluoride into its drinking water to fight tooth decay. When other communities followed suit, those communities saw a 60 percent drop in their children's caries rates over the following decades. I have long heard water fluoridation touted as the most successful public health measure in history. We know it works, yet according to the Centers for Disease Control and Preventions, only 27 states have 75 percent of its citizens on public water systems with fluoride. The communities that still have no water fluoridation carry at least a 30 percent higher decay rate. We haven't yet seen how much better things could be with universal fluoridation, but we have had a gratifying taste.

Unfortunately, we are also experiencing its undoing. Since 2010, more than 150 communities have ended their once-successful water fluoridation practice. We are seeing a rise in caries rates in young children. Fear and propaganda are taking over in many areas. It can seem hopeless, but I still have faith that dentists can make a difference by having respectful and educational conversations with these patients. I tell them that my grandmother was in dentures in her 20s and fluoride could have helped her. I talk to them about the risks and the benefits that we all know like the back of our hand and try to give numbers and facts about the success of fluoridation programs.

I always treat my patients and these parents with respect and compassion. I don't talk to them like they're crazy, and I give them the credit due for caring about these issues. I have a child too and I want the same thing these parents do—to protect her from bad things. We only differ in our opinions of what is bad. When the "bad" thing is actually highly beneficial to the child, it's our job as the doctor to have these uncomfortable conversations. The discomfort of this type of conversation often ranks with discussing religion. Taking the angle of history has helped me converse with the anti-fluoride and anti-vaccine parent in a manner that is both respectful and educational.

In addition, by making it a little personal I become a human being with an interest in helping rather than a doctor talking down to them. I stress that I feel fortunate that my daughter will have it better than her ancestors, thanks to the public health measures that were established in the last century. I also express how vital it is to not forget what it was like before we had these solutions. I can't guarantee that I'm converting anyone, but I hope that I'm at least planting a seed of thought. Fertilized with a small history lesson, there's a chance that seed can take root.

Dr. Dawn Grimes Kulongowski is a 2002 graduate of the University of Detroit Mercy School of Dentistry. She is a solo practitioner in Holly, Mich., and has practiced there since 2005. Dr. Kulongowski serves on her state's forensic dental team, has a passionate interest in mission dentistry and is a frequent panelist on the DentalHacks Podcast.

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