Korean community water fluoridation supported by new evidence

Azaleas

Royal Azaleas in the mountains near Habcheon

New scientific evidence for the effectiveness of community water fluoridation (CWF) is appearing all the time. So that is hardly news – but I just thought it worth mentioning this latest example from Korea because I get told again and again that there is no evidence to show CWF is effective in improving oral health.

This latest Korean study was reported in this paper :

Jung, J., Kim, J., Kim, S., Lee, J., Kim, J., & Jeong, S. (2016). Caries-preventing effects of a suburban community water fluoridation program on permanent dentition after adjusting for the number of fissure-sealed teeth. Journal of Korean Academy of Oral Health, 40(1), 61–68.

The full text is available but only the abstract and tables are in English.

The study compares children from the fluoridated Habcheon township area with children from non-fluoridated areas.

The graphic below compares dental caries on permanent teeth for the different age groups. Clearly, children in the non-fluoridated areas have poorer dental health.

Jung-1

On average, the data indicates fluoridation is responsible for prevention of 24.6% of decayed, missing and filled permanent teeth (DMFT) and 29.9% of decayed missing and filled tooth surfaces (DMFS) (a more sensitive measure than DMFT).

Jung-2

This result is very recent but not at all surprising. Similar results have been reported before.

For example – this paper reported prevention of 27.5% of decayed, missing and filled permanent teeth (DMFT) and 24% f decayed missing and filled tooth surfaces (DMFS) for 12-year-old children in Gimhae.

Kim, H., Cho, H., Kim, M., Jun, E., Han, D., Jeong, S., & Kim, J. (2014). Caries Prevention Effect of Water Fluoridation in Gimhae , Korea. J Dent Hyg Sci, 14(4), 448–454.

Again this is full text but only the abstract and tables are in English.

There are more studies reporting a similar effectiveness of CWF in Korea.

These authors are recommending that CWF, which covers only 6% of the population in the republic of Korea, should be extended to other regions in the country.

CWF has been controversial in the Republic of Korea. Health authorities are promoting the extension of CWF but this is opposed by some groups. Surveys show  the majority of people whose children have good oral health, who are aware of fluoridation  programmes or who understand the protective role of fluoride support extension of CWF. But support is much less among people who are a=unaware of the benefits or whose children have poor oral health.

So, while health authorities support the extension of CWF they also accept there is a need for more public education about the benefits.

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30 responses to “Korean community water fluoridation supported by new evidence

  1. Before I accept this I need data on northerly latitude of the population distribution to allow for vitamin D effect and distance from the coast meaning access to vitamin D through sea food. Hapcheong is well inland and at about 35.58 degrees north. I roughly estimate twice as many Koreans north of it as south of it, with the main population density more than 1 degree further north.

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  2. Vitamin K2 is another factor relating to calcium metabolism. Traditional Korean diet includes fermented vegetables (kimchi) which include it. So it is necessary to ask how Habcheong compares in westernaisation of diet to the main population area of Seoul exposed to western military culture in the war.

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  3. Just spelling it out, Ken you wrote: “New scientific evidence for the effectiveness of community water fluoridation (CWF) is appearing all the time.”
    But it is not scientific comparing a specific fluoridated place in Korea, whose dental health may have been better already before fluoridation, with the whole Korean population.

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  4. Brian, perhaps you read Korean and can therefore enlighten me. Where does this paper refer to Seoul or “the whole Korean population?”

    The abstract refers to “non-fluoridated township areas” and I presume these were in the same area as the Habcheon township.

    You are frantically clutching the straws of location (faulty reading on your part) and vitamins to deny the rather obvious. Of course, confounders could have an influence (and no study can cover all possible confounders) but the influence of fluoride in preventing tooth decay is well established.

    Then again, perhaps your real interest is in promoting Mercola’s sunbeds to the Koreans as a way of preventing tooth decay now that he has been caught lying and must pay a fine in the US.🙂

    Liked by 1 person

  5. “Before I accept this I need…”

    I translate that as “I’ll use any excuse in order to ignore this and anything else that disagrees with my idiosyncratic view-point of the world.”

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  6. National survey: ” Samples collected during the national survey in 2012 from children of the same age residing in non-fluoridated township areas were used as the control,”

    I may later ask a Korean source what has been translated as “township.”

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  7. Ken vitamins are a necessary part of our food. Some our bodies can make in a limited fashion, others they cannot.

    Now you are writing in a mode which I believe seeks to influence how other people perceive me, since you are unable to discredit my argument.

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  8. Brian, I must admit I was making fun of your predictable straw-clutching and defense of Mercola. But I think the guilty party as far as negatively influencing what others think of you is yourself.🙂

    Liked by 1 person

  9. Ken, Mercola recommends UVB sunbeds not the UVA types in tanning shops. I wonder if you will call that off-topic now you have mentioned him. UVA cannot make pre-vitamin D. Vitamin D is a fatty acid antioxidant. It is also involved in cell differentiation and differentiated cells I think won’t proliferate. It is said to reduce multiple sclerosis attacks. Note how that disease is said to occur in temperate climates where the sun has to travel through more atmosphere to arrive. And not as near the poles as where people tend to eat more fish which contains vitamin D. When it is in very short supply the bones do not gain strength and children may grow up bandy-legged: rickets, since it is involved in the metabolism of calcium. Dietary supplementation is risky since it may promote calcification of the arteries. Unless vitamin K2 is obtained from fermented food that people used to eat like sauerkraut, or maybe a little from butter if it comes from grass-fed beasts who chew their cud and ferment their food in their stomach.

    I can’t fathom where the townships are from using Google translate, I don’t think it really says. But the area population is about the same as Whanganui so there must be some 10,000 children in the area? Maybe they have fluoridated a suburb with 500 children in it, but that would seem unusual.

    I note Wiki’s use of the word township about Whanganui: “All but some 4,200 people in the Whanganui District live in the township itself,” so “township’ is applying to nearly 40,000 people: different from what some people may think: rather, “going down to the township” a collection of shops in a suburb perhaps.

    Whanganui population density: 18 per sq km. Google Translate used on the paper gives the township name as Hapcheon rather than Habcheon. And there is no Habcheon on Google Earth so I assume it is Hapcheon which has tall apartments going by the long shadows, According to Wiki I calculate the Whanganui area to be two or three times that of Hapcheon which has a population density of 61/sq km. Were you thinking that to be broken into fluoridated and non-fluoridated areas?

    I think the study means they have, from the National Survey, taken other “townships” rather than big cities which may have different dietary patterns or something.

    Here is another puzzle from table 6:

    ——————DMFS————————–DMF
    —————not adjusted for sealants—adjusted
    non-fluor—–2.05—————————2.01
    fluor———–1.36—————————1.54

    Doesn’t that mean they are doing more sealants in the fluoridated area?
    So what does that mean for the general attention to dental health? Perhaps more heightened awareness? And what dietary stuff is going with it?

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  10. Oh yes table 3 gives fissure-sealed surfaces.

    Sorry Stuartg I wrote DMF when I should have written DMFS last article.

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  11. “The Illinois-based marketers of Mercola-brand indoor tanning systems will pay refunds to consumers and will be permanently banned from marketing or selling indoor tanning systems, under a settlement with the Federal Trade Commission.

    In the FTC’s complaint, which was filed in federal court, the Commission charged that Dr. Joseph Mercola and his two companies ran ads claiming that their indoor tanning systems are safe, that research proves indoor tanning does not increase the risk of melanoma skin cancer, and that their systems which deliver both ultraviolet (UV) light and red light can “reverse the appearance of aging.” The FTC’s complaint alleged that these claims are false, misleading, or unsubstantiated.

    According to the complaint, the ads also falsely stated that the U.S. Food and Drug Administration has endorsed the use of indoor tanning systems as safe, and represented that an organization called the Vitamin D Council has recommended the tanning systems – without disclosing that the Council was paid for its endorsement.

    “These types of false claims are especially troubling because of the serious health risks posed by indoor tanning,” said Jessica Rich, Director of the FTC’s Bureau of Consumer Protection. “The fact is, indoor tanning is not safe because it increases the risk of skin cancer, including melanoma.”

    According to the FTC, Dr. Mercola and the two companies—Mercola.com, LLC and Mercola.com Health Resources, LLC—advertised their systems through the Mercola.com website, Google search ads, YouTube videos, and newsletters and claimed that consumers could “Slash [Their] Risk of Cancer” by tanning indoors and “improve the clarity, tone and texture of [their] skin, basically giving [them] a more youthful appearance.”

    The defendants sold several different models of indoor tanning systems, intended for home use, including beds, door mount models, and standing systems, with varying numbers of UV lamps. Mercola brand tanning systems include the D-Lite, Sun Splash, Sun Splash Renew, Vitality, Vitality Refresh, and Vitality D-Lite. The systems sold for between $1,200 and $4,000 each.

    The proposed stipulated final order bans the defendants from marketing or selling indoor tanning systems. It also prohibits them, in connection with the sale of devices other than indoor tanning systems, from making false or unsubstantiated health-related or efficacy claims, from misrepresenting the existence or results of scientific tests or studies, and from falsely claiming that the benefits of such devices are scientifically proven. The proposed order also requires clear and conspicuous disclosure of material connections between the defendants and any individual providing an endorsement or review of such a device.

    Finally, the defendants must pay refunds to consumers who bought Mercola brand indoor tanning systems between January 1, 2012 and the present. An FTC redress administrator will send refund eligibility notices and claim forms to these consumers. Purchasers who want a refund must return the claim form by the date stated in the letter. The defendants are required to pay a maximum of $5,334,067 to cover the cost of refunds and administration of the refund program.”

    http://www.casewatch.org/ftc/news/2016/mercola.shtml

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  12. Brian, you needn’t translate – Table 1 is in English – “Subject numbers of control and water fluoridation program in Habcheon”

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  13. As usual Ken, two-valued. Tanning bed or not. The public can only think of that. Of course the common beds cause cancer since they emit only UVA which destroys vitamin D on the skin.

    As with any tool you must use according to instruction or it is not safe. But UVA beds are not beneficial from the point of view of vitamin D like teh UVB beds.

    If you keep reptiles indoor they must have UV lamps over them. In that case the public understand that it has to be UVB for them to be healthy.

    Melanoma can occur on regions of skin not exposed to sunlight. I think it has less prevalence in outdoor workers, and Mercola is probably correct about the UVB sunlamps.

    I believe a way nature works is that because vitamin D is toxic over a certain amount that extra sunlight does not produce more it destroys what is there on the skin and has been formed on the warm skin from the sunlight-produced pre-vitamin D since the last sunlight dose.

    Now please report what the FDA said about UVB, rickets and other matters.

    I think I posted here a table showing cancer increasing with latitude in NZ.
    Except for melanoma, because office workers don’t listen to advice, perhaps. Irregular exposure of high dose UV is not good.

    Don’t trust the translation you cited. It also says “cofounders.”

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  14. soundhill,

    Ignoring the stuff about Mercola and his proven false claims about sunbeds, you’ve introduced vitamin D, seafood, terrestrial latitude, fermented vegetables (kimchi), calcium metabolism, vitamin K2, westernaisation (sic) of diet, western military culture, translation of “township”, multiple sclerosis, rickets, sauerkraut (fermented vegetables again), butter, Whanganui and population density, into a blog about CWF and dental health in Korea.

    Other than trying to divert attention away from the finding that community water fluoridation in Korea improves dental health, is there any particular reason why all of these ideas are flying into the discussion?

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  15. http://webdevelopmentdesigner.com/korea/kyongsang-namdo/habcheon/

    The coords on this are in the river beside Hapcheon. “p” and “b” may both be approximations to the actual Korean sound whcih does not seem to give as much air as in English.
    http://www.pronouncekiwi.com/Hapcheon

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  16. soundhill,

    You said “Don’t trust the translation…”

    If Ken can’t trust a paper because of a misspelling, where does that leave all the articles you cite? You know, the ones where you have to tell us what you think the authors meant, as opposed to what they actually said?

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  17. Stuartg failing to read:
    “The FTC’s complaint alleged that these claims are false, misleading, or unsubstantiated.”

    “Or unsubstantiated.”

    As a doctor you should be more careful.

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  18. Stuartg, fluoride may be a cheap alternative to slightly improved dental health instead of a proper diet/environment for some persons. But especially where iodine is short it can have unwanted consequences.

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  19. soundhill,

    “I believe a way nature works is that because vitamin D is toxic over a certain amount that extra sunlight does not produce more it destroys what is there on the skin and has been formed on the warm skin from the sunlight-produced pre-vitamin D since the last sunlight dose.”

    I believe that you believe it. I also believe that no-one other than you understands that sentence.

    Don’t assume that others understand or follow the directions your own brain flies in, especially on the ‘net.

    Perhaps punctuation, defining pronouns and (possibly) rearrangement, addition or deletion, would make that sentence intelligible.

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  20. soundhill,

    …and now iodine.

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  21. soundhill,

    “fluoride may be a cheap alternative to slightly improved dental health instead of a proper diet/environment for some persons.”

    No, all the paper says is: fluoride added to water at CWF concentrations improves dental health.

    You mentioned diet, not the paper.

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  22. soundhill,

    Hmm… “proper environment”. That would be the environment we evolved to take maximum advantage of, wouldn’t it? That would be the grasslands of Africa, wouldn’t it? Coincidentally the diet there is also the “proper diet” that we evolved to eat.

    Do you have the figures for dental health among the nomad tribes of the African plains? We need to compare them with modern urban dwellers, with fluoridated water supplies, who are well out of their “proper environment”, and who do not eat the “proper diet” that we evolved to eat. And whilst we’re at it, let’s compare morbidity and mortality figures as well.

    Sorry, soundhill. I’ll stick with my improper urban environment, including safe fluoridated water supplies and safe food supplies. My improper urban environment means that my family will live a healthier life, of a much longer duration, than we would if we were still living with our “proper diet/environment” of the African grasslands.

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  23. “I believe a way nature works is that because vitamin D is toxic over a certain amount that extra sunlight does not produce more it destroys what is there on the skin and has been formed on the warm skin from the sunlight-produced pre-vitamin D since the last sunlight dose.”

    UVB acts on sterols on or in the skin to form pre-vitamin D. The pre-vitamin D gets converted to vitamin D on warm skin and is absorbed through the skin over a duration of from hours to days. (For interest cats lick it off their fur.) We get much more vitamin D from sunlight exposure than from non-supplemented diet. So it would seem possible for large daily doses of sunlight to produce too much vitamin D for our bodies to deal with. However sunlight destroys the vitamin on or in our skin so naturally limiting the amount we absorb to safe levels. I just wanted to point out that destruction of vitamin D by UV is normal. UVA lamps like the ones the common tanning beds use.destroy vitamin D but cannot activate sterols to pre-vitamin D.

    It seem from Ken’s post that Mercola has been selling or endorsing UVB beds without going through a substantiation process for the claims of health he makes.

    Ken’s ref says Mercola also recommends red light. I presume that is the infra red light that is commonly used by physio-therapists to stimulate circulation. I am not sure if the common tanning beds produce that heat which may be of use to people in terms of not getting too great a dose.

    But there is more to light on the skin. Light converts vitamin B12 in cyanocobalamin form to active hydroxocobalamin.

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  24. Stuartg: “Do you have the figures for dental health among the nomad tribes of the African plains? We need to compare them with modern urban dwellers, with fluoridated water supplies, who are well out of their “proper environment”, and who do not eat the “proper diet” that we evolved to eat”

    I did report how Maori in the Ureweras with 1% tooth decay had a tremendous increase in decay when they went to live in Auckland.

    “And whilst we’re at it, let’s compare morbidity and mortality figures as well”

    At the time the first Maori representative travelled to England Maori longevity was greater than British.

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  25. Sorry my assertion that tanning beds do not provide UVB is outdated. Many of them do, now.
    From Ken’s citation: “According to the complaint, the ads also falsely stated that the U.S. Food and Drug Administration has endorsed the use of indoor tanning systems as safe,”
    Mercola’s response: “The FTC states they had ordered me to stop selling beds in their press release. I offered and had stopped selling UV lights last December 2015 so that I can be free to fully participate in this crucial debate – UV light provides a quite different and preferred method of achieving optimal Vitamin D levels.

    At the time the FTC initiated this action, the FDA classified these devices as a Class 1 medical device. In their own words: “Class I devices are deemed to be low risk and are therefore subject to the least regulatory controls. For example, dental floss is classified as a Class I device”.

    A synonym for low risk can be looked up quite easily, “safe” is a synonym for low risk. The FTC also suggests that my support of the Vitamin D Council was not disclosed.

    The fact that I have supported the Vitamin D Council appears on the footer of every article on the website, along with many of the other non-profits I support.”

    http://articles.mercola.com/sites/articles/archive/2016/04/15/cosmetic-vs-nutritional-uv-exposure.aspx

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  26. soundhill1

    I have obtained DMFT in China from http://www.who.int/oral_health/media/en/orh_idj_283to290.pdf

    Beyond latitude 35 degrees north I find

    Area——–latitude—-DMFT at ages 12,15,18 added
    Shandong 35.7——–2.9
    Gansu 36.0 ——–3.9
    Tianjin 39.1 ——–3.4
    Beijing 39.9 ——–4.3
    Liaoning 41.7 ——–5.5

    The Openoffice Calc trend line equation reports an increase of 0.3 DMFT per degree with R2= 0.63

    divide by 3 to get figure at one age

    or I did the chart at age 18 and got 0.11 and R2= 0.81.

    So in Korea between latitude of Habcheon to 2 degrees further north in the rural areas around Seoul might be expected an increase of 20% in DMFT.

    So the cited study ought to specify latitude.

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  27. Yes Brian, and they should also have cited the number of prostitutes and ministers of religion in each region as well.🙂

    Again you talk about Seoul when the study was done in the Habcheon region.

    This is worse than straw clutching.

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  28. soundhill,

    The nomadic tribes of the African plains appear to be the only humans who still have the “proper diet/environment” that we evolved to take advantage of. That is why I wondered if you had dental health data from them to compare with urban CWF humans who no longer have that “proper diet/environment”.

    From your answer, I suspect that you are the only person worldwide that considers the Maori of the Ureweras to be a nomadic tribe of the African plains.

    I take it that this is another diversion to avoid you acknowledging that people with CWF have better dental health than those who don’t.

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  29. soundhill,

    I suggested that you look up morbidity and mortality as currently found in African plains nomads.

    You reply about longevity in Maori at the time of European settlement of New Zealand. Obfustication much..?

    Data show that morbidity and mortality in African plains nomads is much higher than in modern urban dwellers.

    I suspect that their dental health will also be much worse. After all, they don’t have the CWF that has been shown to improve dental health.

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  30. soundhill1

    Ken I showed the paper to a Korean who thought the control group was from all over Korea, though it did not actually say.

    A group in Habcheon was being compared against the narional survey. I assume that if a particular geographical area from the national survey were being selected as a control it would have been noted.

    He was interested in my football hypothesis. He said Habcheon does not stand out in football prowess.

    I may not get past anecdotes but I have found one player so far in the Korean national team from a similar size town: Gwacheon, population 70,000 fluoridated from 1994 to 2002. But the payer was born before fluoridation started: 1991.

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