Northeast Portland

Before you vote: Fluoride and kids' teeth - what does the data show?

Before you vote: Fluoride and kids' teeth - what does the data show? »Play Video
Photo courtesy kinjosan on Flickr (Creative Commons).

The KATU Problem Solvers are revealing ground-breaking new data that may change the way you vote on Portland's fluoridation measure next month.  It’s data that the state wasn't eager for you to see.

After dozens of emails, phone calls, and formal requests, KATU’s Shellie Bailey-Shah finally received yesterday a draft of the 2012 Smile Survey from the state of Oregon.

The 2012 Smile Survey is a snapshot of Oregon kids' dental health; but by using the raw data, the KATU Problem Solvers reveal a picture yet to be seen in the survey.

Every five years, specially-trained dental hygienists look into the mouths of 1st, 2nd and 3rd graders at 82 elementary schools in the state and document what they find.

The Oregon Health Authority (OHA) then publishes the results in the Smile Survey and uses the normally-sobering statistics about tooth decay as a rallying cry for preventive measures, including community-wide fluoridation.  But until this week, the Smile Survey remained unavailable.

Typically, the survey is released within a year of the data being collected.  In 2007, the OHA started to collect data in January and released it 11 months later in November.  In 2012, the OHA started in March, but as of early this week - 13 months later - it still hadn't released the results to the public.

The reason?  Dr. Bruce Gutelius, the Deputy State Epidemiologist for the OHA, said this year’s survey gathered more information on a thousand more kids.
   
“Instead of being just one school year, it actually had to go over two different school years, because we were having this larger survey than we’d had before,”  he explained.

The OHA did produce the draft yesterday, after receiving an email request from KATU as early as April 1, followed by two Freedom of Information Act requests, filed April 8 and 22.

The 2012 survey shows kids in Multnomah County improved their dental health by 10% since 2007:

  • 2012: 50.7% one or more cavities
  • 2007: 56.3% one or more cavities

The Problem Solvers asked the question:  did the OHA – an agency that has publicly supported community-wide fluoridation - sit on the results of the Smile Survey in fear that voters would see improving numbers and then maybe think that fluoridation wasn't necessary?

“It terms of the timing for the survey, what I would say is we want to make sure that we are always systematic about the way that we collect it, always systematic about the way that we look at it, and always systematic about the way that we report it, because we want it to be complete, accurate and reliable,” answered Gutelius.

Overall, the states’ dental health numbers for kids have only improved by about 3% in the last 10 years.
 
“So we’ve maybe regained some ground that we lost in 2007 and that’s encouraging, but there’s still plenty of work to do, and it’s important to know that (we) still have one out of two kids who have this problem, “ Dr. Gutelius explained.

So what does the data reveal about fluoride's effectiveness in Oregon?  Well, nothing... because despite spending $30,000 of taxpayer money on the survey, the state has never asked that question.

"It’s been looked at for several years in many different communities (outside of Oregon)," Dr. Gutelius said. "We know the impact that it has. We know that’s it’s definitely a safe and effective way to improve kids oral health, and we know it’s a cost-effective way to do that as well."

The OHA points to studies done outside of Oregon, like one done in Colorado in 2005, which shows fluoride led to a 29.1% decrease in cavities in that state and yearly health savings of $61/person.  Even the Centers for Disease Control and Prevention (CDC) calls fluoridation "one of the 10 great public health achievements of the 20th century."

But the Problem Solvers wanted a more local view, so Bailey-Shah started drilling down for answers.  She asked the OHA to share the raw data from the Smile Survey, so that the Problem Solvers could analyze the results for themselves.  When the OHA resisted, she filed two Freedom of Information Act requests to obtain the numbers.  The team then spent hours cross-referencing all 82 schools that were part of the survey to see whether they're located in fluoridated water districts.

The assumption here: if a child goes to a school with fluoride in the water, he likely lives in a neighborhood around that school and would also have fluoridated water at home.

The Problem Solvers then took the average decay rate of all the fluoridated schools and compared it to the decay rate of the non-fluoridated schools, statewide.  You'd think the kids with fluoridated water would fare better.

But in the Problem Solvers’ analysis, the results were nearly the same:

  • 53.7% of the kids in the non-fluoridated areas had one or more cavities
  • 52.03% of kids in fluoridated areas had one or more cavities
  • 47.81% of kids in the Portland water district (which is currently fluoride-free) had one or more cavities

Bailey-Shah took the findings back to the OHA. Dr. Gutelius dismissed the results.

"It's really about what's happening in the state, what's happening in the region.  They're not really meant to draw conclusions about what's happening in any one school," he cautioned.  "We need to have more information about what's happening with an individual child than we collect on this survey to really make some of those conclusions about specific schools."

Admittedly, the Problem Solvers’ analysis couldn't take into account some factors:

  • Do the kids in fluoridated districts drink bottled or well water instead of tap water?
  • How long have they lived in those fluoridated districts?
  • Which kids take fluoride tablets?

Bailey-Shah also shared the findings with the pro-fluoride campaign in Portland.

"The overwhelming weight of evidence is that fluoridation really works," said Mel Rader, co-director of Upstream Public Health.

Rader is a fluoride advocate with a background in water engineering.  He said the comparison is not a reliable, scientific one.  Furthermore, he said the 2012 Smile Survey points to a real need for wide-scale intervention.

"We’re talking about Portland here," Rader said.  "We should be doing a lot better than we are.  We’re doing considerably worse that Seattle; we're doing considerably worse than a lot of comparable areas.  And water fluoridation has been proven to really significantly reduce tooth decay."