Medical professionals have a responsibility to provide their patients with informed consent, not to do so violates a major ethical principle.
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We are fortunate to live in a society in which we have the right to accept or refuse treatment based on the principle of informed consent. If my child or I am diagnosed with a medical condition and a physician recommends a drug to correct it, I have the right to know the risks and benefits of the medication, the alternatives to the medication, and the risks and benefits of the alternatives. Furthermore, I have the right to refuse any treatment.
Fluoridated water is medicated water. I do not believe that it is ethical to force the population of Juneau to drink medicated water. Fluorosis, the white scarring and yellowing of the teeth, is not, (contrary to a recent letter) prevented by fluoride, rather, it is caused by ingesting fluoride. In addition, fluorosis is not merely a cosmetic problem, it is fluoride toxicity, and it can happen at concentrations as low as 1 ppm. In severe cases of fluorosis, the teeth can become brittle, pitted and actually hollow as well. The research shows that the benefits of fluoride occur when fluoride is used topically on the tooth surface. Systemic use of fluoride does not prevent cavities.
I have read letters suggesting that the real people who will benefit from adding fluoride to the water are those who are low-income, with little or no access to health or dental care. I would suggest that these families are also those with the most to lose, when instead of preventing cavities the fluoride they ingest causes their teeth to be permanently scarred (what might be happening to their bones?). These are the families without the resources to purchase bottled water, which they will need to mix their children's formula should they choose to bottle-feed their infants.
I recently spent about a half-hour calling 17 dentists in Juneau. Four of these dentists will take children on the Denali Kid Care program. I believe the reason so few dentists accept Medicaid patients is that Medicaid does not fully reimburse the dentists for their time and billing Medicaid is, I am sure, a paperwork headache. However, I would suggest that if Juneau wants to help low-income children prevent cavities we can start by making dental care more accessible to low-income families.
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