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Amazing Dental News

News From Our Arlington, Texas Cosmetic Dental Practice

At Amazing Dental, we believe in creating a relationship with our patients that goes beyond the office doors. We've specially created this section of our site to share with you important news from our Arlington family dental practice.

Dr. Aamir Budhani
Your Arlington Cosmetic Dentist
Too Much Bottled Water May Harm Kids' Teeth

On grocery store shelves and kitchen counters alike,bottled water has become a staple of the American dietary landscape.

But, some experts say it may contribute to diminished dental health.

While most bottled water manufacturers declare that their products are 100 percent "pure," "clean" or "natural," few brands contain one ingredient that most Americans take for granted: fluoride.

A salt formed from the combination of fluorine and soil and rock minerals, fluoride is voluntarily added by the vast majority of states and/or local municipalities (rather than the U.S. Environmental Protection Agency), to public water supplies across the United States.

The goal: to help reduce the risk for dental cavities.

When it comes to bottled water, the decision to add or not to add fluoride is left entirely up to individual manufacturers. Most do not.

And with Americans now consuming about 8.4 billion gallons of bottled water each year, according to the Beverage Marketing Corp., some experts say that turning away from tap water means more cavities and worse dental hygiene.

Concern are most acute when it comes to children.

Dr. Burton Edelstein, president of the Children's Dental Health Project in Washington, D.C., and a professor of dentistry and of health policy and management at Columbia University in New York City, describes the increasing prevalence of tooth decay among young children as "alarming."

"[Today] one in 10 2-year olds, one in five 3-year olds, one in three 4-year olds and approaching half of 5-year-olds have visually evident tooth decay experience," he said, adding that "the consequences in terms of pain, infection, dysfunction and unmet treatment need are significant."

But where does bottled water fit in, if at all?

In 2009, an Eastern Virginia Medical School study published in the journal Pediatric Dentistry found that nearly 70 percent of parents surveyed said that they gave their children bottled water to drink, either exclusively or alongside tap water.

Parents cited bottle waters' convenience; a preference for its taste and smell; and a fear of tap water contamination.

Nearly two-thirds of parents said that they had no idea whether or not the bottled water they gave their children contained any amount of fluoride.

Dr. Jonathan Shenkin, an American Dental Association spokesman and Augusta, Maine-based pediatric dentist, said that consumers would have a hard time finding out if a product contained fluoride, and even if it did, whether the amount was significant.

"Available studies show that most bottled waters have less than 0.3 ppm [parts per million] of fluoride, well below the accepted level for optimally fluoridated drinking water," he said. "There are no [U.S.] Food and Drug Administration requirements that the amount of fluoride be labeled on bottled water unless it has been added during processing. This leaves consumers in the dark about the fluoride content of the bottled water they consume."

But the connection between bottled water and dental health is just a suspicion, with no scientific proof.

Shenkin acknowledged that "there has been no research to show using bottled water causes tooth decay." At the same time, he cautioned that fluoridated tap water is now believed by experts to reduce the risk of tooth decay by about 25 percent, and that no research has effectively discountedthe possible connection between non-fluoridated bottled water consumption and a rise in tooth decay risk.

Indeed, Shenkin offered a "reminder that the U.S. Centers for Disease Control [and Prevention] listed water fluoridation as one of the 10 great public health achievements of the 20th century."

Edelstein seconded the notion that fluoride is an important tool in the fight against tooth decay.

"Fluoride -- no matter how it gets to the tooth surfaces -- toothpaste, water, rinses, varnishes, gels, is effective in a multitude of ways," he said. "It strengthens the tooth structure while also inhibiting the bacteria's capacity to produce acids from sugars. It is most effective when delivered multiple times throughout the day, by using fluoridated toothpastes twice daily and by drinking fluoridated water."

Edelstein noted that "the advantage of water is that it is consumed multiple times a day," adding that tap water is both convenient and free.

"[But] when bottled water without fluoride is substituted for fluoridated tap water, the advantage of regular, small amounts of healing fluoride is lost and children and adults will be more prone to cavity activity on the surfaces of their teeth," he warned.

That said, Edelstein -- like Shenkin -- also noted that no studies have as yet directly linked a higher risk for cavities to the consumption of bottled water in place of tap water.

"Some have attributed this increase and prevalence to bottled water substitution," he said. "But that remains conjecture as other factors -- increased sugar in diets, changes in demography, dental intervention -- may account for the change."

In a news release issued in March, the International Bottled Water Association (IBWA) denied that bottled-water consumption is associated with an increased risk for tooth decay.

"There is absolutely no correlation between consumption of bottled water and an increase in cavities," the IBWA stated. "In fact, bottled water does not contain ingredients that cause cavities, such as sugar." The organization also noted that about 20 of its member manufacturers actually produce "clearly labeled" fluoridated bottled water.

"Consumers," the IBWA added, "should therefore look at how much fluoride they are receiving as part of an overall diet and should contact their health-care provider or dental-care provider for their recommendation."

Oral Warning Signs Can Indicate Serious Medical Conditions

Regular dental exams not only help to decrease a patient's risk of oral diseases, such as cavities and periodontal (gum) disease, but they may also help to diagnose other, sometimes life-threatening, medical conditions.


Dentists are able to assess a patient's overall oral health and may recognize symptoms of serious diseases, including diabetes, cancer, and eating disorders, which often manifest as signs and symptoms inside of the mouth.



More than 25 million people in the United States alone suffer from diabetes.


"Because diabetes reduces the body's resistance to infection, the gums are at risk for gingivitis, an inflammation usually caused by the presence of bacteria in plaque," says Academy of General Dentistry (AGD) spokesperson Julie Ann Barna, DMD, MAGD. "Additionally, those with diabetes can experience high incidences of oral fungal infections and persistent bad breath."


Oral Cancer

Oral cancer is one of the most common cancers, with approximately 35,000 new cases reported annually in the United States.


"Indicators of oral cancer may include bleeding sores, lumps, or thick, hard spots, as well as changes in the way teeth fit together," says Dr. Barna.


Oral cancer is sometimes difficult to self-diagnose, so routine dental exams are recommended. A dentist will feel for lumps or irregular tissue changes in your neck, head, cheeks, and oral cavity and thoroughly examine the soft tissues in your mouth, specifically looking for any sores or discolored tissues.


Eating Disorders

"Eating disorders, including anorexia nervosa and bulimia nervosa, can rob the body of much-needed vitamins and minerals," says Dr. Barna. "Without proper nutrition, the gums can lose their healthy pink color and become increasingly soft and tender, bleeding easily."


Disorders that involve excessive vomiting, such as bulimia, can cause discoloration and erosion of the teeth due to constant contact with acid from the stomach. People who have eating disorders also may experience swollen salivary glands, dry mouth, sensitive teeth, and loss of tooth enamel.


Diseases negatively impact your general health, but they also can damage your oral health.  Regularly scheduled dental exams allow dentists to detect or monitor your health.


"Patients should inform their dentists about any and all medical conditions and medicines that may affect their oral health, as well as any changes in their medical history," says Dr. Barna. "Remember, maintaining a healthy body includes taking care of your oral health."
Bottled Water linked to Tooth decay in Kids
A recent article from the CDC advises parents to avoid giving their children bottled water as it may not contain sufficient levels of fluoride.  The following is an excerpt from the article:

Bottled Water and Fluoride

Consumers drink bottled water for various reasons, including as a taste preference or as a convenient means of hydration. Bottled water may not have a sufficient amount of fluoride, which is important for preventing tooth decay and promoting oral health.

Some bottled waters contain fluoride, and some do not. Fluoride can occur naturally in source waters used for bottling or it can be added. This fact sheet answers common questions about bottled water and fluoride.

Who regulates fluoride in bottled water?
The Federal Food, Drug, and Cosmetic Act provides the U.S. Food and Drug Administration (FDA) broad regulatory authority over food, including bottled water, which is introduced or delivered for interstate commerce (produced and sold in more than one state). Bottled water that is in intrastate commerce is under the jurisdiction of the state in which the bottled water is produced and sold. Contact the manufacturer to ask if their product is under FDA jurisdiction or state jurisdiction.

Why doesn’t the EPA have jurisdiction over the quality of bottled water since it regulates drinking water?
The Environmental Protection Agency (EPA) and the FDA have a 1979 Memorandum of Agreement specifying that the EPA regulates safe drinking water in accordance with the Safe Drinking Water Act, and that the FDA regulates bottled water as a consumer beverage under the Food, Drug, and Cosmetic Act (Federal Register, Volume 44, No. 141, July 20, 1979).

What FDA regulations apply to bottled water?
The FDA has strict regulations on standards of quality, identity, and good manufacturing practices that bottled water must meet. Its regulations for governing the standards of "quality and identity” for bottled water are found in the Code of Federal Register 21 CFR 165.110. The FDA standards of quality state that domestic bottled water with no added fluoride may contain between 1.4 and 2.4 milligrams per liter (mg/L) fluoride, depending on the annual average daily air temperatures at the location where the bottled water is sold. Domestic bottled water with added fluoride can contain between 0.8 and 1.7 mg/L fluoride, depending on the annual average daily air temperatures where the bottled water is sold. Imported bottled water with no added fluoride may not contain more than 1.4 mg/L fluoride, and imported bottled water with added fluoride may not contain more than 0.8 mg/L fluoride.

Is the amount of fluoride in bottled water always listed on the label? 
The FDA does not require bottled water manufacturers to list the fluoride content on the label, but it does require that fluoride additives be listed. In 2006, the FDA approved labeling with the statement, "Drinking fluoridated water may reduce the risk of tooth decay,” if the bottled water contains from 0.6 mg/L to 1.0 mg/L.

How can I find out the level of fluoride in bottled water if it’s not on the label? 
Contact the bottled water’s manufacturer to ask about the fluoride content of a particular brand.

Does drinking bottled water without fluoride lead to more cavities?
Your oral health—specifically, how many cavities you have—depends on many factors, one of which is how much fluoride you receive in the form of toothpaste, mouthwash, water, food, and professional fluoride products applied by dental professionals. Other factors include how often and how thoroughly you brush your teeth and floss, what you eat, and whether you receive regular dental care. If you mainly drink bottled water with no or low fluoride, and you are not getting enough fluoride from other sources, you may get more cavities than you would if fluoridated tap water were your main water source.

Will the fluoride content change if the bottled water is stored for a long time?
Fluoride will not react with other minerals present in the water during storage, nor will it react with its plastic or glass container. The FDA considers bottled water to be safe indefinitely if produced in accordance with quality standard regulations, and if stored in an unopened, undamaged, and properly sealed container. Many bottlers list an expiration date, however. Note that if there is no expiration date, bottled waters should not be used more than two years after the date of purchase because the packaging may have hard-to-see deterioration.

Can I use bottled water for mixing infant formula?
Yes, you can reconstitute (mix) powdered or liquid concentrate formulas with bottled waters, but be aware that the fluoride content in bottled water varies. If your child is exclusively consuming infant formula reconstituted with water that contains fluoride, there may be an increased chance for milddental fluorosis. To lessen this chance, parents can use low-fluoride bottled water some of the time to mix infant formula. These bottled water products are labeled as de-ionized, purified, demineralized, or distilled, unless they specifically list fluoride as an added ingredient