A recent article on Slate focuses on “Fourteen Oddball Reasons You’re Not Dead Yet.” Among the 14? Believe it or don’t, fluoride.
There were plenty of miserable ways to die before the mid-20th century, but dying of a tooth abscess had to be among the worst—a slow, painful infection that limits your ability to eat, causes your head to throb endlessly, and eventually colonizes the body and kills you of sepsis. Now it’s a rare way to go, thanks to modern dental care, toothbrushes, and (unless you’re in Portland) fluoridated water.
That’s certainly giving fluoride a lot of credit. It’s not like it’s used in the treatment of abscesses. And it’s not like it’s done all that much to prevent them. While it’s true that death from oral infections is much rarer today than in the bad old days – though it still happens – abscesses remain a significant problem. As Robertson and Smith wrote in the Journal of Medical Microbiology,
Historically, the potential for a dental abscess to spread causing severe sepsis and death has been known since antiquity although the role of bacteria in this process was not recognized until the turn of the 20th century (Turner Thomas, 1908). When the Bills of Mortality (London) began listing the causes of death in the early 1600s, ‘teeth’ were listed as the 5th or 6th leading cause of death (Clarke, 1999). By the turn of the 20th century, dental infections were associated with a mortality rate of 10–40% (Turner Thomas, 1908). Collecting appropriate current epidemiological data is difficult due to differences in the methods of reporting throughout the world but the evidence suggests that it is still a significant clinical problem. In Scotland there were 3500 hospital admissions between 2000 and 2005 for acute dental infections while hospitals in England saw a doubling of admissions for surgical treatment of dental abscesses over a similar period (Information & Statistics Division, 2007; Thomas et al., 2008). In the United States, despite a generally dentally motivated population a large prospective study reported that 13% of adult patients sought treatment for dental pain and infection over a 24 month follow-up (Boykin et al., 2003), and in the US hospital admissions relating to acute dental infections are estimated to occur at rate of 1 per 2600 head of population per year (Wang et al., 2005). Periapical abscesses account for 47% of all dental-related attendances at paediatric emergency rooms in the United States (Graham et al., 2000). While the studies cited above do not give an exhaustive analysis of the extent of this problem in different parts of the world, nonetheless they do lend credence to the view that dental infections have significant implications for patient morbidity and health care systems. [emphasis added]
Findings just published in the Journal of Endodontics further show how we’ve hardly conquered the problem of severe oral infection.
“The number of hospitalizations attributed to periapical abscesses increased by 41%, from 5,575 in 2000 to 8,141 in 2008,” the researchers wrote. The team, which included a private practitioner, a Tufts University dental student, and researchers from the Harvard School of Dental Medicine and Boston Children’s Hospital, ruled out an increase in total hospitalizations as the cause, since that number only increased by 5%, from 37.9 million to 39.9 million, during the same time period. But they did state that “a lack of preventative dental care, dental treatment in a dental clinic setting, and oral health education must be considered.”
To support their opinion, the researchers noted the 32% increase in emergency admissions for periapical abscesses during the same time as evidence that these patients had not been receiving routine oral care or delayed treatment until the issue was severe enough to compel them to go to the hospital.
And fluoride has helped…how, exactly?