Bottled Water May Take a Bite Out of Dental Health

Tastes great. More fillings?

Bottled water, missing the aftertaste that can bedevil water from the tap, also tends to be missing fluoride, the public health system’s main weapon against tooth decay.

Americans drink almost 3 billion gallons of bottled water a year, a gush from a trickle a dozen years ago. Some home filters also remove fluoride.

Is that bad for dental health? Scientists are not sure. People get fluoride in other ways.

But they do say people relying on bottled water should look at their other defenses against cavities and consider fluoride supplements or perhaps a return to the faucet if safeguards are lacking.

Fluoridated community water, now available to a majority of Americans, has been achieved over once-fierce objections that it intrudes on individual choice if not liberty itself.

“The great communist plot thing is over with, I think,” said Al Warburton of the American Water Works Assn., recalling debates in the years after pioneering Grand Rapids, Mich., fluoridated in 1945.

When it’s good, tap water is a bargain--a penny for five gallons, on average. Still, a lot of Americans flock to the bottle.

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“I’m concerned about people who are relying on bottled water,” says Dr. Michael Easley, speaking for the American Dental Assn. “They’re not getting enough fluoride and may not realize they’re depriving their children, who will pay the price their entire lives.”

That link has not been fully studied, some dispute it, and the government has not taken a position on it.

“I can’t help but think that unless an individual uses enough of other [sources] of fluoride, it’s going to be a problem,” says Dr. Alice Horowitz of the government’s National Institute of Dental Research. “But nobody knows that.”

With the science uncertain, dentists reach their own conclusions.

At his Chantilly, Va., practice, Dr. Mark Grimes tells patients bottled water is probably OK for grown-ups. “But if they’re into giving their kids bottled water, I’d discourage them.”

At issue is whether people who drink bottled water get enough of the enamel-toughening element from toothpaste, rinses, sodas, canned goods and other products where fluoride is present naturally or as a water additive.

The dental association says relying solely on those sources “is not an effective or prudent public health practice.” At the federal Centers for Disease Control and Prevention, Dr. William Kohn isn’t sure.

Fluoride is especially important for children and its continued use benefits teeth throughout life, he said.

“Still, the most cost-effective way to get fluoride is through community fluoridation, but there are other ways of getting it,” Kohn said. “We don’t know about the bottled-water connection.”

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The International Bottled Water Assn. recommends customers talk to their dentist or doctor about supplements if they are concerned about fluoride deficiency.

The dental association says tablets--or, for babies, drops--are the best alternative to fluoridated water, but they are pricey.

Only about 20 of the more than 500 brands of bottled water sold in the United States have added fluoride.

Dr. Steve Levy at the University of Iowa, who has tested bottled water for fluoride, says most brands are way under the optimal level of 1 part per million. Most are under 0.3 ppm, the level at which supplements have been recommended.

Levy says parents who use only bottled water and have children at risk of tooth decay should consider supplements or tap water. Others may be getting enough fluoride already, he said, and adults who eat and brush properly might get by with fluoridated mouthwashes.

Risk can be hard to assess, but factors include improper brushing or diet and a history of cavities in the child or siblings.

Too much fluoride can be bad for teeth. Someone taking fluoride tablets and drinking bottled water should not assume the water is free of fluoride, but check with the bottler. A few may have too much naturally present.

A minority scientific view persists that even the recommended concentrations are bad for health. The U.S. surgeon general says proper levels are safe.