A new survey shows that Hawaii’s children have the highest prevalence of tooth decay in the nation.
This doesn’t surprise me. I grew up in Honolulu, where despite having parents who hovered over my three brothers and me while we brushed our teeth and sent us to the best dentists they could find, we suffered year after year from dozens of cavities that eventually required painful dental procedures, including root canals and other oral surgery.
Yet despite all the dental problems in Hawaii, policymakers continue to turn their backs on an obvious solution that could improve dental health for everyone in the islands: community water fluoridation.
If there ever were a time to renew discussions on fluoridation, it is now.
baby bad teeth
When it comes to tooth decay, Hawaii is failing its children by not fluoridating its water.
State Department of Health Director Virginia Pressler was at the news conference Oct. 3 announcing the survey that showed, once again, that Hawaii is a loser when it comes to dental care.
Pressler said, “We have known for a long time that we’ve had poor oral health, particularly for the children of the state.”
A state study done in 2013 called “Oral Health: Key Findings” said essentially the same thing — that dental health care is lacking here, particularly for Hawaii’s most needy residents.
That study showed that in Hawaii in 2012 there were more than 3,000 emergency room visits due to preventable dental problems. A 67 percent increase from 2006, much higher than the 22 percent increase seen in the rest of the United States in the same period.
The new survey showed that seven out of every 10 public school third-graders had tooth decay — 71 percent, compared to the national average of 52 percent.
In addition, the survey found that 7 percent of Hawaii’s children at any given time need urgent care to relieve their pain from infected teeth and gums. The national average is less than 1 percent.
“If applied to all children in kindergarten to sixth grade, more than 6,600 children in Hawaii’s public elementary schools experience pain or infection due to dental disease on any given day,” the survey says.
Ample Evidence Exists
It is sad to think of little children with sore teeth, especially when it doesn’t have to be that way.
And its not just kids. Hawaii’s adults are also experiencing pain from bad teeth, particularly the state’s low income people and Micronesian and other Pacific Island residents.
Only about 11 percent of Hawaii residents are served by public water systems that are fluoridated. On the mainland, about 66 percent of the people have access to fluoridated water.
Ask any dentist. Fluoridation helps prevent tooth decay and can save children and adults a lot of agony and cost for dental bills over their lifetimes.
“All the military bases in Hawaii have community water fluoridation. I do see many military dependents as patients and they don’t have the rate of cavities we have in our other patients.” — Cedric Lewis, dentist
Hawaii Dental Association president Steve Wilhite said in a newspaper interview that he looks forward to the day when fluoride is more commonly added to Hawaii’s public water systems.
He says fluoridated water has been shown to result in a 50 percent reduction in tooth decay in less than 10 years.
Fluoride is a mineral that occurs naturally in food and water. Community water fluoridation is when communities adjust the amount of fluoride in water to levels known to prevent tooth decay.
The discovery of fluoride to prevent tooth decay in the late 1940s has been called by the Centers for Disease Control and Prevention one of the 10 greatest public health innovations of the 20th century.
My own dentist, Dr. Cedric Lewis, supports fluoridation and has seen ample evidence in his two Oahu dental clinics that it works.
“All the military bases in Hawaii have community water fluoridation. I do see many military dependents as patients and they don’t have the rate of cavities we have in our other patients,” says Lewis.
“It is really sad we don’t have fluoridation here when it has been done with great success in other communities,” he says.
The state Health Department says the fluoridated water systems on all of Hawaii’s military bases serve 10 percent the islands’ population.
The Hawaii Dental Association, Hawaii Medical Service Association, the Department of Health and the Academy of Pediatrics have all spoken out strongly in the past in favor of fluoridated community water systems, but to no avail.
Too Controversial To Do What’s Right?
Fluoridation opponents often contradict the medical experts, claiming fluoride does more harm than good and that putting it in a water supply violates the rights of individual consumers.
Feelings here run so strong against cavity-fighting fluoride that Honolulu City Council members voted 7-2 in 2004 to prohibit putting any chemicals in Oahu’s public municipal water systems except for the small amounts of chlorine currently used to disinfect water in certain wells.
The Hawaii Dental Association says it will not push the Legislature or the City Council to fluoridate Oahu’s water. Spokeswoman Melissa Pavlicek says dentists in the association are holding back because they don’t think they will succeed in getting public support.
“We were really beaten up by opponents.” — Janice Okubo, Department of Health
“Of course, HDA would encourage any efforts for fluoridation, but we want to work in areas where there is a better chance of success,” says Pavlicek.
She says the association will renew its support for a bill legislators killed last year calling for $4 million to fund dental care for Hawaii’s 209,000-plus adults receiving Medicaid.
Hawaii’s most needy adults currently get insurance only for dental emergencies, and that often means insurance coverage only for having badly infected teeth pulled. There is no preventative dental care offered to adults on Medicaid to keep their teeth from decaying in the first place.
Hawaii’s 141,159 children on Medicaid get full dental coverage, including all forms of preventative and emergency care to include prosthodontics — teeth replacements and dental implants.
Lewis thinks the disparity in dental coverage between adults and children on Medicaid makes no sense.
“The adults are the children’s caregivers,” says Lewis. “What good does it do a child if his parent is disabled and sick from infected teeth?”
The Health Department says it will also hold back this year from suggesting even a pilot project for fluoridated water in a single location.
Spokeswoman Janice Okubo says during the administration of Gov. Ben Cayetano, the department supported a proposal in 2001 to conduct a pilot project to fluoridate water on Lanai.
“At the time, there was some evidence that Lanai had the highest rate of tooth decay in children in the state,” says Okubo. “The proposal met opposition and was cancelled in 2002.”
“We were really beaten up by opponents,” says Okubo.
Some Progress Is Promised
So for now it seems as if the state will be looking at other ways besides drinking water to get cavity fighting fluoride to Hawaii’s adults and children.
Danette Wong Tomiyasu, deputy director of Hawaii’s Health Resources Administration, says the state is looking to expand the delivery of fluoride by enlisting the help of medical doctors.
Tomiyasu says the Health Department is encouraging pediatricians to offer topical fluoride treatments and oral fluoride drops or pills when their patients come in for regular checkups.
“We are working to get more preventative dental health treatments into general health delivery, “ says Tomiyasu.
The Health Department has money now to rebuild its dental health division, which was decimated in 2009 during the Gov. Linda Lingle administration to address the state’s billion-dollar budget shortfall.
The U.S. Centers for Disease Control and Prevention has given Hawaii a $1.1 million dollar grant to be spent over five years to rebuild the state’s dental hygiene and dental care outreach services.
Most of the programs are in planning stages now.
Unfortunately, by the time the new dental health programs are initiated, some residents’ dental health may have already been badly compromised.