Letters of Support submitted by Assemblywoman Amber Joiner

17 Pages·2017·3.1 MB·English

Nevada Public Health Legislative Requests
Require Fluoridation of Public Water Systems serving a
Population of 100,000 or more in Counties whose Population is
400,000 or more.
Background:
The Local Health Authorities (LHA) and the Nevada Public Health Association
(NPHA) support requirement of fluoridation of public water systems serving a
population of 100,000 or more in counties whose population is 400,000 or more.
Community water fluoridation has proven to be a safe, effective and cost-saving
public health measure for preventing tooth decay, and has been recognized by the
Centers for Disease Control and Prevention as one of the ten greatest public health
achievements of the 20th century. NRS 445A.055 requires fluoridation of public
water systems serving a population of 100,000 or more only in counties whose
population is 700,000 or more. The requirement was established by the legislature
in 1999 for counties with a population of 400,000 or more, but the 2011 legislature
increased the population requirement from 400,000 to 700,000, removing Washoe
County from the requirement.
Why It Matters:
The proportion of young children in Nevada aged 3-5 years with dental caries
experience in their primary teeth is 54%, much higher than the national rate of
33%. The proportion of children in Nevada aged 6-9 years with untreated dental
decay in their primary and permanent teeth is 44%, again, much higher than the
national rate of 29% (Burden of Oral Disease in Nevada, 2012 Nevada State
Health Division). Among children, untreated decay has been associated with
difficulty in eating, sleeping, learning, and proper nutrition.
Fluoridation of community water supplies is the single most effective public health
measure to prevent dental decay. Community water fluoridation benefits everyone
in the community, regardless of age and socioeconomic status. Fluoridation
provides protection against tooth decay in populations with limited access to
prevention services. Community water fluoridation is cost-saving even for small
communities. For communities with a population of 200,000 or more, $1 invested
in water fluoridation results in $27 of savings (Griffin SO, Jones K, Tomar SL. An
economic evaluation of community water fluoridation. J Public Health Dent.
2001;61(2):78–86.) For most cities, every $1 invested in water fluoridation saves
$38 in dental treatment costs. (American Dental Association Fluoridation Facts,
2005).
Why we support this initiative:
Throughout more than 60 years of research and practical experience, the
overwhelming weight of credible scientific evidence has consistently indicated that
fluoridation of community water supplies is safe. Community water fluoridation is
recommended by nearly all public health, medical, and dental organizations
including the American Dental Association, American Academy of Pediatrics, US
Public Health Service, and World Health Organization. Since 1950, the American
Dental Association (ADA) has continuously and unreservedly endorsed the
optimal fluoridation of community water supplies as a safe and effective public
health measure for the prevention of dental decay. The ADA’s policy is based on
its continuing evaluation of the scientific research on the safety and effectiveness
of fluoridation.
Public water system fluoridation should be expanded beyond Clark County for the
benefit of the State’s citizens and economy.
Nevada Dental Association

March 4, 2017

Assembly
 Committee
 on
 Natural
 Resources,
 Agriculture
 and
 Mining

Assemblywoman
 Heidi
 Swank,
 Chair

Dear Chairwoman Swank and Members of the Committee,

On behalf of the Nevada Dental Association, I am writing to express our Support for Assembly
Bill 193.

Fluoridation
 of
 community
 water
 supplies
 has
 been
 proclaimed
 by
 the
 Centers
 for
 Disease

Control
 and
 Prevention
 as
 one
 of
 10
 great
 public
 health
 achievements
 of
 the
 20th
 century.

According
 to
 the
 best
 available
 scientific
 evidence
 fluoridation
 is
 safe,
 effective
 and
 economical

in
 preventing
 tooth
 decay.
 Today,
 three
 in
 four
 Americans
 benefit
 from
 fluoridated
 water,
which represents
 more
 than
 211
 million
 people. Residents of Washoe County
 should
 join the
majority of others in Nevada
 who
 enjoy
 the
 decay-­‐preventing
 benefits
 of
 fluoridation.

Studies
 show
 that
 community
 water
 fluoridation
 prevents
 at
 least
 25
 percent
 of
 tooth
 decay
 in

children
 and
 adults,
 even
 with
 the
 widespread
 use
 of
 fluoride-­‐containing
 products
 such
 as

toothpaste.
 Simply
 by
 drinking
 water,
 people
 can
 benefit
 from
 fluoridation’s
 cavity
 protection
 –

regardless
 of
 age,
 education,
 race
 or
 socio-­‐economic
 status.

The
 bottom
 line
 is
 that
 community
 water
 fluoridation
 remains
 the
 single
 most
 effective
 public

health
 measure
 to
 prevent
 tooth
 decay.
 That
 is
 why
 organizations
 such
 as
 the
 American
 Dental

Association
 (ADA)
 as
 well
 as
 more
 than
 100
 other
 international
 organizations
 recognize
 the

public
 health
 benefits
 of
 fluoridation.

Please support the passage of Assembly Bill 193.

Sincerely,

Robert
 H.
 Talley
 DDS

Executive
 Director

Nevada
 Dental
 Association

3/5/17

Heidi Swank, Chair
Assembly Committee on Natural Resources, Agriculture & Mining
[email protected]

Dear Ms. Swank:

Fluoridation of community water supplies has been proclaimed by the Centers for Disease Control and
Prevention as one of 10 great public health achievements of the 20th century. According to the best
available scientific evidence fluoridation is safe, effective and economical in preventing tooth decay. Today,
three in four Americans benefit from fluoridated water, which is more than 211 million people. Our residents
should join the growing number of people who enjoy the decay-preventing benefits of fluoridation.

Fluoridation saves money. On an individual basis, the lifetime cost of fluoridation is less than the cost of one
dental filling.

Studies show that community water fluoridation prevents at least 25 percent of tooth decay in children and
adults, even with the widespread use of fluoride-containing products such as toothpaste. Simply by drinking
water, people can benefit from fluoridation’s cavity protection – regardless of age, education, race or socio-
economic status.

As a dentist, my first concern is my patients’ health. It’s difficult to watch people suffer needlessly from
cavities that could have been prevented with access to fluoridated water. Fluoride toothpaste and
fluoridated water deliver a one-two punch in the fight against cavities.

The bottom line is that community water fluoridation remains the single most effective public health
measure to prevent tooth decay. That is why organizations such as the American Dental Association (ADA)
as well as more than 100 other international organizations recognize the public health benefits of
fluoridation. The Healthy People 2020 goal is to increase the percentage of the population served by
fluoridated community water systems to 79.6 percent.

Additional information regarding fluoridation is available from the ADA at ADA.org /fluoride.

Sincerely,

James Garol, DDS, MSD

Cc: Amber Joiner
Michael Sprinkle
For more information, visit ADA.org/fluoride © 2013, American Dental Association. All Rights Reserved.
July 2, 2013
March 2, 2017

Chairwoman Heidi Swank
Assembly Committee on Natural Resources, Agriculture, and Mining
546 Barbara Way
Las Vegas, NV 89104-2858

Dear Chairwoman Swank,

On behalf of the 10,000 members of the American Academy of Pediatric Dentistry (AAPD), we
state our endorsement of fluoridated water for its significantly beneficial effects on the oral
health of the children of Nevada. We believe that all children deserve a healthy start in life, and
that every effort should be made to improve access to optimally fluoridated water and other
resources that improve health outcomes, particularly for children who suffer from health
disparities.

According to the AAPD Policy Statement, “Fluoride is both safe and effective in preventing and
controlling dental caries.” Our guidelines, representing the best clinical practices for treating the
oral health needs of children, state that sound scientific research from over a half-century
indicates reductions in cavities of 55 to 60 percent from water fluoridation. Recent data show a
reduction in cavities of approximately 25 percent, without significant enamel fluorosis, when
water supplies are fluoridated at an optimal level.1

As pediatric dentists, we are specialists in treating the oral health of children, and we are on the
front lines of providing care to our country’s most vulnerable children. Water fluoridation serves
the entire community and can have the strongest impact on underserved and financially
disadvantaged families.

Tooth decay is the most common chronic early childhood disease in the United States. By age
five, about six in ten children have had cavities.2 The pain from tooth decay hinders many
children from eating, speaking, playing, learning, and even getting a good night’s sleep. Children
with healthy mouths have a better chance of overall health, because infection in the mouth can
make a child more susceptible to infections in other parts of the body, such as the ears, sinuses
and brain. Relationships have been found between oral infections and diabetes, heart disease
and strokes.3

1 Gooch, BF. U.S. Public Health Service Recommendation for Fluoride Concentration in Drinking Water for the Prevention
of Dental Caries, Public Health Reports, July–August 2015, 130: 1–14.
2 US Department of Health and Human Services. Oral health in America: A report of the Surgeon General. Rockville, MD:
US Department of Health and Human Services, National Institute of Dental and Craniofacial Research website.
http://www.nidcr.nih. gov/DataStatistics/Surgeongeneral/sgr/home.htm. Accessed Aug. 12, 2015.
3 American Academy of Pediatric Dentistry. State of Little Teeth Report, 2014.
http://www.aapd.org/assets/1/7/State_of_Little_Teeth_Final.pdf. Accessed Aug. 12, 2015.

211 East Chicago Avenue, Suite 1600 • Chicago, Illinois 60611
312-337-2169 • Fax: [phone] • www.aapd.org • www.mychildrensteeth.org
Page 2, American Academy of Pediatric Dentistry

The tooth decay epidemic not only exacts a toll on children, but affects local healthcare systems
as well. For example, the overburdened Medicaid program pays hundreds of millions of dollars
every year to treat cavities in children, yet the condition is completely preventable, especially
with the help of water fluoridation.4

In summary, water fluoridation is safe, effective, costs very little, and will benefit your citizens,
especially those children most at risk of dental disease. We urge you to support this valuable
public health initiative.

Sincerely,

Jade Miller, DDS
President

John Rutkauskas, DDS, MBA, CAE
Chief Executive Officer

About the American Academy of Pediatric Dentistry

Founded in 1947, the American Academy of Pediatric Dentistry (AAPD) is a not-for-profit
membership association representing the specialty of pediatric dentistry. The AAPD’s 10,000
members are primary oral health care providers who offer comprehensive specialty treatment
for millions of infants, children, adolescents, and individuals with special health care needs. The
AAPD also represents general dentists who treat a significant number of children in their
practices. As advocates for children’s oral health, the AAPD develops and promotes evidence-
based policies and guidelines, fosters research, contributes to scholarly work concerning
pediatric oral health, and educates health care providers, policymakers, and the public on ways
to improve children’s oral health. For further information, please visit the AAPD website at
www.aapd.org.

4 Casamassimo PS, Thikkurissy S, Edelstein BL, Maiorini E. Beyond the DMFT: The human and economic cost of early
childhood caries. Journal of the American Dental Association, 2009, 140: 650-657.
February 28, 2017

The Honorable Amber Joiner
Nevada State Assembly
P.O. Box 9810
Reno, NV 89507-0810

Dear Assemblywoman Joiner:

On behalf of the American Public Health Association, a diverse community of public health
professionals who champion the health of all people and communities, I write in support of A.B.
193, legislation that would require community water fluoridation in counties in Nevada with a
population of 100,000 or more. This legislation would allow the implementation of fluoridation
in Washoe County, giving those residents the same health and economic benefits as the state’s
residents living in Clark County. Since 1950, APHA has supported community water
fluoridation as a safe and effective means of preventing tooth decay. Our most recent policy
statement, Community Water Fluoridation in the United States, is available on the APHA
website.

The overwhelming preponderance of scientific evidence supports community water fluoridation
as a safe, effective and cost-saving public health measure for the prevention of dental caries that
benefits all segments of the community. The Centers for Disease Control and Prevention
recognized water fluoridation as one of ten great public health achievements of the twentieth
century. The U.S. government’s Healthy People initiative has included the expansion of
community water fluoridation as a national health objective in every iteration since it began in
1990 including the Healthy People 2020 health objectives for the nation.

Consistent with the recommendation of virtually every major public health, medical and dental
organization in the United States, APHA supports access to community water fluoridation for all
residents of Nevada and throughout the nation.

Sincerely,

Georges C. Benjamin, MD
Executive Director

800 I Street, NW • Washington, DC 20001–3710
202-777-2742 • www.apha.org
March 2, 2017

Amber Joiner
Nevada State Assembly, District 24

Re: Public Health Benefits of Community Water Fluoridation

Dear Ms. Joiner:

As you may know, about ¾ of Americans using a public water supply enjoy the cavity
prevention of fluoridation. Surgeon General C. Everett Koop called fluoridation "the
single most important commitment a community can make to its children and to future
generations." Fluoridation is particularly important to disadvantaged people, especially
children.

Clark County (Las Vegas) has been fluoridated for many years. The principle opportunity
in Nevada for expanding fluoridation is Washoe County (northern Nevada -
Reno/Sparks). This is really a simple matter of equity and is sufficient reason for changing
the state's current fluoridation law.

In the early 1960s, the average U.S. adult had 18 teeth that were decayed, filled or
missing altogether. There were so many cavities then because these adults mostly grew
up in an era without fluoridated water and fluoride toothpaste. Fluoride is a mineral that
exists naturally in public water supplies but usually at a concentration that is too low to
prevent tooth decay. This explains why so many U.S. communities choose to fortify their
water with additional fluoride. According to the Centers for Disease Control and
Prevention (CDC), fluoridated water reduces tooth decay by about 25 percent over a
person’s lifetime.

Although America’s dental health has improved significantly in recent decades, tooth
decay remains the most common chronic disease of children and teens—even more
common than asthma. Research shows that children with dental problems are much more
likely to miss school, and teens with recent dental pain are four times more likely to
struggle academically. In 2013, a CNBC story pointed out one of the consequences for
adults with unhealthy or missing teeth:

“In America, most people—including employers—make instant judgments based on
appearance, including someone’s smile and teeth.”

The best way to avoid the pain, social stigma, cost and other negative impacts of tooth
decay is to use every form of prevention we have.

Community water fluoridation is the most cost-effective health measure for preventing
decay. First, it saves money for families who would otherwise pay for more frequent
fillings, crowns and other dental treatments. The lifetime cost of a single decayed molar
can exceed $6,000. Even families with dental insurance can face significant out-of-pocket
expenses when they need dental procedures. Second, fluoridation saves money for