Nobody gets tooth decay by drinking water, but Coca-Cola recently announced they were “investigating the possibility of including fluoride in some of [their] bottled waters”. A strange announcement given water drinkers are not the ones who need the tender ministrations of industrial medication.

Juice and soft drink gulpers are the ones who need help with their teeth, but government and now Big Sugar are carpet bombing the water drinkers rather than laser targeting the sugar drinkers.

Researchers have known since the 60s that tooth decay is caused by a little chap called Streptococcus mutans (SM). It is one of the 200 to 300 species of bacteria that inhabit our mouths.

SM is a little unusual though. It’s rather like a koala in that it only really likes one thing to eat. No, not gum leaves. SM wants sugar. To be more precise, SM likes the two components of sugar, glucose and fructose in exactly the proportions they are found in sugar, 50/50.

In hundreds of well controlled studies, scientists have been able to determine that feeding SM sugar causes it to produce plaque and lactic acid. Plaque is the gummy coating on teeth. If you feed SM pure glucose or fructose it can only produce the acid. It can’t make plaque without sugar and without plaque there is no decay. If you want to rot teeth, the most effective way is to give SM a constant wash of sugar solution (like soft drink or fruit juice). Eating sugar in food still works but it is nowhere near as effective at helping SM do its job.

SM has really enjoyed our change in diet in the last few decades. The amount of sugar laden, soft drink, juice and flavoured milk we drink has risen from virtually nothing prior to World War II to almost 1 litre per person per day (PDF 1.04MB). Consumption of soft drink alone has more than doubled in the last 30 years. And with this our need for dental services has also risen exponentially.

Unfortunately fixing decayed teeth is monumentally expensive, so our governments have been reluctant to include those costs in our “free” public health system. The number of decayed teeth (PDF 1.86MB) in the mouth of the average six-year-old increased by 11.4 per cent between 1990 and 1999. And Australia now spends 1 in every 10 health dollars on those white (well, yellowish) things in our mouths. The health cost is accelerating almost as fast as the sales of soft drink.

Our governments, desperate to avoid the popular demand for them to pay the bill for a disease that affects everyone (that consumes sugar), have increasingly turned to the quick-fix solution of mass medication using fluoride. And there is no denying that mass fluoride medication has an economic appeal. Victoria estimates that it has saved more than $1 billion in public dental services in the three decades since it started pumping fluoride into its water supplies. Big Sugar doesn’t mind some free marketing, so has clearly jumped on board with the message.

The chemical used most commonly for water fluoridation is fluorosilicic acid. It is produced as a co-product from the manufacture of phosphate fertilisers. Because some people have concerns that putting such a thing in our water supply might not be a good thing, the World Health Organisation (WHO) conducted a thorough review of the health effects of fluoride in 2002.

The WHO report concluded that there was at least a 12.5 per cent reduction in the number of dental cavities in communities where water fluoridation had been introduced. These numbers are supported out by a recent Australian study (PDF 1.1MB) which show that the average six-year-old will have one less decayed tooth (which still leaves two) if there is fluoride in the water.

The problem is that 90 per cent of swallowed fluoride is retained by the body. Fluoride accumulates in the bone (and tooth) internal structure and ultimately causes a disease called fluorosis. The WHO report noted that the risk of dental and skeletal fluorosis was significantly increased in areas where the water was heavily fluoridated. Over time, the accumulation of fluoride may result in increased brittleness leading to crumbling teeth and more easily broken bones.

And WHO aren’t the only ones raising red flags. The risks associated with swallowing too much fluoride are so real that earlier this year the American Dental Association put out a warning to mothers (PDF 23.1KB) not to mix infant feeding formula with fluoridated water.

Not even the most wildly supportive research suggests that fluoridating water cures tooth decay. It merely defers the problem and the expense of treatment. The price for treating less decayed teeth now, is that someone in the future can deal with elderly people suffering continuous fractures.

You don’t have to look too hard to see why. Fluoridation lets government and Big Sugar alike look like they are doing something tangible about dental health without actually doing anything which challenges the status quo. At the same time politicians can justify the closure of public dentistry facilities (such as school clinics) because they have “solved” the problem. And they can defer discussion about who should pay for dental health until somebody else’s watch. Best of all, the “treatment” is administered without asking any voter to change their lifestyle.

Strangely, neither government nor Big Sugar appears to be contemplating the possibility of removing or changing the sugary drinks that cause the problem in the first place.

If mass medication is the way we solve society’s lifestyle influenced health problems, then why stop at fluoride? Bowel cancer is growing at unprecedented rates, so let’s back the Metamucil trucks up to the reservoirs and the bottling plants. Too many of us still smoke, so how about dumping a load of whatever they put in nicotine patches into the water as well. Maybe if we tip in a few hundred gallons of anti-depressant, we could even do something about our falling consumer confidence (there’s an idea, Kevin). The possibilities are endless.