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Wednesday, November 26, 2008

Looking for Clues: Is There A Fluoride Shortage in the United States?

It's all I can do to keep up with the bizarre fluctuations in gasoline prices, nevermind what appears to be a national shortage of fluoride. In October 2003, our family left New York City, where there's flouride in the city water, and moved to the Roxiticus Valley , where we have well water and with no fluoride in it. Now, I'll save the story of Maddie's pre-school experiences with pediatric dentistry for another day, but let's just say I became convinced that she was at risk of tooth decay. Worried about the effect of the lack of fluoridated water in our area on London and Maddie's teeth, we consulted Dr. David Matthews of Far Hills Dental Care in Far Hills, New Jersey. He recommended prescription multivitamins with a fluoride supplement included, and the girls have been taking PolyVitamin Fluoride Tablets for a few years now.

Then, at the end of the summer, we started having problems refilling London and Maddie's fluoride vitamin prescriptions at CVS in Chester, NJ. The pharmacist suggested a fluoride supplement combined with Flintstones chewable multi-vitamins, and we made the switch around the start of the new school year. When we went back to CVS to refill the fluoride supplement prescription in early November, however, the pharmacist was stumped. CVS (not just in Chester, but apparently nationwide) was now out of the fluoride supplement, the recalled PolyVitamin Fluoride Tablets were still missing in action, and we were out of fluoride options for London and Maddie's growing teeth.

Looking for clues online, I found an article about the fluoride crisis from the Times Leader in Wilkes-Barre, Pennylvania and will share a few of the highlights and recommendations:

  • "If you are a parent attempting to stave off your child’s cavities using fluoride supplements, you may have noticed that filling these prescriptions has been a little challenging lately. Many area pharmacies have experienced shortages or no supply of fluoride tablets and multi-vitamins with fluoride for anywhere from two weeks to sometimes five months."
  • The shortage stems from the Actavis Group's recent recall of its multi-vitamin/fluoride supplements due to the product being "out of specification results for assay at the stability time point." Other manufacturers of similar prescription products were unable to increase production.
  • "These prescription fluoride supplements are known as systemic fluorides because they are ingested and absorbed by the body to strengthen the enamel of the permanent teeth that are forming. This process makes the teeth stronger and more resistant to cavities and tooth decay." The fluoride supplements are produced in three different strengths which are prescribed by pediatricians and pediatric dentists based on a child’s age
  • Although I've considered giving London and Maddie bottled fluorinated water until the Fluoride Crisis is over, the Times Leader article quoted Dr. Richard Brown from the Children’s Dental Center in Kingston, Pennsylvania, who does not recommend using it as an alternative to the supplements "because it is not known how much fluoride is in the water." Excessive fluoride could cause a complication called fluorosis. It is characterized by yellowing of teeth, white spots or pitting of the tooth’s enamel. In severe cases, teeth may have black or brown spots and/or cracks or pits in the teeth. Eew!!
  • Of course, topical fluoride products such as fluoride rinses (my girls use ACT "pink bubblegum rinse") and toothpaste will also help prevent decay in your child’s existing teeth. Unfortunately, Dr. Brown advises that brushing and rinsing is "not going to help the forming teeth.” Systemic fluoride benefits the formation of teeth because fluoride is easily absorbed by the body. Fluoride works in conjunction with other minerals—calcium, magnesium, zinc and phosphorus — to help form and maintain teeth. Calcium has long been recommended for healthy teeth, but it is digested at a slower rate by the body than fluoride.

What’s a mother like Roxy to do? The Times Leader article advises us not to panic. Some pharmacies are beginning to receive stock of the fluoride supplements. "Even though the orders are being shipped slowly, local pharmacists expect the [fluoride] shortage to be short-lived." In the meantime, kids' developing teeth might benefit from an increase in calcium consumption through natural sources such as dairy products or plant sources like tofu, kale, spinach or other green leafy vegetables. Just don't try to get Maddie to eat "that green stuff." My girls will stick with an extra helping of ice cream followed by two minutes of tooth brushing and pink rinse.

If you have any questions about fluoride supplements or the recall, talk to your pediatrician, pediatric dentist or pharmacist, or call Actavis Group directly at 800-432-8534. I'm seeing Dr. David Matthews at Far Hills Dental Care next Friday for my cleaning and Invisalign appointment, so I'll see if he has any new advice and I'll share it with all of you next week.

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