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Is Fluoridated Water Dangerous?

By March 30, 2016 1 Comment
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A neighborhood kid once caught hand, foot, and mouth disease from my daughter before we had any signs that she had it. Her mother scolded me and asked me to please alert them next time my daughter was sick.

Ouch!

I don’t blame her for being protective. That illness is a doozy, as many of you likely know from experience. But being reprimanded by another parent when both our toddlers were so sick just made the whole thing worse.

This in-person interaction made me feel awful and I quickly turned to my virtual support network to share my thoughts and for reassurance. And I’m not unique.

As anxious parents, we persistently echo our worries and stories through blogs, videos, and other social media outlets. Connecting with other parents through social media provides us with important support, and even desperately needed humor! Being a parent can be isolating, so seeing our own beliefs and experiences reflected back on social media can be reassuring. This can be helpful when we feel vulnerable like I did when another mother chided me, but it can also be harmful.

As a professor of Oral Health and Epidemiology at the Harvard School of Dental Medicine, my research demonstrates that what is shared across the Internet often contradicts scientific consensus and current knowledge on a variety of health topics. It can be comforting to hear our own beliefs reflected back to us, but it’s harmful when those beliefs aren’t accurate.

Nearly 80% of us search for health information online. The internet is a rich network of information, but also of misinformation. A lot of this misinformation has shaken parents’ confidence in some of public health’s greatest achievements, including fluoridated water. One of my favorite quotes, from Thomas Patterson, Bradlee Professor of Government and the Press at the Harvard Kennedy School, states, “The internet is at once a gold mine of solid content and a hellhole of misinformation.”

Last year, we celebrated 70 years of community water fluoridation in the United States. Over 120 of the world’s leading health, dental, and medical organizations praise the success and benefits of fluoridation. As a dentist, water fluoridation is a topic I am very familiar with and it’s one that there’s a lot of misinformation about on the internet. Often parents ask me the same five questions about water fluoridation, but most of us don’t have easy access to a dental epidemiologist, so I’ll answer them for you here, from one parent to another:

1) Is fluoridated water safe to drink? Yes.
From time to time, you will see a scary-sounding study float fluoride-infographic-how-it-worksacross your Facebook page. But it’s important to
remember that expert consensus and an enormous body of sound, scientific evidence continue to find that fluoridated water is safe and does not contribute to or cause illness or disease.

The Facts:

  • A U.S. Public Health Service review of data and research concluded, “Expert panels which reviewed the international body of literature agree that there is no credible evidence of an association between either natural fluoride or adjusted fluoride in drinking water and human cancer.”
  • The consumption of fluoridated water has not been shown to cause or worsen conditions of the thyroid, kidney, heart, or other glands/organs. The only proven risk associated with excess fluoride is a cosmetic condition known as dental fluorosis. (See below.)
  • For more information, see Common Questions about Fluoride.

2) If Fluoride is a chemical, why is it safe to have in our drinking water? 

When we use the word ‘chemical’ we sometimes take it to mean dangerous, but the truth is that everything that occurs naturally (and man-made) has a chemical structure, even water and oxygen.

Fluoride is a naturally occurring element in all water sources; some fluoride levels are too low for any dental benefit and some sources are very high. Fluoridation is the process of adjusting these levels for optimal dental benefit while minimizing risk for fluorosis.

3) Is fluoridated water safe for children, babies, and formula-fed infants? Yes.

Parents often ask me if fluoridated tap water is safe to mix formula for their infants or if they need to purchase distilled or bottled water. If you’re on a municipal water supply and there aren’t unrelated issues with the safety of your tap water (as in the case in Flint, Michigan), fluoridated tap water is safe for children, babies and formula-fed infants.

 The Facts:

  • The American Academy of Pediatrics (AAP), the American Dental Association (ADA) and the Centers for Disease Control and Prevention (CDC) are among many who agree that water fluoridation is a safe and effective way to prevent tooth decay in children.
  • According to the ADA, it is safe to use fluoridated water to mix infant formula. The risk if mixing infant formula with fluoridated water is mild fluorosis. (See below.) If you have concerns, talk with your pediatrician and dentist.
  • For more information, see Fluoride and Children.

 4) Does fluoridated water negatively affect IQ or children’s developing brains? No.

Between the 1940s and the 1990s, the average IQ scores of Americans improved 15 points – at the same time that fluoridation expanded to serve millions more people. To be clear, this is a case of correlation, not causation. There is nothing in the peer-reviewed literature to suggest fluoridated water has caused the increase in IQ scores. Some have claimed that fluoridated water has decreased IQ scores in the US, and we know that’s just not true as American’s IQ scores have risen alongside the use of water fluoridation.

The Facts:

  • Many point out a study known as the ‘Harvard study’ (ironic, I know), which postulated an inverse relationship between fluoridated water and IQ. It’s important to note that this study looked at the IQ scores of children in China, Mongolia and Iran and in many of these areas, the water had exceedingly high levels of naturally occurring fluoride – as much as 10 times higher than levels used to fluoridate public water systems in the U.S.
  • The study did not test cause and effect or conduct research designed to explain a possible relationship between fluoride and IQ. Numerous experts have debunked this claim, myself included.
  • For more information, see Does Fluoride Lower IQ Scores?

 5) What exactly is dental fluorosis? Should I be concerned about fluorosis from drinking fluoridated water?

Dental fluorosis is a change in the appearance of the teeth, typically in the form of very faint white markings. It does not affect the function or health of the teeth. In fact, teeth with mild fluorosis are more resistant to cavities.

Fluorosis is the result of consuming too much fluoride while teeth are forming, before the age of 8, particularly if children swallow fluoridated toothpaste. The American Dental Association recommends specific quantities of toothpaste according to age, in order to minimize the risk of fluorosis. For optimal dental health, provide water fluoridated at the recommended levels and supervise brushing so that children learn to spit, not swallow.

 6) How much fluoride do children need? What are the recommended levels?

The fluoride that is added to public water supplies conforms to stringent safety standards and results in water that complies with the Safe Drinking Water Act. The quality and safety of fluoride additives are ensured by Standard 60, a program that was commissioned by the U.S. Environmental Protection Agency (EPA). This program is monitored by an independent committee of experts, including the Association of State Health Officials and other key organizations.

In 2015, the Department of Health and Human Services recommended that the level of fluoride in drinking water be set to a uniform level (0.7 mg/liter) across the nation. This resulted from research showing no difference in water consumption in warmer climates and responded to the increased availability of fluoride from a variety of sources by reducing the amount contained in water. 

Take home message: Fluoridated water is safe. Children and adults who consume a typical diet, drink optimally fluoridated water, and use fluoridated dental products as recommended will not exceed the maximum levels for fluoride. And they’ll have healthier teeth!

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Categories: Policy, Politics, + Pop Health, Science 101 + Mythbusting

Failure to Plan Parenthood in Texas

By March 1, 2016 2 Comments
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 The other day, I had a craving for coconut ice cream.

Stick with me here (and no, I’m not pregnant–this was just a garden variety gluttony)

I was dying for it, and in a stroke of luck I didn’t have to rush home to my kids that day, I had the chance to fully indulge myself. Of course, now that I had the opportunity to indulge, I went to four different stores looking for some and then I finally gave up. I had the motivation to drive all over creation to find it, the time and the ability to seek it out, and the money to pay for it once I found it but I STILL couldn’t get what I wanted when I wanted it.

That’s just life sometimes, and as a mother I’ve realized that’s life more often than not. But my great unfulfilled quest to find coconut ice cream made me think of a study I’d just read in the New England Journal of Medicine. Yes, I know. When you work in public health your brain never shuts off about this stuff.

Heading home without my ice cream was no big deal, but what if I’d been looking for something else instead. The only impact of me not getting my ice cream was that I was disappointed and Haagen-Dazs lost a sale. But what if I’d been looking for something of life-changing importance and I wasn’t able to get it? Let’s imagine we’re talking about birth control.

I know this seems like a stretch, but like I said, stick with me here.

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Categories: Policy, Politics, + Pop Health, Pregnancy, Birth + Family Planning

Ladies, Don’t Drink and Don’t Have Babies: When Public Health Messaging Fails

By and February 8, 2016 1 Comment
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We strive to be evidence-based communicators here at The Scientific Parent, and sometimes we collectively wring our hands at public health messaging by our counterparts at other organizations. After all, the public health nerd core tends to be made up of nerds, and while we love nerds (seeing as how we consider ourselves members of that tribe), sometimes nerds can get lost in health data and forget that it doesn’t exist in a vacuum. Data may be objective in the eyes of researchers and statisticians, but in the real world and life, those numbers have context.

That’s why over the last two weeks we’ve found ourselves squirming over recent public health campaigns. For example: common sense would suggest that telling women in Texas to simply not get pregnant due to the threat of catching the Zika virus is utterly unhelpful. First, because of the lack of universal access to free contraceptives for both sexes, and also because the messaging places an undue burden on women with no equivalent advisory (i.e.: ‘don’t get anyone pregnant’) for men. Also, family planning and expansion usually doesn’t stop because viral outbreaks, as public health officials in every other country on the planet can tell you (including those in Brazil who are seeing women avoid mosquitos that carry Zika, not pregnancy).

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Categories: Policy, Politics, + Pop Health, Pregnancy, Birth + Family Planning

Trouble in the Water: The Poisonous Price of Fiscal Conservatism in Flint, Michigan

By January 25, 2016 2 Comments
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As a single parent to two teenage girls, I have spent the majority of my adult life trying to protect them from every conceivable injury, or hurt that I can. I never thought what I might have to protect them from was as essential for survival as water, and as ubiquitous as a municipal water supply. But that’s exactly what’s happening in Flint, Michigan, where I grew up and where I still have family.

The residents of Flint are currently involved in what can best described as a catastrophic failure of leadership, and at worst environmental racism. The residents of Flint, my hometown, have been drinking water contaminated with lead for nearly two years. This includes children and infants (through formula made with contaminated water or through high doses in contaminated breast milk.)

There is nothing worse than watching your child in pain, and knowing there is nothing you can do about it. That is exactly what the parents of Flint, Michigan are faced with every single day.

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Categories: Chronic Illnesses + Conditions, Policy, Politics, + Pop Health

“My Kids Aren’t Guinea Pigs,” Says Parent Affected By Porter Ranch Gas Leak

By January 4, 2016 4 Comments
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A brave parent stepped forward to talk to The Scientific Parent about the Porter Ranch gas leak, and asked that he remain anonymous, for fear of retaliation against his family. Here is his story.

I am part of one of the 3,000 families displaced by the Southern California Gas Company (SoCalGas) leak in Porter Ranch, but I consider my family lucky, because we’re finally safe. The latest reports say that an additional 3,000 more families are waiting to leave the area, and are still living in a zone that’s being called the biggest environmental disaster since the BP oil spill. Notice I say leave, not evacuate. I’ll get back to that.

On Oct 23, 2015, SoCalGas announced that their Aliso Canyon Storage Facility was leaking a combination of methane and mercaptan gases into my community, which is in Los Angeles, California. Methane is a natural gas. Mercaptan is the chemical the gas companies add to make it smell so people are warned when there’s a gas leak in their home.

At the time, they said the leak shouldn’t affect us, and at that point we didn’t know that symptoms of exposure to those gases are headaches, dizziness, weakness, nausea, vomiting, and loss of coordination. If we had, we would have realized that my family had been experiencing these symptoms for some time.

For weeks, our 3-and-a-half-year-old son, was lethargic and didn’t have his usual energy to do things. What normal three year old isn’t constantly running around and into things? My wife was complaining about nausea, and that her breathing was short and challenging. I had headaches every day when I came home from work. We never thought any of those things were related.

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Categories: Accidents, Injuries, + Abuse, Policy, Politics, + Pop Health

Your ‘Stomach Flu’ Isn’t a Real Thing, You’ve Caught Something Much Grosser

By December 16, 2015 2 Comments
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The stomach flu isn’t a real diagnosis – there’s no such thing.  I remember finding that out as a kid and being confused; after all, everyone around me had had it at one point or another. How could everyone be wrong? We’ve all used this term at some point to describe an illness that’s forced us to pray to (or sit with) the porcelain gods. However, it turns out it’s one of those generational quirks of language that’s been passed down, and it’s not founded in science.

The viruses or bacteria that we attribute to “the stomach flu” are very real, however, as I can tell you from personal experience.  There’s just no such thing in epidemiology as a family of viruses or bacteria called “the stomach flu.”

Let’s start off by defining what the flu is. “Flu” is short for influenza, which is a viral infection that affects your respiratory system, namely your nose, throat, and lungs. Symptoms include coughing, congestion, fever, and muscle aches. According to the CDC, there are 3 types of influenza viruses: A, B, and C. The seasonal flu is typically an A or a B type, and it runs in cycles that are heavily skewed to wintertime in the United States. The C type is considered milder, and isn’t seasonally dependent or the type that’s a cause for epidemic concern. All three types are spread through contact with an infected person’s respiratory secretions, meaning contagious droplets of water that you inhale or get in your eyes, nose, mouth, when an infected person talks, coughs, or sneezes around you. Ewwwww.

The stomach flu, on the other hand is what we colloquially call a variety of digestive-related illnesses that involve distressing gastrointestinal symptoms (i.e. vomiting, diarrhea, stomach cramps, etc.) combined with malaise, and a low-grade fever, when in reality it’s a form of gastroenteritis (“gas-tro-enter-EYE-tis”). Gastroenteritis is caused by viruses and bacteria (and rarely, parasites) that infect the digestive tract, none of which are members of the influenza family.

I repeat: the “stomach flu” is a virus or bacteria that has much grosser consequences, and is not at all related to influenza.

Viral gastroenteritis is the most likely culprit when it comes to most of the so-called “stomach flus,” and it’s typically the result of one of two groups of viruses: Noroviruses or Rotaviruses.  And, ick alert: you typically catch it from direct exposure to an infected person, exposure to infected fecal bacteria (poop), or exposure to things cross-contaminated by fecal bacteria like food that’s been handled by contaminated hands, since it’s so hard to completely sanitize against, as any Celebrity Cruise worker can tell you.

Grossed out yet?Norovirus flu FINAL

A read-through of this horrifying in-depth article from
National Geographic on

the science of the Norovirus
describes how it causes your body to become a walking germ factory; how hard it is to kill it on surfaces including your own skin, and how easy it is to infect those around you as you’re purging liquid from your intestinal tract cells at a rapid rate, and loading up each gram of your diarrhea with five billion Noroviruses. You read that right. Five billion. As for the infectiousness of your vomit? I’ll just leave this article on a the Norovirus Vomit Machine here. I can’t even.

Horrors of science aside, viral gastroenteritis is rotten because in addition to the symptoms listed in our handy-dandy graphic in this article, it’s completely exhausting and there’s nothing you can do other than rest, stick with eating what you can hold down, which may or may not include the once-heavily recommended B.R.A.T. diet (Bananas, Rice, Applesauce, and Toast) to coax your stomach into digestion,  and to stay as hydrated as possible. Dehydration is the danger zone of these type of illnesses, which is where gastroenteritis can turn from miserable to deadly. It’s essential to replace liquids lost from loose stools and vomiting. For parents of kids who have had this, I’m sure you’ve had the hard task of trying to pressure these foods and liquids into your child who is exploding from both ends, and feeling like it’s all a waste because it’s coming back out as quickly as its going in. I’m sorry. You’re doing the right thing, though, since nutrients and liquids are critically important to maintain during these illnesses.

Norovirus

The Norovirus: Courtesy of the CDC

In my recent experience, I went to my local emergency room five days after my symptoms began, but only after I started to have heart palpitations and an unbearable case of heartburn. I managed to stay hydrated as I’d choked down an entire Pedialtye (ack!), but I was wrecked. The doctor attributed my illness to a nasty case of Norovirus, which is circulating in the San Diego area again, but he said those extra symptoms were actually from exhaustion and hunger – I needed more nutrients and rest. How could I get more nutrients if nothing was sticking in my stomach? I asked him. He said to keep eating anyway, since “your body has to finish shedding the diseased lining of your intestines for all of the purging to stop.” Fabulous, right?

Here’s the problem with waiting it out, however. You shouldn’t make the call to simply rest and switch to a BRAT-like diet on your own for you or your children and wait for the symptoms to pass for more than a day or two. Rest, hydrate, and bland diet, yes. However, viral gastroenteritis and bacterial infections (i.e. c.diff., salmonella and e.coli) that affect the digestive tract can initially look the same, be acquired through the same channels (contaminated food, etc.), but can’t be treated the same way.

You must treat the bacterial infections because they don’t just “run their course” without having massive impacts on you or your child’s system – and you likely need medical intervention like antibiotics to make them stop in a timely manner. Below are threshold recommendations per the Mayo Clinic, but your family physicians may have other guidelines so we urge you to contact them first:

Seek immediate medical care if in addition to the previously mentioned symptoms of malaise, stomach cramps, vomiting and diarrhea, you or your child havethe following symptoms:

Adults:

  • You’re not able to keep liquids down for 24 hours
  • You’ve been vomiting for more than two days
  • You’re vomiting blood
  • You’re dehydrated — signs of dehydration include excessive thirst, dry mouth, deep yellow urine or little or no urine, and severe weakness, dizziness or lightheadedness
  • You notice blood in your bowel movements
  • You have a fever above 104 F (40 C)

For kids, seek medical care if they:

  • Have a fever of 102 F (38.9 C) or higher
  • Seem lethargic or very irritable
  • Are in a lot of discomfort or pain
  • Have bloody diarrhea
  • Seem dehydrated — watch for signs of dehydration in sick infants and children by comparing how much they drink and urinate with how much is normal for them

For babies seek medical care if they:

  • Have vomiting that lasts more than several hours
  • Haven’t had a wet diaper in six hours
  • Have bloody stools or severe diarrhea
  • Have a sunken soft spot (fontanel) on the top of his or her head
  • Have a dry mouth or cry without tears
  • Are unusually sleepy, drowsy or unresponsive

As always, self-diagnosis is not the way to go when you’re dealing with an illness, particularly one that’s this high-impact – consult your physician or child’s pediatrician for an exam and testing if you have any of the above symptoms and have a concern about you or your child’s well-being. And remember, until you do, hydrate, eat, and rest as much as you can!

For illness spreading and prevention tips, see this helpful guide.

 

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Categories: Infectious Disease + Vaccines, Science 101 + Mythbusting

Confessions of a Toddler School Drop-Out

By December 14, 2015 No Comments
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This post originally appeared on the Graham’s Foundation blog on December 3, 2015

Three weeks ago, my toddler dropped out of school. My husband and I didn’t anticipate it. We started in September just like everyone else…with adorable “first day of school!” pictures on our front porch and excitement for everything my son would learn, and the new friends he would make.

It was a leap of faith for us to try out a group childcare setting in his second winter of life. My son, now 21 months old, was born at 31 weeks and 6 days in January of 2014. When he was discharged from the NICU in late February of that year, we- like all preemie parents- feared colds, flu, and RSV. We limited visitors, bought stock in hand sanitizer, and checked proof of TDAP and flu vaccinations at the front door.

With a thriving toddler interested in learning and socializing, we decided to graduate from the parent-nanny caregiver model and enroll him in a Montessori program four mornings per week. We took careful note of the advice from fellow parents about sickness in the first year of school or daycare.

“He will definitely get sick, but then his immune system will be unstoppable for the rest of his educational career,” they promised.

We thought we’d see a few bad illnesses this year, but for the most part he’d just have a chronic runny nose.

Boy – were we wrong.  

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Categories: Ages + Stages, Infectious Disease + Vaccines, Toddlers + Preschoolers

How I Got H1N1 (the “Swine Flu”) and Changed My Mind About Vaccines  

By December 7, 2015 1 Comment
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About 10 years ago I thought vaccines caused autism. I didn’t believe this fallacy with any fervor or passion – in fact, I hadn’t researched it any sense of the word.  It was just something I’d picked up from what I call background noise, the kind of passive media consumption we all tend to do in this super-technical world we live in.

Then I was hospitalized with a vaccine preventable disease  – and I suddenly cared a lot about vaccines, autism and how one person’s decisions can impact a community.

I was in my mid-20s when it happened. I didn’t have any kids or plans for kids in my immediate future, so vaccines and autism were not things at the forefront of my mind. I’d had all my shots as a kid, I got an annual flu shot, but that was about as far as I went when it came to vaccinations.

It was during the height of the H1N1 media hysteria (or the “swine flu,” as it was dubbed, based on its common animal host) when my husband and I attended a party with some friends.  I was 27 and despite the excessive media coverage, catching that virus wasn’t something I was concerned about.  I was young and healthy with no major medical issues.  If I got it, I figured, it would just be a bad flu, and I’d survive. I was above the media hype.

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Categories: Faith + Beliefs, Infectious Disease + Vaccines, Science 101 + Mythbusting