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: 312-337-6329 • 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