Subscribe
Share
Share
Embed
UNH Nutrition student, Max LaPointe ‘21, follows HB103-FN: establishing a dental benefit under the state Medicaid program and HB611-FN: abolishing fluoridation in water.
University of New Hampshire students explore the science behind the underlying aspects of current issues under consideration at New Hampshire's State House.
Science Literacy with Dr. Maggie Dylewski Begis
[blurb]
UNH Nutrition student, Max LaPoint ‘21, follows HB103-FN establishing a dental benefit under the state Medicaid program and HB611-FN abolishing fluoridation in water. Max interviews Dr. Maggie Begis, Clinical Professor in UNH’s Agriculture, Nutrition and Food Systems and Director of the Didactic Program in Dietetics. They discuss how to evaluate health information we read on the internet and try to figure out what the deal is with fluoride?
[links]
This bill was retained in committee by the house: http://gencourt.state.nh.us/bill_status/Results.aspx?q=1&txtbillnumber=HB%20611&txtsessionyear=2021
Recommended tutorial for learning how to evaluate internet health information
https://medlineplus.gov/webeval/webeval.html
Tool to see which water systems add flouride
https://nccd.cdc.gov/DOH_MWF/Default/Default.aspx
Alaska community water fluoridation study:
https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-018-0684-2
CA adult Medicaid dental study:
https://www.healthaffairs.org/doi/10.1377/hlthaff.2014.1358
[Transcript]
From UNH Cooperative Extension, this is Relative to New Hampshire.
Step into the classroom and listen in while group of UNH students explore the underlying aspects of current issues under consideration at New Hampshire's State House. We pick apart those issues and connect with experts. All to share with you, insights from our scientific community that enhance our understanding of the biological world right here in New Hampshire, home of the greatest democracy in the world.
I’m your moderator, Dr. Anna Kate Wallingford.
I’m Max LaPointe.
Anna: Now Max had been following HB103-FN establishing a dental benefit under the state Medicaid program, and he was reporting back to the group on what her learned from attending public hearings. The group is a team of science liaisons made up of UNH students from a diverse array of departments in the College of Life Sciences and Agriculture, as well as my co-moderators Extension’s Public Engagement Program Manager, Nate Bernitz and Extension’s Public Affairs Manager, Lauren Banker.
Now, HB103 had a big old financial note attached to it because it would act to expand the dental benefits that would be covered by Medicaid. Ultimately this bill was retained in the House committee on Health, Human Services, and Elderly Affairs, partly because they wanted more information on the fiscal implications of establishing this benefit. Max had some personal interest in dental health considering a recent, traumatic wisdom tooth extraction, he spoke with a representative from Delta Dental to get some perspective and the group had many long discussions about how dental health is a critical part of overall health, including this session where Max caught up on a public hearing he had attended.
Max: HB 103, which is adding dental insurance to Medicaid right now. And apparently, that's been something that we've brought up in 2015, they said that there was some research put into see if this would be worth it. They did think that it could save us money in the long run, instead of having people old go to their primary care doctors or go to the ER a bunch of times when the root problem is really a dental problem.
Right now, if you were a low income American, you have Medicaid, once you turn 21, you completely lose your dental insurance. People that are having health problems and oral health problems, go to their family practitioner, they go to the emergency department, they don't actually treat the root of the problem. And they have to keep going back and sometimes end up losing teeth and have all these problems going forward. So they want to implement a way that dental for people that have Medicaid are covered for dental insurance.
They had Joe Shapiro who's a representative come and talk about it. He had said that this was supposed to be passed in 2019, there was a similar bill. But because of the COVID budget cuts that Sununu said that they just couldn't afford it right now. And it kind of got vetoed by him. But this year, I guess he came back out and said that he really believes that Republicans and Democrats can work together and make this happen. And I guess since 2015, the Department of Health and Human Services has a group that's been meeting and putting this all together and thinking about what it's going to cost and the dates and how it's going to work. And so it's Dr. Sarah Finney, who is the leader of that, and she came and spoke, and kind of just echo what Joe said about how it's just important than that this is something that we really need. Basically, what I got, instead of the science, everyone was really just worried about the cost. It's just they didn't have that fiscal note, no one felt comfortable with voting on it. And they want to see just how much this it could increase taxes or what it's going to be for the representatives and for the state what it's going to cost everybody so it was kind of pushed off to a later date. And I don't it doesn't say when the house is gonna be meaning on it again.
Anna: Well, maybe maybe that will be become clear over time. Before we get into like the fiscal note and the kind of policy of it can we can we spend some time talking a little bit about the link between dental health and like, for lack of a better term regular health, like, obviously like people going to take advantage of like emergency health centers will have some impact on you know, just like the running of that but like did they talk at all about dental health in general like as far as like the severity of just dental health on its own?
Max: When Dr. Finney came in and talked about it, she had she had mentioned that. That Yeah, good having important dental health and that infections and things like having people's teeth pulled can affect their ability to get jobs, you know, people with teeth missing out of their mouth, they're less likely to be hired for certain things. But they didn't really bring up anything about how dental health can affect long term health. But in the actual bill itself, it lists a lot of evidence of why it's important.
Anna: Something I was kind of thinking about is like, I know that for some people, a regular teeth cleaning might be like, the, like, the most common time that they interact with, with a health professional? There's also definitely potential for like interventions like dentists, they're not medical doctors, but they have medical training. So they might be able to recognize early-onset mouth cancer or things like that?
Emily: My mom is a cardiac nurse practitioner, and she's told me about how gum health is directly related to your heart. And if you like don't floss, and then floss and your gums start bleeding that can go straight to your heart. So you can have a lot of heart problems associated with poor dental health as well.
Anna: All right, does anybody have any questions that you would want to ask a dental professional or somebody in the medical field about this? Or do we want to just kind of wait and see what happens to this bill as it plays out? I do want to return to it after Max figures out what's going to happen to that fiscal note. And we'll come back to this?
Anna: While we certainly looked for experts to come and talk to us about how preventative care can help avoid unrelated health issues and how very deadly a tooth infection can be…we also tripped over HB611-FN abolishing fluoridation in water and found it too interesting to pass up. We’ll start with how dumbstruck we all were that people were trying to abolish fluoridation to begin with…
Anna: … Um? fluoridation in water. There's a bill trying to abolish fluoridation of water that's kind of like food and health. And actually, actually Max, maybe that should be you because that's a dental thing too. So do you see HB 611? About abolition, abolishing fluoridation and water?
Max: I'm looking at the list right now. abolishing fluoridation of water. That's something I don't know a ton about. Dental Health. But I I was under the impression that fluoride and water is like a huge, huge, positive contribution to keeping people from getting cavities, and it's good for our teeth. So that's kind of interesting.
Anna: Yeah, there's a lot of movements that say it's like really, really horrible for us too.
Max: Really?
Yeah. Yes. Is there any evidence? No, I don't know.
Allie: I think it verges into conspiracy theory territory sometimes? I know Alex Jones does not like fluoridation in the water. So I mean, I think there probably are some valid concerns. I don't actually know. But everything I've heard about it is a little nutty.
Chandra: Fluoride content actually affects you, too. And then just like it gets deposited and color change happens with the tooth, and it affects a lot and causes a lot of problems that it's,
Anna: Yeah, it's one of it's one of those things where like, don't go too far down the rabbit hole, because there's gonna be a lot of conflicting evidence on either side of it. I don't know. It's interesting. Don't spend too, too much time on it. But that hearing might be interesting if you could track it down.
Max: Yeah, sure. I'll check it out. And maybe I'll even read because we have access to a bunch of awesome databases here, trying to figure out what we know about fluoride in the water. Already. I'm sure there's got to be some, like meta analyses on that, or something like that.
Anna: I’m taking this description of how fluoride works directly from the American Dental Association’s website mouthhealthy.org, where you can find videos of how this all works. They say that fluoride acts to protect the enamel, or the hard protective covering of your teeth. “Tooth enamel is the outer covering of your teeth. It’s stronger than bone and made from calcium and phosphate. Your spit, or saliva, is also loaded with calcium and phosphate and bathes the teeth to keep them strong.
When you eat things like candy, crackers or noodles, cavity-causing bacteria starts feasting on the carbohydrates in these foods. This produces acids that attack your enamel. It causes calcium and phosphate to be stripped from the tooth enamel, leaving you more vulnerable to decay and cavities.
However, saliva disrupts the attack as it coats your teeth and adds back calcium and phosphate to replace what had been stripped away. When your saliva has fluoride in it from sources like toothpaste or water, your teeth are able to take it in. Once in your enamel, fluoride teams up with calcium and phosphate there to create the most powerful defense system your teeth can have to prevent cavities from forming: fluoroapatite. It’s much stronger, more resistant to decay and fights to protect your teeth.”
But Max did dig into the information provided by the authors of this bill, including a website that offered some rather conflicting evidence. What to make of resources like this? He turned to one of his professors to help him make sense of this seemingly science-based evidence.
[Maggie introduction]
Max: So you are more than qualified to look over this website and maybe speak to its credibility then. So at the hearings, you know, when they are presenting this to legislators, they seem pretty interested in this. And the main argument is, this is about teeth. But this website, and a lot of these facts, aren't arguing that it better prevents cavities. They're talking about other neurological problems and other things that aren't really being talked about with fluoride.
For the general public, would you have any tips on people that aren't going to be able to dive into a study and look at the credibility of the research to, to assess a website like this and know if they're getting good information? Maybe that's someone that's not an expert?
Maggie: Yeah, that is definitely tough. But usually, I encourage people to look at more reputable sites to see like the CDC and see what they say about it. Then maybe checking the credentials of whoever is running the website, looking to see whether or not they're trying to get something from you. On this particular website, you can donate. I'm assuming that they rely on donations to keep their website going? I couldn't find any information on how much people donated or anything like that.
But it's definitely it's tough. It's hard for the general public to be able to interpret some of these things. And we see it in the nutrition world all the time. I continuously have patients and clients telling me, you know, what they said, a study said, and I'm like, Yeah, but the study wasn't done well.
Max: How would you rate the credibility of this website, when you look through it? And you saw the information they said, and sources they cited? and things like that? Is this a source that people can trust? Should they be iffy about this? Like, how would you rate the credibility of this website?
Maggie: I would rate the credibility very low. And I can elaborate on that, if, you know, certainly, there's a lot of information on that website. So I kind of put myself into like a random lay person; what would I think if I were to look at this website? It's very overwhelming, and that it provides all of this information about studies and so forth. Putting myself in a lay person's shoes, I would think, wow, these people really know what they're talking about. And this is scary.
I saw their mission. It was to, let's see, “the Flouride Action Network is dedicated to protecting public health by ending water fluoridation and other involuntary exposures to fluoride.” Fluoride is not my expertise, but I know from being a nutritionist and a mom, that fluoride is often in the water and important for our teeth. I went and I tried to figure out what a professional organizations say about fluoride in the water, CDC and the American Dental Association. Both of those organizations promote and support the fluoridation of water. So similar to how I would approach like a weight loss supplement website, I'm like, Wait a second, this kind of goes against the grain. So certainly a red flag.
I looked at what their mission was, and compared it to the standards saw who ran the site. And it looks like it's Dr. Paul Canet. Who has a PhD in chemistry, certainly a very good degree, I suppose. I searched him a bit to see if he had any published research on this topic. So I looked in PubMed. And he has a couple of publications, but they're all review papers. So he doesn't have any primary research studies. This isn't something that he himself studies. That's okay. Fair enough. So I didn't end up googling him. And it seems like a lot of people are skeptical about his website. I found a fact sheet published by the American Fluoridation Society that indicated that this particular website was false or misleading. Again, I don't know a whole lot about the AFS, the American fluoridation society, but their website is cited by the CDC. So I would imagine that must be a well known credible, professional organization. I thought that was interesting.
Then I went on to look at some of the studies and they had different categories. So I focused on the IQ, the children and IQ, because I have kids and I care about that they mentioned like a large number of studies I can't remember was like 60 or 70 studies that support the fact that fluoride is dangerous for children. Again, if you're a lay person, you look about like, Wow, look at all those studies that say that. But as a scientist, you know, we dive into the studies. And I certainly didn't look at all of them, but I scanned the list of them. I don't think any of them are done in the United States. I'm aware, we regulate how much fluoride goes in the water and their standards set out by the EPA, I believe. The couple that I clicked on, it looked like they were completed in a different country, where it's well known that the fluoride levels were high in the water. Essentially, they're they're studying a population where we know they're getting too much fluoride, and too much of anything, including fluoride, can be detrimental. And so that's not really fair to use that.
The methodology of some of the studies was not sound. For example, a lot of times they were measuring the IQ - they were looking at maternal, I think prenatal fluoride consumption, and then assessing the IQ levels of very young children, less than five years old. I don't believe that’s a fair assessment of the IQ of a child. Usually they assess IQ later after age five. I don't know that those were sound methods. And so even some of their results were kind of pushing it. One did you know say that the odds of developing excellent intelligence was decreased compared to children in the control group. So essentially saying, you know, they found a relationship between fluoride intake and above average, excellent IQs but then didn't find a relationship with the other categories of IQ, which really isn't clinically meaningful. People like to do this with these websites, they like to make it sound like they have all of these studies and all of these data, and unless you know what to look for your you may be impressed. I wouldn't say this website is credible at all.
Anna: As much as we would like to have Dr. Begis standing over our shoulders every time we read something fishy on the internet, we aren’t so lucky. She did provide us with a link to a tutorial on being smarter consumers of internet-based information that I’ll include in the show notes. I’ll also include some papers that Max recommended about the most recent study linking municipal fluoridation to public health benefits.
One of the most interesting things that Dr. Begis hit on regarding the long list of scientific research pointing to the dangers of fluoride, was that they were all conducted outside of the United States. I don’t know if you picked up on this but Chandra, our PhD student advisor in our liaison group, discussed her experience back in her home country of India, where natural fluoride content of their water is already very high. She said it does cause problems where some people get yellowing of the teeth. Of course those papers still weren’t all that convincing that high levels of fluoride cause neurological disorders but its always important to remember the context.
This bill was held in committee, so it has not become a law in NH. I do have to say that even the authors of this bill seem to acknowledge the dental health benefits of fluoride. Authors requested a financial note because 10 municipalities and 7 communities that either place fluoride in the water or purchase fluoridated water from the city of Manchester would need to stop the practice and provide the children in those communities prescriptions for fluoride supplements from their medical and/or dental providers, which would impact the Medicaid program in the state. It sounds like the intention of this bill is essentially to acknowledge that some people just don’t want this chemical added to their water…if this is something you care about, you can find a link to a cdc database of municipalities that do add fluoride to their water in the show notes.
Thanks to all who helped with this project and for listening!
Relative to New Hampshire is a production of UNH Cooperative Extension, an equal opportunity educator and employer. All music is used by permission or by creative commons licensing. UNH Cooperative Extension is a non-partisan organization, the views and opinions expressed in this podcast are not necessarily those of the university, its trustees, or its volunteers. Inclusion or exclusion of commercial enterprises in this podcast does not equate endorsement. The University of New Hampshire, New Hampshire Counties, and the US Department of Agriculture cooperative to provide Extension programming in the Granite State. This podcast was made possible by the UNH Extension Internship program - if you’re interested in supporting great work like this for the future, learn more at www.extension.unh.edu/internships.
[Music Credits]