Trooth Decay with Tooka Zokaie

Fentanyl crime bills sweep conservative state legislatures. Scientists successfully transplanted frozen rat organs, and it's been a year since the Supreme Court ended the constitutional right to an abortion in this country. This is America dissected.

I'm your host, Dr. Abdul El-Sayed.

You know what the dirtiest part of your body is? Relax, folks, it's not that kind of podcast, but it is that kind of podcast. The dirtiest part of your body is one. You probably spend a lot of time washing at least twice a day. If you follow recommendations and think of yourself as at all a clean person, it's your mouth.

Think about it, it's dark, wet and warm, exactly the kind of place that bacteria love to hang out in, which is why so many of them do. Our mouths are, well, let's face it, cesspools of bacteria. Which is why it should come as no surprise that oral health is so hard to get right. How many of you have ever had a cavity?

OK, good news is that nobody can hear you. Bad news is that 90 of us have had at least one. I have. And here's the astounding part. One in four of us has a cavity right now.

In order to prevent them, we spend time brushing at least two times a day, flossing which we really should do after every meal, and using mouthwash. And yet our mouths are awash in bacteria. Back in the day, losing all your teeth was simply a matter of time. It was expected that you'd lose your natural teeth into early adulthood, that, if you had the means, you'd replace them with dentures.

Today, we expect to keep our adult teeth well into adulthood, if not all the way through our lives. But here's the interesting part if you brush your teeth this morning, even flossed, it might not have been the most important thing you did for your teeth. The most important thing you did for your teeth might have been taking that first drink of basic tap water. That's right.

Most tap water in America is fluoridated, meaning that every time you drink your water, you're bathing your teeth in a compound that binds with the stuff your teeth is made of. Or more decay resistant compound. Scientists discovered the decay fighting properties of fluoride by accident, observing that. Local residents in Colorado Springs had unusually hardy teeth, owing to the naturally occurring high concentration of fluoride in their local water. And by the end of World War Two, the city of Grand Rapids became the first community to begin adding fluoride to its water. Over the next decade and a half, the rates of cavities called dental caries was down 60 percent. I want to remind you, your mouth is literally the biggest opening. And when you have bacteria making snug homes for themselves in the insides of your teeth, that's not a good thing.

Poor oral health has been linked to all sorts of other diseases, including strokes, heart attacks and dementia. While excessive fluoride, far higher than the amount added to drinking water, has been linked to a number of outcomes. There hasn't been any strong, consistent evidence linking any side effects to fluoride in water at the recommended level of one part per million. But that hasn't stopped conspiracy theorists and fear mongers from taking aim at water fluoridation.

Some communities have elected to take fluoride out of their drinking water. And, sure enough, play stupid games, win stupid prizes. The scientific evidence has shown consistent increases in the risk of cavities after fluoridation stops. As you all probably know, water fluoridation isn't the only public health intervention that's fallen prey to miss and disinformation. It's part of a long growing list, but it hasn't gotten the attention it deserves.

So today, I wanted to invite someone on the front line of the fight for fluoride to share a bit more about this critical oral public health tool. Why it's been under such attack and what we all can do about it. Our guest today is Touka Zoukai. She's the senior health policy analyst for the California Dental Association. Here's my conversation with Touka Zoukai.

But community water fluoridation as a public health program is now about 0.

7 parts per million in our water, and this mineral is part of our body's health. It remineralizes our tooth's enamel to make them stronger and longer lasting. And we now have 73 of the U.S population on water systems with optimal water fluoridation.

So it is a very powerful public health program it's a privilege to have. I'm lucky to be in a community that has fluoridated water and I haven't had cavities the whole time I've been here.

Now you mentioned two things I want to dig into there. The first is that community in Colorado, and I want to dig a little bit deeper into that history. What did what was found about them? Why were they such an important sentinel event in in alerting us to the value of fluoride in water?

H. Trendley Dean. He was a founder of the NIH Dental Hygiene Unit in the U.S public health services. And he began a long running epidemiologic study. And explore the relationship between fluoride intake, dental fluorosis and tooth decay. And by 1942, the NIH published this study that accounted for children aged 12 to 14..

And it was from 21 cities in Colorado, Illinois, Indiana and Ohio. And children tended to have fewer cavities and less severe decay in cities with more fluoride in the community water supply and this effect plateaued at around one part per million. And so additional studies. You know, we have now over 75 years of studies led to pilot fluoridation program. The first one was Grand Rapids, Michigan, and it began to fluoridate their drinking water supply.

And they saw that developing children, you know, you mentioned, you know, two young ones with developing teeth in your family. The new teeth that would erupt in water. Fluoridated communities had fewer cavities, had longer lasting teeth, and less caries, and caries means tooth decay, so cavities. And you know, there were over 11 years of observational children's studies, ages six to nine.

In New York, for example, they compared Newburgh and Kingston. And as they continued these different kinds of epidemiological studies and observational studies and classic studies, they saw that repeatedly. At point seven to one part per million, that tooth decay was decreasing. And the mechanism makes sense. Because, you know, our teeth are enamel or made of fluoride, and when we drink fluoride in our water, it becomes part of our saliva, bathes our teeth in this kind of enamel saving mineral, and we have longer lasting teeth as a result.

Walk us through just how bad circumstances were prior to fluoridation.

Some of it has to do with higher sugar consumption in our foods, it has to do with how we to our foods, processed food. So nutrition is definitely a part of oral health. And with fluoride, we are able to make our teeth stronger during development now, while fluoride in water has lifelong benefits. It really has the biggest impact as teeth are developing, because your body is making teeth out of what you consume.

So when you have fluoride again, this natural mineral that is in a lot of different products, but specifically when you're in a fluoridated area, tooth decay is decreasing. And to this day, 25 reduction in cavities are due to water fluoridation. Now we have fluoride in other products. But even to this day, studies show that about 25 of a reduction in cavities is due to the fluoride in our drinking water. That serves about three fourths of the U.S population.

There isn't anything.

Physically, physiologically harmful from fluorosis, at least when you have around 1.

5 to 2.

5 parts per million. But it does lead to an aesthetic effect. Now, unfortunately, with misinformation campaigns and confusion and hesitancy regarding water fluoridation, there are other concerns about fluoride and their possible side effects. And even though these have been researched for over 75 years. And even as research studies get stronger and scientists continue to investigate to see if we can find something new. The only real side effect we find from water fluoridation is reduced dental cavities.

But at water fluoridation levels, just like any mineral, calcium, sodium, vitamin D, so you know, other vitamins and minerals. There's a threshold effect. There's an optimal amount, it's the same with fluoride, there's an optimal amount for health and development.

Potential consequences I mean, how much fluoride are we talking about, where there really could be any real detrimental issue aside from fluorosis?

Now I'm Iranian, so I love my black tea, and black tea has three to four parts per million of fluoride. Our ocean water, you know, it has fluoride, so there's a lot of different substances and products that naturally have fluoride. Spinach, you know, one of the great greens that we consume, that has fluoride, so it's tasteless, it's odorless.

You can't really tell it is there, but it's a powerful mineral. And one of the. You know, one of the bigger concerns about fluoride that some communities have when considering fluoridation is, is this going to change the taste of my food or the agriculture? And to that, I say, you know, I'll ask you, where in the U.S do you think they have the best bagels and pizza?

So I want to, I want to just ask, because I think.

To insurance coverage, to care, to education. And, as I said a little earlier, dental cavities, dental caries are the number one chronic disease in children. You know, you'd think it's asthma or something else that we hear a lot more in our in our public health education. But it really is a public health issue to think about oral health. And in my work, we usually make this the dentist or dental hygienist, or dental assistance role.

It's the dental professionals to address dental health and oral health. But how come every other medical profession and specialty has public health allies, has health systems allies, and, you know, researchers and supporters that aren't dentists? I myself am not a dentist, but I'm so lucky for the ones that I work with. Because they've become the public health champions for community water fluoridation, for oral health access and beyond. So it really is a call to action that I have for my colleagues in public health and population health to think about oral health because it is impacting their communities.

And the number one reason for missed school days is dental pain. One of the top reasons for emergency department visits is a non-traumatic dental condition, one that could have been addressed by a dentist or a dental team. So we have a systems issue and we have.

A fairly fragmented oral health system, specifically within public health, as someone who's an advocate for oral health and public health. And I go to, for example, APHA and these wonderful health meetings and summits. The folks in the room when the topic is oral health tends to be the folks in the room that are always there. When it's about oral health. And when I go to other topics that are very important, we see more diversity of interests when it comes to public health. So my ask for anyone listening is, if you're a public health champion, what are you doing to address oral health? who's someone you can call when it comes to oral health?

And are you aware of your local oral health program?

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When did this conspiracy theory take hold?

Silica acid and say that three times. But when it goes in the water, it's like many other kinds of fortification, where it's the fluoride and then the silica is then filtered out. So it's totally safe to drink. But there was this original conspiracy that it was a way of doing mind control. Or, you know, I've heard the Communist plot theory, and that kind of goes around a lot.

But that has now evolved to be a full spectrum of hesitancy, from neurodevelopment to osteosarcoma. To any other scary sounding phrase of, You know, this is because of the fluoride and with the water treatment process. I mean, it's a, it's a five part process. We got calcium carbonate, we got chlorine, like it is a.

It props to the water engineers because they do a fabulous job when it comes to keeping our drinking water safe and clean. And then adding the fluoride as an extra public health benefit. But because the fluoride is a part that we talk about in public health, it's also easy to latch on to as something to be afraid of.

How has the conspiracy theory around Florida and water changed, and how has it potentially taken on legs with the advent of internet based misinformation?

And I remember waking up to almost every major news channel. Sharing fluoride and water can decrease IQ, and I got all these calls about what is going on, why is why? is fluoride decreasing IQ? What is the issue? And it was just, you know, that phrase continuing to be shared.

No fluoride impacts neurodevelopment, fluoride decreases IQ. And just last month, another publication looked at a meta-analysis of all the studies that have been published looking at fluoride and neurodevelopment, especially looking at optimal fluoride exposure. So not those endemically high fluoride areas. And they found no association, not better, not worse, none, and that's kind of what's expected, but we're still seeing those news articles that touted fluoride as this neurodevelopmental impact element. That it's still something that we're trying to share at local city council meetings and even with some larger science groups.

And what was interesting is when that study came out, you know, again, so New York Times and PR, they were all sharing how fluoride decreases IQ. And the major medical, public health, dental associations, major universities, even organizations that specifically look at science, misinformation, and communication. It was about 25 organizations, you know, top scientists, all saying that this study does not mean fluoride decreases IQ. But my family, and, you know, my community, is not going to be looking at that. They're going to be seeing what, you know, their iPhone brings up, or what pops up on the screen. Where it's the scary skull and bones next to fluoride. And it's not going to be these Ivory Tower publications saying no, no, it's safe.

No, we need more research, but there's multiple studies that have contradictory findings. And overall, fluoride safe in drinking water. You're good to go. That's not what people are seeing. So I don't blame the individuals in the public to be afraid because they're being fed fear. And the public health professionals are continuing to share themselves. You know what is safe and what isn't, and what the research states. And, you know, as I said, a lot of dental providers are educating their patients and their community members on the safety. Because they get, you know, the journals and the blasts, and you know, the work that my organization does to share the latest research. But that's not going to the general public, and the public health professionals haven't engaged with this enough.

So, the translational science of the safety and efficacy of water fluoridation, even with continued research, has a long way to go.

And observational study, I mean, it's a study where you didn't necessarily randomize people to the thing that you're trying to study. In this case, you're looking at the relationship between fluoridation and IQ. And when you do a meta-analysis, what you're trying to do is you're trying to separate the signal from the noise. Now you have one study that clearly was some of the noise, and then you have a confirmatory study that did not show the same relationship.

That's more about the signal, it's just higher powered.

Themselves, what happens? In effect? The emergent phenomenon, is, in effect, misinformation, because you're only covering the noise and not the signal. And then the third piece of that is. Even if this study was confirmed over and over and over again, it fails to put in context the broader benefits of fluoridation. Because I want you to think about what a cavity is. And Tuca's used the word carry quite a number of times.

It's a bacterial infection of the tooth, and so what you're talking about is a consistent infection bacteria seeding.

We saw a lot of, not not just campaigns to remove fluoride. And, you know, we had individuals come and speak to the local city council members or their advisory councils on health to share the latest evidence. But it was more about trying to stop a removal rather than initiating new fluoridation systems. So community members would hear about the, you know, the information about fluoride and IQ, or fluoride and drinking water. And some level of hesitancy. And go to their local city council to try to remove water fluoridation. And there was a draft, what they call National Toxicology Program report, so there was a draft released in 2019 that looked at fluoride and neurodevelopment. As a result of a number of studies that, as I said, there were different studies done on fluoride and IQ, and some showed no association.

Some did so, they were trying to see what's really going on. And the report did not look at different thresholds of fluoride, so there were studies used in that draft report that looked at high levels of fluoride. There are some areas in the world that have endemically high fluoride, so it just means they.

Naturally, the fluoride is higher than what you'd recommend, even in fact, in the United States, some fluoridation programs filter fluoride out, so not all of them are adding fluoride. It's an adjustment. And that draft analysis that didn't have any kind of threshold effect. Or it wasn't meant to be used for water fluoridation, it did have an original draft presumed neurotoxic effect of fluoride.

And again, this study was not meant to be used for water fluoridation because it wasn't looking at the levels used for water fluoridation. And this draft report was taken to city council meetings, saying, Look at this report.

Under the National Academies of Science, Engineering and Medicine. We need to stop fluoride, and some places were successful at stopping fluoride, and some places we were able to do enough education and explanation to continue water fluoridation as a program. But this draft report that again, was not meant to be used for water fluoridation. That wasn't even meant to be used for decision-making yet, because it was a draft form. It stopped fluoride in about six cities in the United States, and there were about six more that we were able to maintain. And it's difficult because one of the Healthy People 2030 goals, so, you know, it's a set of goals that we're trying to reach for. Public health is to increase water fluoridation in the United States to 77.1%.

That important point, one in water systems that I've recommended amount of fluoride and the public health community, or those that are, you know, involved in this. We're trying to just stay above water at this point because we don't have enough public health professionals that are comfortable talking about fluoride and are comfortable with this kind of science. Because there is so much to know when you're in public health, and it's a very important area that I think there can be some more education. So it's not about stopping removal attempts and more about doing more initiation and community education. So they feel comfortable about really this privilege.

What effort to repeal water fluoridation programs do you see as a broader attack on the very concept of public health in general? The idea that we as a collective would do things to improve our collective health. And that there is the lack of an ability to opt out. And you're seeing that, you know, across the board, whether it's vaccinations or water fluoridation programs, as we're talking about right now. So how much do you feel like this is more about public health?

Thank you, thank you.

And another part of it is we don't present scientific information in a health literate way.

To try to improve health literacy, in fact, California has the country's only oral health literacy toolkit, so I recommend you check that out. But there's a lot of different ways to try to make our information more accessible, more legible. And one of the tough things with fluoride is it's a nuanced science, there's a lot of engineering that goes into it.

It's part of the five-part process of the water treatment that, again, our amazing local water engineers are trained to understand. Well. It's a nuance, and that's what makes it a little bit difficult in public health. And this issue with trust, because we haven't done the work to build trust. And why? You know, trust is earned, and a lot of practitioners, especially public health practitioners, have work to do to earn that trust again. Especially with COVID-19 and the pandemic and other outbreaks and the impacts of a life-changing pandemic that we have a lot of work to do to try to rebuild trust. And emphasize that public health is, more than you know, responding to infectious disease outbreaks and giving mandates.

It really is about being a community member and wanting to foster health and wellness for all the people in your community, you know? Water fluoridation impacts the lowest income and most vulnerable groups that are in a community, because they're more likely to drink the water that comes out of the tap. And I don't know how many public health programs can say that, that they're an equitable public health program by design. Because it is offered to the entire community and it is meant to be something that is accessible. Because one of the arguments against water fluoridation is we'll just get it from your toothpaste or get it from your mouthwash. But that's a privilege, whereas water fluoridation is accessible to the whole community when you offer it.

But are people even drinking their tap water? You know, there's that extra step of building trust and making sure folks are comfortable drinking their water that comes out of the tap. So we have a lot of work to do in public health, not just in oral health, to rebuild trust, to connect with our communities and to see how we share the best science. So it is something that individuals are comfortable engaging with. And I think the first step to that is asking, Am I even a trusted person to be sharing this information?

That is an opportunity to have intervened that we've missed.

While claiming to be fighting fentanyl, the conservative response has amounted to doing one of two things blaming the influx of fentanyl on the southern border. Or passing draconian anti-fentanyl laws designed to punish dealers and deter use, these bills were proposed in 46 of 50 states. Virginia codified fentanyl as a quote weapon of terrorism. 30 states have a drug-induced homicide statute. On the books. Look, fentanyl is a scourge.

There's no doubt about it, and we absolutely need to protect unsuspecting people from it. But the question is, does the law and order throw the book at them approach actually work?

There's a long history in this country of criminalizing drugs, and the cost of that fall hardest on people who suffer substance use. And too often, the enforcement has targeted black and brown people. And when it comes to this most recent crackdown? A study published in the American Journal of Public Health found that drug overdoses soared in a county in Indiana after drug dealers were swept up in a drug bust. Their buyers, frantic for a source, ended up buying from new dealers whose potencies they didn't have any knowledge of, leading them to OD.

Focusing instead on harm reduction approaches intended on treating the underlying disorder and minimizing the risks associated with use. But old habits die hard, and so are too many folks in this country. In other news, it's been a year since this happened. The Supreme Court has just issued and this is the decision many were waiting for a ruling in Dobbs versus Jackson Women's Health Organization.

And over this past year, we've watched as half of the states in this country have moved to limit the right of bodily autonomy in their states. Limiting or restricting access to abortions, the consequences have been profound thousands have had to sit in limbo without the care they need. 22 million people are without access to reproductive health care. The number of abortions with providers has dropped nearly 3,000 per month on average.

In a poll of ObGyns in states with abortion bans, 40 said that the bans impacted their care in cases of miscarriages or emergencies in pregnancy. In short, it has been chaos simply because six people in robes is what was best for the bodies of millions of other people. Let's end on a positive note, shall we?

Scientists may have unlocked a breakthrough that could fundamentally transform transplant medicine. They successfully froze and then thawed rat organs and transplanted them into a live rat who survived. Look, this is a BFD. Here's why 100,000 people are currently waiting for transplants in the United States.

Last year, only about 41,000 of those people got them. And that's because transplantation is a logistical tightwire act. It involves harvesting, transporting, and transplanting an organ within an hours-long window. Without the ability to plan any of it. Successfully. Freezing and thawing organs could address these logistical quandaries once and for all.

Science here is equally incredible. The challenge with freezing living organs is that ice crystals basically act like gigantic saws inside of a cell. They shred everything from the inside. And so, the process involves infusing those organs with nanoparticles that protect this from happening, and then cooling them using liquid nitrogen at about 24 degrees per minute, which is extremely fast. Then the trick is rewarming them all at once so the organ itself doesn't split.

The breakthrough could open the door for cryopreservation, previously the holdout of science fiction. And that's pretty cool, that's it for today. On your way out, don't forget to rate and review the show. It really does go a long way.

Look, friends, I ask you this all the time, rate and review. It really takes you like a minute. Please do also if you love the show and want to rep us.

America Dissected is a product of Cricut Media. Our producer is Austin Fisher. our associate producers are Tara Terpstra and Emma Lickfrank. Vasilis Fotopoulos mixes and masters the show. Production support from Ari Schwartz.

Our theme song is by Takeo Sazawa and Alex Rugiera. our executive producers are Leo Duran, Sarah Geismar, Michael Martinez and me. Dr. Abdul El-Sayed, your host. thanks for listening.

This show is for general information and entertainment purposes only. It's not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host and his guests, and do not necessarily represent the views and opinions of Wayne County, Michigan, or its Department of Health, Human and Veteran Services.

Can you imagine being in a situation where your kid needs health care and you don't? You're not allowed to give it to him? That's the situation that 12-year-old trans activist and author Kai Shapley and her mother, Kimberly, left their home state of Texas and relocated to Connecticut less than a year ago. Faced recently, they joined host Brian Boitler on Positively Dreadful to talk about the reality of being targeted by their state for gender expression.

Take a listen.