by Angelica Afcan

Imagine not being able to tear off that piece of dried fish you had for lunch. Imagine looking at old school photographs and seeing your toothless smile. Imagine having a lifelong speaking problem, all because you did not have your front teeth when you learned to talk.

The brutal truth is that many of us do not have to imagine this, because it is something either ourselves or someone we know has experienced.

The children of our Yukon-Kuskokwim region have four times the rate of decay than that of the entire nation; that’s 20 cavities instead of just 5. Our rural villages need community water fluoridation to prevent tooth decay, improve oral health of our entire people, and reduce trips children make to the operating room.

Waqaa, wiinga Cupaugua, Kuigaarmiu, Nunam Iquarmiu. My name is Cup’aq, my English name is Angelica Afcan, and I’m from Nunam Iqua. I am the daughter of Joseph and Rose Afcan and the granddaughter of James and Julia Afcan, and John Sr. and Natalia Lamont. I currently live and work as a Dental Health Aide Therapist in Hooper Bay, which has a population of 1,093 according to the 2010 census.

I do not need to describe how isolated our rural communities are, you know just as well as I how hard it is to see a dental provider and get all of your cavities fixed. I am one of two Dental Health Aide Therapists in Hooper Bay, and our main goal is prevention.

We want to prevent our children from every having even one cavity, but we cannot do that alone. There are not yet enough Dental Health Aide Therapists to meet the needs of our populations. Without proper dental care, it is hard to know how to take care of our teeth, or if our teeth have cavities that can be fixed, until it starts to hurt.

In most cases, once a tooth starts to hurt, it is too late to save. Alaskan Natives historically have had the healthiest teeth in the world, mainly because our healthy diet did not have processed sugars.

As told by Robert Shaw, “the first Russian explorers entered the region in the late 1700s and established trading posts from 1819 to 1851” (240). This is when the Yup’ik people were first introduced to processed foods and sugars. Processed foods and sugars lead to cavities, which is currently one of our largest health problems.

One way to prevent cavities is by community water fluoridation. There are areas in the world lucky enough to have fluoride in their water without having to add it, and it is enough fluoride to prevent cavities naturally. Many of our rural villages have natural fluoride in our water but not enough to prevent cavities. However, we do have the opportunity to use controlled community water fluoridation. This means that enough fluoride can be added to our water for our benefit.

Cavities are a preventable disease. Like many diseases, it is spread by bacteria. Bacteria are found on our hands, and if we do not wash our hands, we can get sick. This is kind of how cavities are formed. There are thousands of bacteria that mix with the food we eat, and the saliva we produce to form a sticky biofilm on our teeth. This biofilm is known as plaque. The plaque is the same color as our teeth, so it is difficult to see, but we all have it.

The bacteria in our plaque turn the sugars we eat into acid. This makes our mouths acidic and takes away minerals from our teeth. This process is known as demineralization, or the start of a cavity.

In normal conditions, our spit helps to give minerals back to our teeth, allowing a nice balance so our teeth do not form a cavity. However, what happens most of the time is that the demineralization happens too fast for the spit to give enough minerals back to our teeth; making cavities.

What fluoride does when it is added to the water is give a mineral to the outer layer of our teeth, making it harder for a cavity to form (122). The best way to provide enough fluoride to all our people is through the safe and effective way of community water fluoridation.

Community water fluoridation is known to prevent cavities. As AJ Spencer and LG Do quote in their article, “Water fluoridation is a safe and effective public health program.” Water fluoridation is one of the two ways Australia is using to fight their high rates of tooth decay, the other being the widespread use of fluoride toothpaste (2).

This shows that fluoride is a trusted way to prevent cavities. Australian children experience the same oral health problems as Alaskan Native children of the Yukon Kuskokwim delta (1). We need to follow their lead by providing community water fluoridation in our rural villages so that we can better prevent this oral disease.

Community water fluoridation will improve the oral health of our entire people. Not only can fluoridated water be good for our children, but adding fluoride to the public water system gifts all ages the prevention benefits of fluoride.

As Robert Fortuine states in his article, “because of their isolation and the un-certainty of travel and communication, these people also have necessarily limited access to medical services” (852). This continues to ring true today.

Providing community water fluoridation for our rural villages will help prevent us from having to suffer in pain or pay hundreds of dollars to fly into Bethel for a temporary fix to our tooth problems. Preventing cavities for our people will improve the oral health for all of us.

Preventing cavities will reduce trips our children have to make to the operating room. Children who are referred to the operating room for their teeth are the children with lots of cavities who also are experiencing pain and suffering.

To get to the operating room, they have to fly with an escort all the way in to Bethel, and some go as far as Anchorage to receive treatment. The reason some children have to fly all the way to Anchorage is because there is only one pediatric dentist in Bethel able to treat our children. That equals to 2 round trip tickets being purchased all the way to Bethel or Anchorage, on top of the costs of surgery in the hospital, a place to stay, and food to eat.

Once the child and escort reach the operating room, the risks get scarier. In the operating room, these children are put under general anesthesia which imposes a risk of death; a risk too high to take just to stop tooth decay. If cavities can be prevented in the first place, and they can, then our children will not have to be sent hundreds of miles away from home, put under general anesthesia, and return with a mouth full of missing and silver teeth. It is a current cultural norm that needs to stop.

Going to the operating room, means going under general anesthesia, and general anesthesia is not only life threatening, but affects brain development. Recent studies have shown that children who have gone to the operating room more than once have a lower IQ. This means that going to the operating room is bad for brain development.

Some children as young as one year old have so many cavities that they are referred to the operating room before all their teeth our grown in. Once all their teeth grow in, if cavities are not prevented on the new teeth, they will most likely have to be referred to the operating room a second time for their teeth. This is why it is so important to prevent our young children from having to be referred to the operating room for their teeth.

Some people are scared of fluoride because they think it is toxic, but this is only true if lots of fluoride is added to the water. In an article on fluoride neurotoxicity by four authors, Anna Choi, Guifan Sun, Ying Zhang and Philippe Grandjean, it states, “fluoride concentrations in community water are usually no higher than 1mg/L, even when fluoride is added to water supplies as a public health measure to reduce health measure to reduce tooth decay” (1362).

Though this is what water fluoridation should be, there are areas in the world with higher levels than 1mg/L and it has been proved that in areas with lots of fluoride in the water, children had a lower IQ than those areas with less fluoride in their water (1365). We are exposed to toxins from everywhere, and although fluoride is toxic in high amounts, it is not toxic in small amounts. We only need a small, non-toxic amount of fluoride to prevent cavities in our people.

Metaphorically, adding fluoride to water can be compared to adding chlorine to water. If lots of chlorine was added to the water it would be toxic, but the chlorine is kept in small safe amounts only adding the benefit of killing germs in our water. Fluoride in small amounts will only add the benefit of preventing cavities for our people.

Yes, lots of fluoride is toxic, but we can make sure that the levels of fluoride never go beyond the safe level of 1mg/L by having a properly certified water plant operator. We are lucky because many of our communities already have certified water plant operators, you can look yours up on the Alaska Certified Water/Wastewater Operator Database in the state website.

This makes it very easy to ensure that only the safe and effective amount of fluoride is added to our water, only providing benefits to our people. Yukon Kuskokwim Health Corporation, which is the health corporation who serves our people, has it listed on their website that they have a whole department devoted to training and providing technical assistance to 47 village water and sewer systems. They also provide an Operator Training & Certification program, which would make it easy for additional operators in our rural villages to attain.

Our rural villages should not wait any longer. Community water fluoridation is essential to prevent tooth decay, reduce trips children make to the operating room, and improve the oral health of our entire people.

Our children should have the opportunity to tear off a piece of dried fish, smile a healthy smile, and learn to speak properly. Alaskan Natives once had the healthiest teeth; preventing cavities with community water fluoridation can help us to head back in that direction. Fluoride-aryugtua. I want fluoride in our water.

1 Comment

  1. Ms. Afcan’s views and advise are exactly in line with those of America’s Pediatricians and Family Physicians. The overwhelming professional consensus is that water fluoridation is safe and prevents cavities. This has been especially important in rural Alaska.

    In 2008 the Alaska Department of Health and social Services and the CDC’s Arctic Investigations Program (AIP) found a very heavy burden of advanced cavities in children living in remote Alaskan villages. 87-91% had cavities compared to 35-51% of US children generally. Operations under general anesthesia for mouth full of rotten teeth. Severe cavities like that can cause pain and affect a child’s normal growth and development.

    Cavities were more likely with high soda pop consumption and lack of brushing teeth. But more important than either of those was whether the drinking was fluoridated. Water fluoridation carried even more protection against cavities. The severity of cavities was greater in villages without fluoridation.

    Alaskans should join with the scientists and professionals and insist that wherever possible the cavity protection of fluoride is provided in the drinking water.

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